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Mr. Brown. You know that is what happened on practically every bit of construction in America that the Federal Government paid for during the war.

Mr. Ogg. The farmers would be strongly opposed to anything of that kind being done. If the committee thinks that there is any danger of that, I think they should take steps to prevent it being done.

Mr. PRIEST. There is nothing in the bill providing for or against it.

Mr. BROWN. There was nothing in the general law that required it either, but it was done during the war.

Mr. Ogg. I do not think in fairness that any group ought to load a bill of this character down and use it as a vehicle to force other objectives, use this as a vehicle for that sort of objective.

Mr. Brown. In many areas, there is no union labor available. I am not objecting to its use in such areas where they are, where it is the customary thing, and where the workmen are all organized, but in many counties, where these buildings are to be constructed, you would have to import foreign labor to do the work if there was a requirement that only union labor could work on the job.

Mr. Ogg. I think that is the point, Mr. Congressman. It should not be a question of whether the labor is union or nonunion labor.

Mr. BROWN. know that should have also been true in the war, but even in rural areas, they imported union labor to do the work, or compelled local labor to joint the union to work on the project.

Mr. Ogg. In this where we are trying to serve humanity

Mr. Brown. I thought that is what we were doing when we fought the late wars.

Mr. Ogg. We ought to try to get the most done for the least money to serve the most people. I think that we should not use a bill of this character to promote unionization or nonunionization.

Mr. Brown. That is right. I agree fully with your position, but I was wondering what might be the result if some Federal administration order would be issued along the line of that in effect during the war, when you are speaking of using labor.

Mr. Ogg. I think you should take steps to safeguard the program. Mr. Brown. Then you suggest an amendment to this bill?

Mr. Ogg. I think it would be well to safeguard against any attempt to inject into this program that issue. I think it does not belong there.

Mr. Brown. I agree with your position fully.

Mr. Ogg. I do not want that to be construed either against or for unionization.

Mr. Brown. My position is exactly the same.

Mr. Ogg. It does not belong in a bill of this sort, as I see it. In this bill we want to get the most hospitals built to serve the underprivileged and to serve humanity at least possible cost, and that should be our objective, as I see it.

Mr. PRIEST. That is a very worthy objective.

Mr. Occ. I hope, gentlemen, that we will get that. We are very anxious, the farm people, to see this bill passed at this session of Congress.

As I indicated a while ago, in many of our rural States, we cannot go ahead with these prepayment medical plans, hospital plans, and so on, until you get the hospitals. And many of our States are going


to the State legislatures for State appropriations hoping that this bill will pass, so that they can go ahead. We cannot get the doctors to go to these rural areas unless there are some hospitals there and diagnostic facilities.

I hope, gentlemen, that you can get this legislation through at this session. You certainly have our wholehearted support in doing that.

Mr. PRIEST. In line with the thought you have just expressed, Mr. Ogg, I had an interesting communication last week from a county medical association down in my State very much in line with what you have said, and it went even further than I had expected that they might want to go. They recognized the situation in the rural areas, and particularly in those mountainous and semi-mountainous areas in my State. They even suggested in this letter, after discussing it in one of their meetings, in order to get young doctors to go into these areas they would be willing to subsidize the education of a certain number each year, that is, that the Federal Government subsidize a certain number each year, with an understanding that for 5 years after they had served their internship they would agree to practice in these rural

It was a rather forward step as I viewed it at the time, recognizing the seriousness of that situation.

Are there any other questions? Mr. WINTER. Mr. Ogg, you stated there were 1,300 counties in the United States that do not have hospital service; is that correct!

Mr. Ogg. They do not have hospitals, yes. That is, hospital facilities.

Mr. WINTER. That do not?
Mr. Ogg. Do not; yes,

sir. Mr. WINTER. What is your idea as to how small an area should a hospital serve in a rural area?

Mr. Ogg. Well, I am not any expert on this and do not profess to be, but it would seem to me that it would be hard to lay down any pattern. I think, frankly, that is one danger in this bill, it seems to me there is a tendency to try to standardize it too much for every State. That is why I suggested earlier that the State agency have the initial responsibility at least of determining the standards, the location of these hospitals, how large they ought to be, and instead of trying to set up one pattern for the whole United States as to how large a hospital unit ought to be and all of those things, you might find that you could reach more people and render greater service by having somewhat a different pattern and a different set-up in different States.

You have got all sorts of patterns out there, patterns of population and differing situations as to the concentration of your population, local habits, and all sorts of local conditions that enter into this thing, and it would be very difficult, it would seem to me, as a layman, to do that.

While you might lay down some over-all general standards, I think there is danger to regiment it in too

much of one pattern of standards, and it would seem to me that the State agency is better qualified to determine the very point you are bringing out, whether you should have in this State a relatively large number of small county hospitals, or whether you should have a system of what you might term area hospitals of a larger type, or whether you should have a combination of the two.



I think, just as a layman, it would seem to me, as a matter of common sense, that you would probably have to have a combination, you would have to have a number probably of county hospitals which would be, in most instances, in the distinctly rural areas and there small hospitals, but you would need some larger hospitals in a reasonably accessible area where they would have more expensive equipment to take care of types of cases that the small hospital, with its simited diagnostic and treatment facilities, probably would not be able to care for.

As I say, I am just a layman, I am not qualified to speak in a professional way on that problem.

Mr. WINTER. You are not advocating the building of a hospital in every county, are you?

Mr. Ogg. No, sir, we are not advocating building a hospital any. where unless there is a need for it. I think that is the question that would have to be determined on the basis of need.

The inadequacy of the facilities there, how near to the facilities already existing, if they can be cared for by the facilities there; certainly they ought not to build one just to have one in every county, but in some counties.

Mr. WINTER. Perhaps every community will want a hospital when this bill, if it is enacted into law, becomes law.

Mr. Ogg. I should hate to see, on the other hand, all of these hospitals concentrated in the metropolitan centers. I think that would be a great mistake, because you have got vast areas out in the rural areas that are too far away from those centers, whereby a lot of people would not vail themselves of them.

Mr. WINTER. They are to be taken care of by what is called the health center, are they not, in the provisions of the bill ?

Mr. Ogg. No, I do not think that would adequately take care of them. I think you will have to have some small county hospitals if this bill is to accomplish its purpose. There are many of them. I think of one right now that is very efficiently run. It is a small county hospital in a rural county. There is not a town in the county over a thousand people and you have lots of counties like that.

Mr. WINTER. How big is the area of that county, do you know?

Mr. Ogg. It is about, oh, I guess 25 miles square or 30 miles square. It is about 50 miles, 60 miles, from a metropolitan center. You have in other areas vast areas where you are not near any metropolitan hospital facilities. Mr. WINTER. But you have a population which is very thin in

do Mr. Ogg. Yes, for that reason you have got to have these facilities out where the people are.

Mr. WINTER. On that point, these facilities are going to have to be constructed in areas where there is some possibility of showing the financial support necessary to operate that particular institution.

Mr. OgG. That is correct, but I think if you adjust the type of institution so that the cost is not excessive, you do not have to have a big hospital, not an expensive one. There are all sorts of buildings. You can have a small one. You can have it efficient, reasonably well equipped, and well run without having it on an elaborate, expensive scale. It can still have good standards. It can have efficient opera

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tion and good equipment, but the point I am making is, I think it would be a great mistake if you try to put all of these hospitals in these cities. That is the trouble now. They are too far away from where the people live.

Mr. WINTER. The rural areas, when you speak of cities

Mr. OgG. And the other point is, if you put them into the cities, the city people are right there, you may have difficulty getting in.

Mr. WINTER. What do you mean by putting them in the cities; you are referring to what?

Mr. Ogg. I mean the large metropolitan cities.
Mr. WINTER. You do not mean the small cities in the rural areas?

Mr. Ogg. I am speaking of the large cities. Necessarily, some should be in the large cities, because in some areas that will be the best location, but the point I am making is that the figures all show that the great lack of hospital facilities are in the rural areas.

Let us put enough out where the people are so that they can get the care and not have to go to a lot of expense and inconvenience going away off somewhere else and the relatives have to pay board while they stay there with their people in the hospital, and add that additional expense.

There is no reason why you cannot have a small, efficiently run hospital out in the rural areas, as I see it.

Mr. WINTER. Well, I can see some objections to building hospitals in rural areas unless that rural area is thickly populated enough to support the hospital. Mr. Ogg. Certainly, but the bill requires, before any can be approved,

, that they have a plan that they produce a satisfactory produce and show evidence that they can support it. That is the preliminary qualification.

Mr. WINTER. Mr. Ogg, what I have in mind, I would like to get you to state just how far you think we can go in the construction of these larger hospitals in relation to a given area or a given population?

Mr. OGG. Well, I would say, with the facts as I stated, more than 1,300 counties that do not even have a general registered hospital

Mr. WINTER. That is correct. Mr. Ogg. With that situation, and everybody knows it is the rural areas that do not have the hospital facilities right now, with that situation as it is, with the mandate in this bill that they must give priority to rural projects, it seems to me that this bill ought be directed, first, and if it is not, it is not going to do what our people want done, and what I think the purpose of this bill is, is that the first priority must be given to these projects for hospitals out in these rural areas that do not have the facilities.

If you start using this money to improve hospitals that we have already got in the big metropolitan centers or to build additional hospitals when you have got the great masses of the rural people that do not have any, I think it is contrary to the mandate in this bill. If it is not, I hope you will change the bill so that that is the mandate, because I think you would do the farm people a great injustice. .

Mr. WINTER. Do you think that the city people who have been here sponsoring this bill have that same thing in mind that you are talking about?

Mr. Ogg. I want to say this, I was very much pleased and impressed, as I read the testimony before this committee, the representatives of

labor organizations, Mr. Green and his statement, and the testimony of several of the Government witnesses, all brought out the fact that the great need in the rural areas was there.

Mr. WINTER. Did they not attack it this way, their theory was, as I recall it, from the Surgeon General, when he was on the stand, and he had a picture of one of the units which they intend to build in these smaller areas, that that was the starting point of an integrated program that would graduate on up into larger hospitals as the population increased and as the need increased ?

Mr. Ogg. Well, I want to make clear that I do not think I have said, and if I did I did not intend to, that you should not build any hospital facilities in urban areas, because I think you are going to have to do that, and I think you should where there is a justifiable need that cannot be met otherwise. But what I was trying to say here was that I think the intent of this bill, and if it is not, I think it ought to be the intent of this bill, should be to get first priority to the communities and areas which do not now have adequate hospital facilities, and that I think the evidence is conclusive and overwhelming that most of those areas are the rural areas.

Mr. WINTER. I think that is the intention of the bill. I think that is what the Surgeon General testified to.

Mr. Ogg. I think that is it. Mr. WINTER. That is what he had in mind. Mr. Ogg. I think that is the intent of the bill, as I read it. Mr. WINTER. Well, now, another question I would like to ask: Have you given any thought whether or not in these rural areas with a gigantic program of this kind, is there any likelihood that those particular areas will be coming back asking for financial support to operate these hospitals?

Mr. Ogg. Well, there is always that possibility, yes, sir, that they will.

Mr. WINTER. Has it been discussed any, to your knowledge?

Mr. OGG. Well, that question has been discussed but it has been our feeling that the communities ought to maintain the hospitals themselves. They may need some State aid. Some of the States, probably, are going to provide some funds for that, for the system in maintaining the hospitals.

Mr. WINTER. The reason I asked you that question, in your statement that you gave before the Senate on S. 191, I notice you say that the Farm Bureau, in 1935, created a special national committee on medical care which set up a standard or definition for adequate medical care in rural areas, as follows:

Regular health examination for all adults, emphasis on preventive measures rather than cures, prompt care of everyone who is ill, competent examination and diagnoses, and so forth, prenatal care for pregnant women, adequate medical attention for school children.

Is that part of the rural program that you want to tie in with this hospital bill?

Mr. Org. No, that, Congressman, was a set of general, broad objectives that this committee adopted, as I recall it. When was that, 1925?

Mr. WINTER. In 1935.

Mr. Ogg. That was to guide them as goals to work toward as a committee. It was not intended, as I would understand it, to infer that

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