we are going to expect the Federal Government to come in to provide funds to do all of that sort of thing. In fact, while we have supported in the past grants-in-aid for maternal and child health, we have done it provided it is confined to educational work. We are not supporting this Wagner-Dingell bill, if that is what you have in mind. We are against it.

In other words, to answer more fully your question, I believe that the bill provides, and we favor that provision, that the people in the States or in the communities must provide for the support of these hospitals. I do not see any objection to the State assisting them, and I think probably in many States they will, but we are not asking the Federal Government to do that. We are in accord with the provision of this bill that people in the States and communities should maintain these hospitals. We do not want the Federal Government to contribute to the support, because when you do that it is very difficult to avoid Federal control of the operation of these institutions.

Mr. WINTER. In other words, I take it your organization is opposed to socialized medicine in any form?

Mr. OGG. Yes, sir. We do not think this bill in any way will contribute to that.

Mr. WINTER. Just one other question. You stated something about some program that the agricultural areas were putting into effect.

Is that something on the order of the Blue Cross?

Mr. OGG. Yes, sir. We have, I think, in about 21 States our State and county organizations who are cooperating with the American Hospital Association in Blue Cross plans.

Mr. WINTER. Do you know about what the cost of that is?

Mr. OGG. I put in the record of the hearings of the Senate, at the request of the committee; that is, the Senate committee, something on that. If you will turn to a résumé of these plans, the provisions and the costs, I will give you the page reference

Mr. WINTER. That runs about $9 a year per person, does it not? Mr. OGG. Well, it varies in different States. It runs more than that in some States, depending on the amount of the service they get. Some States get a larger amount of benefits than they do in others.

Mr. WINTER. I noticed you set this up on the basis of 21 days the first year and 30 days the second year, something on that order, that the person would be entitled to hospital care.

Here it is, 21 days for the first year; 24 days for the second year; 27 days the third; and 30 days the fourth year.

Mr. OGG. Well, it varies in different States. Each State works out a plan. So they are not uniform in their provisions.

Mr. WINTER. The aggregate amount that you have set out here is $12 per family.

Mr. OGG. Which State are you referring to?

Mr. WINTER. I presume that is for Minnesota. That is the one that you were talking about at the time.

What I was getting at is this: Supposing that you had a program in the rural areas at $12 a family, and you had a county of 10,000 population which could all be classed as rural, you would not have to exceed 3,000 families, and if you got them into the program, all of them, you would have about $36,000 a year.

Mr. OGG. You do not get everybody into every program.

Mr. WINTER. Of course you do not. What I am getting at is this, I do not see how you could support a very large hospital

Mr. OGG. That all depends.

Mr. WINTER. Unless you combine a good many counties together in some form as the Surgeon General testified to that would provide the smaller units down through those areas.

Mr. OGG. I think you are going to find in many counties, that the local people in the community have got some responsibility, and I think they want to help in developing these facilities. I think you will find a lot of them will put up the money themselves, the county governments, and the State. I think you will find many States that are going to appropriate money to aid in this program.

Many of our State organizations, that is, the leaders have told me they are going to ask their State legislatures for appropriations. Mr. WINTER. That is right.

Mr. OGG. To help develop them. They know in some communities the population is so sparse and the income is so low that you could not maintain an adequate hospital there and pay for it out of one of these prepayment plans without any other financial resource.

Mr. WINTER. That has got to be taken into consideration.

Mr. OGG. I think you will find the local people will be glad to assume some responsibility, because they see the value of it.

Mr. WINTER. What I am getting at, Mr. Ogg, they can not assume a responsibility that is beyond their means to carry out.

Mr. OGG. No, of course not.

Mr. WINTER. And in my State there is county after county which do not have such service, in the western part of the State. They have six, seven hundred, two thousand people in the whole county.

Mr. OGG. I do not think we are in disagreement on the point that you ought to put a hospital in every county. I think that would be a mistake.

Mr. WINTER. What I am trying to get at is this, you say your rural areas should have priority for hospitalization. You mean as to the building of the larger hospitals or for the health centers that are a part of an integrated program that will give that particular health center the benefit of a research work that is being carried out in the big hospitals and the facilities of that hospital?

Mr. OGG. I think, necessarily, you would want an integrated program. I think that is the sensible approach, but the point I was stressing there, and as I think the bill intends now, that in deciding which projects are going to be built, first you have a survey to determine what is needed, and you lay out a program designed to meet those needs, and following that you come to the third step.

Mr. WINTER. Might I interrupt you right there?

Mr. OGG. Yes, sir.

Mr. WINTER. I suggested the other day, and I think it is still a pretty good thing to do, that to pass legislation providing for this national survey first, go out and make that survey, and actually find out what the needs are before we go off on a program here half-cocked of building hospitals.

Mr. OGG. Well, we do not have to hold up the action. I do not see any reason to hold up action when you know what the needs are. Mr. WINTER. You do not know what the needs are.

Mr. OGG. This bill makes provision, in other words, as I read the bill, that is exactly what it provides. You first make the survey and then you develop a plan based on that survey. That State plan has to first be approved before a single dollar of money can be expended for any hospital project.

Mr. PRIEST. Will my colleague yield?

Mr. OGG. So that you do exactly what you say in this bill, as I read it. Is that correct?

Mr. WINTER. Yes.

Mr. PRIEST. It would seem to me that it would be unwise to delay a program over all of the states until a complete national survey might be made when one state might be able to finish a survey within a month after the bill is passed, and start its construction program. If we followed the line of making a survey first only—

Mr. WINTER. Mr. Chairman, does this program contemplate that the richer States are going to get the jump on this thing and get the money from the Federal Government long before the others will get anything?

Mr. PRIEST. The allocation provisions of the bill, I think, will prevent any such circumstance as that. I believe, regardless of how long it might require a State to submit its plan, that the allocation set up in the bill under the formula would still be available to that State.

Mr. WINTER. I agree with the gentleman on that for the survey. Mr. OGG. Again, I want to emphasize we favor the integrated program, but I do believe we feel very strongly about this priority, not that we want to be selfish, but we must have that if we want to serve the people that are not being served, which we cannot do unless you have a priority system that puts the money in the places where it is needed most first. Otherwise, those people are going to have to wait too long.

Mr. WINTER. That is more or less going to be up to your State organization in the original survey that is made.

Mr. OGG. It will be up when they allocate the money for these projects to decide that. You are going to have a lot more applications than money to meet them. So, somebody has got to decide which project gets the money first.

Mr. WINTER. You are going to have a lot more projects than you have money to meet for a while, and in my opinion unless it is pretty well regulated at the start, it will end up like REA and every other program, they are going to be coming back to the Federal Government for twice what you are asking for in this bill, and the next year, two or three times more, unless we do have some integrated program, like the Surgeon General is talking about here and stick to that program.

Mr. OGG. I agree in the principle of an integrated program, but I do not think that ought to force rural people to have to go way off to some far, remote place to get adequate hospital facilities.

Mr. WINTER. That is one of the questions I have been trying to get you to answer. How far do you think that a person should or should not have to travel for hospital service?

Mr. OGG. That is the point I made earlier. I do not think anybody; I do not think the Surgeon General himself can decide where every hospital in the United States ought to be. I think that the State agency is the best.

If you get a competent State agency set up as we hope they will be under this bill, they will know better than anyone in Washington where those hospitals can be placed in that State to the best advantage. Certainly, he ought to have the right to review it and the right of veto if he did not think it was sound and would get the best results.

Mr. WINTER. You are asking for priorities for rural areas and base your statement on the theory that the rural people should not have to travel too far to get hospital service. Now, what is too far?

Mr. OGG. That would depend upon a lot of factors. I do not think you could lay down any set rule. It depends on the local conditions. I would say that, as I said earlier, in a general way, I think that you will need in these 1,300 counties that have no facilities, I think we should concentrate on getting facilities there, but that does not mean that you have got to build a hospital in every county. You might have a hospital to serve two or three counties, if the counties are not too large and located in such a manner that you could make such an arrangement that would equitably serve them.

I do not see how any one can lay down a standard to say that you have to have a hospital that will serve a radius of 25 miles or 50 miles

in

every case.

I do not think it would be practical.

Mr. WINTER. These 1,300 counties are not in any one given area, they are scattered all over the United States?

Mr. OGG. That is right.

Mr. WINTER. Some are in my district that do not have a hospital. Mr. OGG. That is right.

Mr. WINTER. But there is not a person living in my district that could not be brought to a pretty good hospital within 45 minutes to an hour.

Mr. OGG. I say those conditions have to be taken into consideration. And the only point I am making, as a matter of principle, is that you should directly, I think, wherever or rather, I think you should direct whoever is administering this program to go into the things that you are talking about and try to develop a program to locate facilities where they will reach the maximum number of people who are not being reached now.

Mr. WINTER. I think that is what the purpose of this program is. Mr. OGG. I do not think anybody can lay down a numerical yardstick and say that you are going to have a hospital for so many people or for a certain number of square miles, because you have got too many varying conditions.

Mr. WINTER. The reason I asked you this is because you say that should be based on priorities for rural areas. We are interested, of course, in the statement of any witness who comes before this committee. We want to consider what you say, but what we have got to determine, if we should decide that they should have some priority in the rural areas, is what are we going to base it on?

Mr. OGG. Base it on the need and the lack of facilities.

The primary consideration would be the lack of adequate need and the inability to provide those facilities.

Mr. WINTER. Your lack of facilities in the rural area is no more entitled to priority than the lack of those facilities in an urban area. Mr. OGG. If the lack is equally strong, I would agree.

Mr. WINTER. I can see where we get into a lot of trouble, there. I have just this one question and then I am done.

Mr. OGG. There is a degree in lack. There are degrees of that. Mr. WINTER. Certainly. It is going to take a long time to get that survey made on that basis.

Mr. OGG. I think that is right. Again, I believe that people out in the States, if you leave it to them, I think that they will work out a better program than we can here in Washington on that.

Mr. WINTER. You have go to have some check valve in there somewhere to take care of that.

Mr. OGG. I agree with that.

Mr. WINTER. And everybody in every town is going to want a hospital.

Mr. OGG. For that reason, the Surgeon General should review and pass on those matters.

Mr. WINTER. Just this one question more.

As I understand, the only amendment that you favor to this bill, or, amendments, are those that you have suggested. You are not in favor of any amendments that were suggested by the Surgeon General, I take it.

Mr. OGG. I would not want to say these are the only amendments we favor. I threw these out as suggestions for your study.

Mr. WINTER. Are you for S. 191 except as for what you have stated? Mr. OGG. I want to say we are strongly for S. 191. I merely threw out those suggestions for your study as it seemed to us it might strengthen and improve the bill. We are very much for this bill. We would like to see it passed with all necessary safeguards for rural

areas.

We supported the passage of the Senate bill through the Senate and we are ready for it right now the way it is. I just threw those suggestions out to you for your consideration, as it seemed to me they would improve the bill and more fully carry out its purposes.

Mr. PRIEST. Are there any other questions?

We certainly thank you, Mr. Ogg, for your testimony.

Before calling the next witness, may the Chair state that we have a rather crowded schedule this morning with five witnesses. We had hoped to be able to take care of these witnesses during this morning's session, because important legislation on the floor of the House prevents us from having an afternoon session.

Before calling the next witness, the Chair understands that the Surgeon General has a slight amendment to suggest, and because, he of necessity, must get away from town, the Chair would like to hear Dr. Parran on that proposed amendment at this point.

STATEMENT OF SURG. GEN. THOMAS PARRAN, UNITED STATES HEALTH SERVICE-Resumed

Dr. PARRAN. Mr. Chairman, this is in effect a technical matter. You will recall that Public Law 410 does not set a ceiling on the number of commissioned officers authorized to be appointed from year to year. It does set a ceiling of three per year in grades above that of captain. The appropriation each year carries a limitation, a ceiling as to the number of commissioned officers.