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Mr. MacCRACKEN. I think the section that they are particularly interested in is the one which appears on page 19 of the bill. It is section 631, paragraph (e) where ie defines the term "hospital.”
It says, in lines 16 and 17: "Such as laboratories, out-patient departments, nurses, homes, and training facilities." They were not sure whether or not that was broad enough to cover the services which are rendered by the optometrist, both as to the refraction of the eyes, prescribing glasses, and also the visual training which the optometrists are now doing
They were particularly helpful during the war. There is a little booklet which, perhaps, the members of this committee might like to have, and I am sure that Dr. Ezell will supply it, entitled "Grounded Eagles Fly Again.” It tells just a little of the work that the optometrists did in visual training which enabled men whose vision disqualified them for jobs as pilots in the Army and Navy, on a reexamination, to qualify and to do excellent work.
It seems to me that any public health program should include, without doubt, provision for visual care and visual training.
That is the primary function of the optometrist.
And so we want to be sure that if this bill does pass that it is broad enough to make available their services to those who are using these facilities.
Mr. PRIEŠT. So far as you know there is no suggested amendment to that section or that paragraph; that is, in specific language ?
Mr. MacCRACKEN. May I suggest that these be inserted after the word “laboratories,” “optometric equipment”. There may be some further suggestions in Dr. Gillis' statement as to another paragraph, but I am not sure about that this morning.
Mr. Priest. We are glad to have you here and to extend the privilege of submitting a statement for the record to Dr. Ezell. Are there any questions? Thank you, Mr. MacCracken.
The committee is happy to have General Fleming, Federal Works Agency Administrator, this morning.
General, you may proceed. STATEMENT OF MAJ. GEN. PHILIP B. FLEMING, ADMINISTRATOR,
FEDERAL WORKS AGENCY General FLEMING. I deeply appreciate this opportunity to discuss with the committee S. 191, and I wish to associate myself with those who have urged the imperative need for the expansion of hospital service to the people of the United States. Some measure of that need may be appreciated when it is realized that of the 3,000 counties of the United States, some 1,200, with a combined population of 50 million, have no hospitals at all, or hospitals so inadequate that they fail to meet even the most meager standards of medical treatment.
Indeed, I think the need so acute that it is not likely to be met unless the Federal Government will lend financial assistance in the effort. And so I strongly endorse the objectives of the bill, and I think the country owes a debt of gratitude to those citizens and organizations who have devoted so much time and effort in working to improve our national standards of medical care.
I speak from rather extensive experience with the construction of hospitals and with the administration of Federal aid to the States and local communities, not only in the planning and building of hospitals but the provision of various other types of community facilities.
But while I endorse the objectives of the bill, I call attention to two matters which the President already has presented to the committee, his views being a part of the record of these hearings.
The bill set up a hospital council to be composed of the Surgeon General of the Public Health Service and others, some of whom are to be private citizens with no official responsibility in the premises, to be appointed by the Federal Security Administrator. There is no doubt that the judgment of any administrative official can be greatly assisted by the advisory opinions of those who are expert in the field in which he operates. But in this case the proposal is to permit the advisors to control administrative judgment and actually to perform executive functions. I consider that highly undesirable, not to say indefensible. Executive responsibility should be fixed and certain and it should not be hampered in such a way as to make it unworkable, nor should it be diffused among those who cannot be held accountable for the consequences of their acts.
Another objectionable feature of the bill is that which submits to judicial review the action of the official authorized to make administrative decisions. Here the proposal is to ask the courts to perform functions for which, I think they themselves will agree, they are unqualified. This novel proposal is indefensible because it is as fallacious to expect a court to make an administrative judgment as it would be to expect an administrative officer to make a judicial judgment. The judgment of the authors of the Constitution, who assigned appropriate powers to the executive, the legislative, and the judicial departments, should not lightly be set aside even in so good a cause as that represented by this bill. It is true, of course, that it is a grave matter to lodge unlimited discretion in a Federal administrative official, yet his exercise of discretion is always subject to review by the President, by the Congress, and finally by the courts when it can be shown that his action is arbitrary or capricious; he always can be held accountable for his actions. But to submit routine administrative action to judicial review, not because it is arbitrary or capricious but because some dissenter may differ from the judgment of the administrative official, is quite different and I submit that it should not be done.
I venture additional observations. The bill relates to Federal grants to the several States for surveys, and the planning and construction of hospitals. I suggest that the collection of funds by the Federal Government from the taxpayers of the Nation, and the payment of those funds into State treasuries to be, in effect, reappropriated by the States, is a very devious way of expending Federal funds. Grants of Federal funds to the States for purely State purposes, to be expended on properties owned and operated by the States, as in the case of highways, is a familiar American pattern. But nothing of that kind is proposed here; rather, the intention is to grant Federal funds to the States to be granted by them to cities, towns, counties, and private societies to construct facilities only remotely under the control of the States.
Mr. Brown. I am interrupting because I must leave to go to the Rules Committee. We have an important matter there.
I have heard part of your statement and checked the balance of it. Your main theme seems to be that you want this bill amended so as to give complete power to the Federal Government, is that right?
General FLEMING. I think, yes, sir. Certainly complete control in the Federal Government.
Mr. Brown. And do you think the Government ought to control, through its contribution of $75,000,000 a year, everything that is done out in these hospitals?
General FLEMING. Not at all, no, sir. I do not think there should be any control over the operation of the hospitals, not the slightest. We expended funds under the Lanham Act
Mr. Brown. I do not mean the operation. I mean control of everything in connection with the selection of the hospitals, where they are to be built, and how they are to be constructed, and what of, and the size, and everything else.
General FLEMING. No; I mean we have had the experience of kind in the Federal Works Agency and the old WÑA, and we did not control the size or the type of construction. That was left within reasonable limits. We did not let them build under the Lanham Act a wartime measure any marble palaces, but we let them do the other.
Mr. BROWN. I remember a marble dog pound built not so many years ago down in Memphis by a Federal agency. I do not think that was good government, either.
General FLEMING. I do not think either.
Mr. Brown. It was done by a Federal agency. And the State administration, I do not think, would approve it. I certainly hope not. I am just wondering if it is your philosophy and your testimony, seemingly, that we must center all of the power and all of the control in the Federal Government in Washington. If so, that is just so foreign from a lot of my beliefs that I
General FLEMING. I do not think it is foreign.
Mr. Brown. There will be a lot more money put in by the local and State governments in this thing than by the Federal Government.
General FLEMING. That is true, but take our highway system, where Federal funds go in.
Mr. Brown. Yes, that is right.
General FLEMING. And yet we must approve here under the law any project before it can be built, under the Federal-aid highway system.
Mr. Brown. I remember we had an awful time finally convincing some bureaucrats down here in Washington that they should not put those "lips” in highways to hold all of the water, slush, ice, and dirt on the road. They finally cut them out, but that was an idea that one individual had down here, and enforced, because the control of the funds was in his hands. There were hundreds and probably thousands of miles of highway constructed that way.
You cannot find one engineer out of a thousand, who would say that was good sense or good engineering.
Such situations are I am driving at. I think we must leave some control, some discretion, with the local people who have to live with this thing, and administer, operate, and function, under it.
General FLEMING. This bill gives all control ---
General FLEMING. It takes Federal funds for that. If the application meets the requirements of the bill, then the Surgeon General must certify that fund to the State, and the State decides what city, what town, what private institution shall have those Federal funds, and I do not approve of that.
Mr. Brown. You are opposed to it?
Mr. Brown. Instead, you think the power should be placed in the hands of one individual here in Washington to decide that for the whole country?
General FLEMING. No, I do not say that at all. I mean one individual, the one administration, could set up certain standards and when they are met, make the allocation just as we have done for a number of years, back since 1933 in the PWA program.
Mr. Brown. But in the end, General, you fix the final discretion; that is, in your way of doing, with the Surgeon General ?
General FLEMING. That is right.
General FLEMING. It would not be one individual. He has an administrative responsibility, or the Administrator of the Federal Security Administration has the responsibility. This takes away that responsibility.
Mr. Brown. As this bill is drawn, he has responsibility to distribute the funds for the Congress.
General FLEMING. That is right.
Mr. BROWN. As a representative of the people. You want to give him an additional power that the Congress has not given him so far in this bill.
General FLEMING. He just is an agency that passes on funds under a certain formula to the various States.
Mr. Brown. Has it ever entered your mind that perhaps that is exactly what the Congress wants him to do; and does not want him to do anything else?
General FLEMING. That may be.
Mr. Brown. Exactly what the Senate of the United States decided by its action and its vote when it changed the bill so as to eliminate the very things that you mention.
General FLEMING. You have no objection to my opposing that?
Mr. Brown. No, certainly not; but I am not surprised; I do not want to say "surprised," because it is the usual formula, and we are speaking of formulas, that all of the different agencies of Government sort of gang up on poor old Congress, and the States, and say, "Now, whatever one of us wants we must all be for.” I have been sitting in the
Rules Committee, in which we liave been considering a bill to set up some sort of a cultural program so that we can build radio stations and colleges and universities and office buildings anywhere in the world without any limit on the amount of money we spend, or anything else. And here comes a letter from the Secretary of Agriculture, who is one of my closest personal friends—and I am very fond of him—and other letters from about everybody else in the Government, saying, “Yes; we must have this bill exactly as it is presented.” Personally, I do not think Mr. Anderson, or any of these other boys know what is in that bill, but the word had gone out; “Get behind this; this is the program.
» General FLEMING. You do not have me on that bill, because I do not know anything about it.
Mr. Brown. General, if you do come over before the Rules Committee in favor of that bill, I am certainly going to interrogate you.
General FLEMING. All right. (Laughter.)
Mr. Brown. After all, we are here representing the people back home. We are here representing our States, too.
General FLEMING. You are here also representing the communities, the towns.
Mr. Brown. That is what I say, the people back home.
General FLEMING. And the counties. I have found in administration, for instance, of the Lanham Act, that these towns and counties prefer to deal directly with us than to deal through the States with us.
Mr. Brown. Of course, we have had quite a spending program, as you and I know, General.
General FLEMING. And the same way in this administration of Title 5 of the George bill, which sets up planning funds for the various States, in accordance with the formula, and there, again, we find that the towns, the counties, the political subdivisions of the States, prefer to deal directly with us rather than have me just draw 48 checks and send them out to the various 48 States and let the States pass those out. That would be the simplest way for me to administer the job. All I would have to do would be to draw 48 checks.
Mr. Brown. If I were the town mayor heading a delegation to get a grant from your agency, under the present regulations and law, I would certainly tell you exactly that, but I still do not think most of them believe it. I live in one of these communities. I run newspapers in several of them. I know what the people talk about. I know they feel they are being coaxed to spend their money by the Federal Government offering to do certain things.
General FLEMING. This is just an advance to them which they pay under this Title 5 of the George bill.
Mr. BROWN. Under the Lanham Act?
Mr. Brown. Under part of your Federal Works Agency program, but there has been a lot of outright gifts under that, too, as you know.
Mr. PRIEST. Will my colleague yield at this point for this one observation on the subject?
Mr. BROWN. Yes.
Mr. PRIEST. I have had a number of letters from county officials within the past week since these hearings opened, in which they bring