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in a town in Kansas, for instance, wants to build a hospital, wants to get money for planning a hospital, they must come through the State over-all agency, a State over-all planning agency, which approves the location and the size of that hospital there.

The same sort of thing could be worked in here that it must comply before we can deal with the local community, that is, it must comply with some over-all State plan, but thereafter our dealings are with the community. It must comply with this over-all State plan, which you will find in title V of the George bill.

Mr. WINTER. What I understood you to say was that you did not want this over-all planning agency to have any authority.

General FLEMING. I did not ever say that at all.
Mr. WINTER. To locate the hospital in any particular place.

General FLEMING. I do not think that the State allotment of funds under this bill, their share of the $75,000,000, should go in a check to one State authority and let them pass it out wherever they pleased.

Mr. WINTER. Why could they not do just as good a job of passing out the funds in the State as you could do from the Federal Government here passing it out wherever you pleased ?

General FLEMING. Maybe they can. They are dealing entirely with Federal funds with no funds of their own involved, and we have found, in our experience, that where we do that, we do not get the best sort of cooperation.

For instance, under the Federal Aid Highway Act, the normal building of highways is on a 50-50 basis where the State has its half of the funds in and we put in our half. They spend the money. They do the contracting to build the roads and do it very economically. During the war we had to build a number of access roads to industrial areas, to military reservations, to mineral deposits, into the forests. The States had no funds for it and we did it on a 100 percent basis. We put in all of our money. And the States had all Federal money with nothing of their own in. They were not so concerned about the price they paid for a right of way as when they had their own funds there.

Mr. WINTER. Are you saying that the States are not as concerned about spending Federal money as the Federal agencies are themselves? General FLEMING. I am; yes, sir. Mr. WINTER. You think you will do it cheaper? General FLEMING. Yes, sir.

Mr. WINTER. Has that been the experience you have had in the past?

General FLEMING. Well, I have given you this one experience in the highway field. It certainly is there.

Mr. WINTER. I can give you hundreds of experiences of the Federal Government spending money on the construction of various things during the war that cost 10 times what they would have under normal circumstances, and that is not a fair comparison.

General FLEMING. When you take war construction, that is different.

Mr. WINTER. They had to be built quickly and for a particular use, and that is the reason that was done.

General FLEMING. I mean we had the experience in the war where we would contribute 75 percent of the funds and the States 25 percent,



and every time they had some of their own money in there, they were more conservative in their expenditures than they were when we had all of our own in it.

Mr. WINTER. Are you saying that the States have not done a good job of building highways under their setup?

General FLEMING. They have done a splendid job.

Mr. WINTER. Why can we not do the same thing with the hospitals in our States ?

Mr. Priest. Will the gentleman yield?
Mr. WINTER. Yes; I will be glad to.

Mr. PRIEST. I think we sometimes overlook this difference in that connection. A highway is built by the State. It is a State problem. It is owned by the State and not a community or a municipality or a county. I think we do run into quite a difference there in the State building a road between communities in the State and to a State line, a matter that is the property of the State and built by State money appropriated by the State legislature, and the State supervising a community hospital in which community funds and not State funds match the Federal funds.

General FLEMING. It may be just private, too, and not necessarily community.

Mr. WINTER. What is the difference, the money comes from the people of that particular State? Why should the citizens of any particular State be barred from having anything to say about it other than in an advisory position and then have some agency here in Washington pay no attention to them, just go on and do as they please?

General FLEMING. I think where Federal funds are involved, in this amount, there should be some Federal control, and this takes it out of Federal control.

Mr. WINTER. Why does it take it out of Federal control? The only time that it is going to take it out of Federal control is where the State involved does not believe that they have received fair treatment. Otherwise there is nothing to affect the Federal control in this bill, is there?

General FLEMING. I think there is; it very definitely takes it out completely from Federal control. It says, when these requirements are met, the Surgeon General shall allocate that money.

Mr. WINTER. When these requirements are met, and those are the requirements that the Federal Government is setting out before any State or local community can participate in these funds.

If a local community complies with those requirements, then why should some Federal agency have authority to deny them the benefit of the funds under this particular act?

General FLEMING. I do not think it necessarily denies them, but I do think

Mr. WINTER. That is what you are asking for.

General FLEMING. When these Federal funds are used, there should be

Mr. Priest. Will the gentleman yield again on that point ?
Mr. WINTER. Yes.

Mr. PRIEST. If a local community might meet the requirements and be turned down by the State agency in charge, of course the bill as


drafted does not leave a local community in such a position that it may if it meets the requirements, set forth by the Federal Government, obtain funds, because it must clear first with the State agency and be a part of the plan before it can.

Mr. WINTER. That is right. Now, Mr. Chairman, there has been some testimony offered here that some of these people believe that you should have the right of appeal, if the State agency turns it down, to the Surgeon General. There is just a complete circle here. There would never be any end to it. I agree with you, General, that your system would be one way of stopping any questions about any arguments about where the hospitals would be and the construction of them, if all of the authority is left with the Federal Government, but that is the thing, at least, the people in my particular area of the county want to get away from. We are getting completely away from every bit of State rights in practically all of the legislation that this Congress has been passing for the last 25 or 30 years. We have been gradually getting into one central power and the States are just beginning to realize that.

As one distinguished democratic member of the House of Representatives said the other day, "are becoming nothing but vassals. Either we are going to have State governments or wipe them all out, one of the other.” And so far as I am personally concerned, I still believe in state rights.

General FLEMING. I think where State funds are involved, that is certainly the proper way of doing it, but here you are dishing out Federal funds.

Mr. WINTER. You are dishing out Federal funds for $75,000,000 a year under this bill for 5 years. The total over-all cost of this program is going to run into billions of dollars in the support and maintenance of the hospitals, and why should not the people who are going to support them after they are built have something to say about where those hospitals are going to go and how they shall be built?

General FLEMING. I think they certainly should have something to say about where they shall go.

I see no reason, just as under Title V of the George bill, why it should not be passed on by some State over-all authority to make it comply with the State over-all plan.

Mr. WINTER. Would you give that State over-all plan authority that you and your organization could not override?

General FLEMING. We have that now in title V of the George bill. If there is a State authority which is competent to pass on it, and this bill would require to set up such authority, then it must comply with the State over-all plan.

Mr. WINTER. Maybe I misunderstand you. You are not objecting then, to the State over-all authority that is set up in this bill, making the survey and saying where the hospital shall be built ?

General FLEMING. No.

Mr. WINTER. Your objection to it is that you do not want them to have any authority or anything to say in how they shall be constructed or in the construction of the hospital; you want that left up to the Federal Government to let the contract?

General FLEMING. No; I do no want the Federal Government to let the contract, but I think the control of the funds, if a grant is made for part of it

Mr. WINTER. What do you mean, control of the funds, if you do not control the letting of the contract and how many bricks will go into this building and what kind of cement shall be used, and thus and so?

General FLEMING. I think we want to be sure that it is a building which will endure.

Mr. WINTER. Do you not think the people out in the communities that are going to build these want to build buildings that will endure!

General FLEMING. I think they will, but a lot of times they do not.

Mr. WINTER. The Federal Government does not always do it, either.

General FLEMING. For instance, the State of New Jersey has a very competent over-all planning board, and we cannot allot money to any political subdivision of the State for planning under the George Act until the project has been approved by that board. That is the law. And we deal directly with them. Some States do not have such things. And it is going to take time to set up all of these.

Mr. WINTER. Let me get you clear: if that over-alì board with power in the State, the planning board, as you say, makes its decision, then are you bound the way you look at' it, to make the allotment to them?

General FLEMING. No; we are not bound to make it.

Mr. WINTER. You put the hospital somewhere else where you want it?

General FLEMING. That thing comes to us, and if we have the funds and it is approved by the State board, why we approve it, but our dealings thereafter are directly with the applicant and not through the board.

Mr. WINTER. After it is approved by the State board, then you would not do anything to oppose what the State board has set out in their approval ?

General FLEMING. No.

Mr. WINTER. If they approved hospital “A” should go in a certain locality, you would build that hospital there?

General FLEMING. No; I am talking now about the George bill, which simply provides for planning.

Mr. WINTER. I am talking about this bill.

General FLEMING. Well, this bill, yes. I think if they approve it, then we have got Federal funds in there and we should see that those Federal funds are wisely and safely expended.

Mr. WINTER. What do you mean by wanting authority to see that they are wisely and safely expended ?

General FLEMING. I think we should pass on the contracts. We should have inspectors on the job and we should pass on the design and see that it is a competent structure.

Mr. WINTER. You have seen the pictures of the so-called health centers that the Surgeon General had here before the committee, have you not?

General FLEMING. No; I have not.
Mr. WINTER. You do not know anything about those.

One other thing, General: You stated that there were some 1,200 counties with 50,000,000 people without hospital service.

General FLEMING. Yes.

sick person.

Mr. WINTER. You mean that 1,200 counties that are scattered throughout the United States do not have hospital service?

General FLEMING. Do not have competent hospital service. Some of them have a little place with two or three beds in them, but nothing else.

Mr. WINTER. What size counties are these 1,200 counties that you are talking about? How many people in them?

General FLEMING. I got that information from the Bureau of the Census.

Mr. WINTER. Well, some of them are counties where the population, is as low as 500, are they not?

General FLEMING. Very likely they are; yes, sir.
Mr. WINTER. And some of them go up to 3,000 and 4,000?
General FLEMING. That is correct, sir.
Mr. WINTER. And they are not all in any given area?
General FLEMING. No.
Mr. WINTER. They are scattered all over?
General FLEMING. Scattered all over.
Mr. WINTER. The United States?
General FLEMING. Yes, sir.

Mr. WINTER. I have some in my districts and those small counties that do not have hospitals are not more than 50 miles from good hospital service.

General FLEMING. Well, sometimes 50 miles is a long way to move a

Mr. WINTER. That is correct, but under modern conveniences of traffic and travel and highways that we have, they would not be over 45 minutes to an hour and a half from a hospital, would they?

General FLEMING. We have had lots of applications under the Lanham Act for hospitals in just such counties. We could not meet the need, because there was no war need there. They alleged a war need because their doctor was not there.

Mr. WINTER. Everybody wanted a hospital.

General FLEMING. Their doctors had been taken away and only one or two left in the county, and they had to travel all of that distance around to their patients to do that.

Mr. WINTER. You are not basing the need for this country on what the applications are that you have for those projects under that act, are you?

General FLEMING. No; I am not.

Mr. WINTER. In fact, everybody in the country, and every county and every State practically wanted to get their arm down in the Federal Treasury while they thought the chance was good.

General FLEMING. I just gave those figures to show the need for more hospitals in this country. Mr. WINTER. I am not arguing that point with you.

I you 100 percent that there is need for more hospitals and that they should be built under some kind of a program, but I just cannot see why we have to get clear away from letting the local people who are going to administer these hospitals have any

official responsibility with them, and that is what, I take it, that you do not want, to have those people have any official responsibility?

General FLEMING. Oh, no; I did not go so far as that, Mr. Congress

agree with


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