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Mr. WINTER. I thought that was it. I wrote down what you said. It is in your statement. You said that it was connected with the committee, private citizens with no official responsibility.

General FLEMING. I think that you are giving this authority for Federal funds under the bill to citizens who have no official responsibility.

Mr. WINTER. Why do they not have?

General FLEMING. I say, they can serve, as I said in my statement, very well in an advisory capacity, and I think that they should in that.

Mr. WINTER. What do you mean they have no official responsibility, just because they are not an officer of the Federal Government?

General FLEMING. Not an officer of anything.

Mr. WINTER. Cannot a private citizen have responsibilities without using the word “official” that are just as great as official responsibilities?

General FLEMING. I do not know whether he can be held responsible for the disbursal of Federal funds.

Mr. WINTER. He would not be doing that.

General FLEMING. He would be deciding on where the Federal funds should go and for what purpose.

Mr. WINTER. That is correct, but he would not be spending the funds. Your agency or some other agency of the Federal Government would still have the authority you want. I do not believe in turning the Federal funds loose to every Tom, Dick, and Harry in the country to spend, but this committee, after they had made their decision, would have nothing whatever to do with the construction of the hospital.

Mr. PRIEST. Will the gentleman yield for a question there?
Mr. WINTER. Yes.

Mr. PRIEST. It is a little hard for me to understand whether you and
General Fleming are discussing the hospital council.

Mr. WINTER. Yes.

Mr. PRIEST. That is, the Federal Hospital Council as set up in the bill, or whether you are discussing people, local citizens, in a local community.

Mr. WINTER. No; I am referring to the council.

Mr. PRIEST. It was my understanding that the point that General Fleming mentioned was that it was his position that the council should not have administrative authority.

General FLEMING. That is correct, sir. You have administrative authority now vested in Dr. Parran and in the Administrator of the Federal Security Agency, and I think they are competent over long years of experience to carry out that authority, and I think they should have simply an advisory council, not to have control, as to where these funds should go. I think they should advise, and their advice should be heeded, but it need not have the force of determination.

I have an advisory council set up for myself that I asked for, from the various engineers, and architectural and building and contracting societies, that I call in from time to time, and I listen to their advice and very often take it. Many times I will not take a step without their advice, but when they recommend something to me, I do not have to do what they say. This requires the Surgeon General to do what they say.


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Mr. WINTER. An administrative officer, if he had to do everything that his advisers recommended, would find himself in a terrible fix, would he not?

General FLEMING. Yes, sir.
Mr. WINTER. That is all.
Mr. PRIEST. Are there any questions, Mr. Gillette?

Mr. GILLETTE. You stated that the present law for the Federal Works Agency is assisting in advances of $3,442,000 and planning 169 hospitals for local communities.

In what way are they assisted ?

General FLEMING. That is in the planning. That comes under title V of the George bill. We advance to these local communities funds for the preparation of plans for hospitals or for other types of public works. It runs ordinarily about 4 percent of the total cost of the structure. We advance first to them about 2 percent of the total cost of the structure, and then they go ahead and prepare their plans, and when they get their plans all finished, we give them the remainder, whatever that may be, the cost of this plan preparation. We have their assurance that some time within the fairly near future they will undertake the construction of the hospital with their own funds.

Definitely stated, there is no commitment on the part of the Federal Government to provide any of the construction funds, and whenever construction funds become available and they start construction, then they must repay the advance made to them.

It comes back into the Federal Treasury. Mr. GILLETTE. Then your agency would not have anything to say about the locating of the hospital?

General FLEMING. Not at all.
Mr. GILLETTE. Or the type of construction?

General FLEMING. As I say, in a State that has an over-all authority, we require that the over-all authority approve that allocation of funds before we make it.

Mr. GILLETTE. In the case of a community furnishing half of the funds, and the Federal Government the other half, who would then locate the hospital; in your judgment, who should locate the site of the hospital?

General FLEMING. Well, we have never had anything of this character with us before. We have always dealt with the applicant. Under the Lanham Act, the applicant comes to us and would show a war need, and would show what they could do.

In some cases, they could do nothing. So we put in 100 percent of the money. Where they would put up 50 percent of the money, we would make a grant of 50 percent and they would construct the hospital, decide where it should go.

Mr. WINTER. Just one further question. Do you not think it might be a better system than set up in this bill, to let the Surgeon General and your Department deal directly with the local authorities, and the State authorities have made their survey and determined where the hospital should go?

General FLEMING. That is the point I made. I thought we should deal directly with the local people.

Mr. WINTER. After the survey is made?

General FLEMING. That is correct, sir.
Mr. WINTER. Now you and I are getting nearer together.

Mr. PRIEST. It was my understanding from the beginning, and I gather that particularly from the next to the last paragraph in your statement, that that was your general idea, that after a survey had been made and approved, we will say, by the Surgeon General, for the location of these hospitals, that from that point on, then you, as a construction agency, the Surgeon General's office as a health agency, then should deal directly with the community in which te hospital was to be constructed ?

General FLEMING. That is correct.
Mr. WINTER. That is provided with community funds?
Mr. PRIEST. That is right; that was my understanding.
We appreciate your appearance before the committee.
Mr. WINTER. One more question.

We will say that the Catholic Church wanted to construct the hospital in a given area. How else would they do that unless they could come direct to an agency, such as you stated, in the Federal Government, and get their funds after it had been approved ?

General FLEMING. If there was a State over-all agency, they certainly would have to go there first.

Mř. WINTER. What I mean is, supposing that we get into an argument between the Protestant and Catholic hospitals, and the municipal hospitals, or State-owned hospitals: Somebody has got to have the authority somewhere.

General FLEMING. If it is between the Catholic and Protestant hospitals, I would rather have the State decide than make that decision myself. Mr. WINTER. Certainly you would, but the local people would not. Mr. PRIEST. You do not want that authority, do you?

I have this question: this brings up a question that is not, of course, new; we have it in other Federal-aid programs. Of course, the first Federal-aid program of any importance was the State highway Federal assistance. We have run into somewhat a similar situation recently on this committee with reference to airports. We have a bill now tied up in conference in which that is the main point in controversy, largely because the building of airports is considered more of a municipal function, that is, the building and operation of them, than it is a State function.

The whole question is not new. It is one on which we find opinions very sharply divided.

We appreciate your statement before the committee, General. I am sure when we go into executive session the committee will want to give full consideration to every suggestion that will be helpful in getting out a hospital bill that will build hospitals where they are needed and as economically and as efficiently as they can be built to serve the public.

We appreciate your testimony, sir.

I see our colleague from the House, Congressman Biemiller, from the State of Wisconsin.

We will be very happy to hear him at this time.




Mr. BIEMILLER. Thank you, Mr. Chairman.

Mr. Chairman and members of the subcommittee, I am appearing here today to give my wholehearted endorsement to H. R. 5628 introduced by the chairman of this subcommittee, Mr. Priest. I want to congratulate Mr. Priest on the splendid bill that he has introduced. I hope that this subcommittee will report out the bill introduced by its own chairman.

I believe that Mr. Priest's bill is far superior to the other hospital construction bills pending before this committee. It is the only bill which contains provisions which are sure that there will be adequate standards in both the construction and maintenance of hospitals and that the final administrative authority for this program will not be placed in the hands of private parties.

Both of these provisions I deem essential to a sound hospital construction bill.

The first recommendation contained in President Truman's national health program which he sent to Congress on November 19 relates to hospital construction.

The President stated in his message that "the Federal Government should lay down minimum national standards for construction and operation." And then, further on, the President said, “In approving State plans and individual projects and in fixing national standards, the national agency should have the help of a strictly advisory body."

In my opinion, only the Priest bill meets these two provisions in the President's message. They are very sound provisions, I believe.

This subcommittee is responsible for practically all legislation relating to our Nation's health. It has done a marvelous job. We all recognize, however, that a lot remains to be done to improve health standards in this country.

These hearings on the hospital construction bill are recognition of the fact that this subcommittee believes that good health is a fundamental human right.

Every year the Congress appropriates millions of dollars for the Fish and Wildlife Service, hundreds of millions of dollars for roads, airports, rivers and harbors, and flood control. We appropriate each year for the Forest and Soil Service alone as much as it is proposed to spend annually for hospital construction in this bill.

Last year Congress appropriated nearly $50,000,000 for work in construction with insect, plant, and animal diseases. Now, these are all necessary appropriations and I approve of them, but we can afford to spend at least twice or three times of this amount for the health of human beings while in hospitals.

We have spent billions on the atomic bomb. I think it is time we began to invest some money directly in the health and welfare of the American people.

I know many people talk about our national debt and use this as an excuse to oppose vital legislation, such as the health programs pending before your committee.

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I hope your subcommittee will not be misled by these arguments. I do not believe that it is the size of the debt which is of primary importance. It is the relation of the debt to our national income. If our national income is high and continues to increase, the debt will be relatively light, but if we have unemployment and depression, any debt will be a heavy one.

Our real problem, therefore, is not the debt but how to keep our economy operating at a high level, constantly expanding, and with a minimum of unemployment. A well-rounded program of health measures, including health insurance and an expanded social security program can help to achieve these objectives.

The American people are willing to pay for hospitals and hospital care. Every public opinion poll shows that the cost of sickness is one of the greatest fears in the minds of our people, and that they want action from their Government to help remedy existing inadequacies.

That brings me to an important point concerning the pending hospital construction bills.

I feel very strongly that we must keep the Advisory Council in the legislation strictly advisory. I do not believe we should give the final control over hospital construction to the American Medical Association or the American Hospital Association, or any other private parties. Once the Congress gives any private persons or organizations the power to override a public official, Congress is handing over its power, lock, stock, and barrel, to private interests.

Also, one of the bills pending before this committee provides that any applicant dissatisfied with the action of the Surgeon General of the United States Public Health Service denying the construction project, may appeal to the United States Circuit Court of Appeals. If such a provision should be enacted, it would be the first time that Congress had provided that the Federal grant or gratuity would be subject to judicial review. It would mean that to be consistent, the Congress would have to provide similar court review for applicants under old-age assistance, aid to the needy aged and dependent children, for all veterans' pensions and compensation, for Federal grants for highway construction, and all other similar programs. In my opinion, such a provision would eventually lead to confusion. It would result in delay, countless court cases, and administrative indecisions.

The only solution for the Congress is to clearly specify all of the conditions in the law and then hold the Surgeon General responsible for the day-to-day administration of the law.

If there are complaints about the law, or its administration, let Congress not the courts change the law. If the law is not clear, let Congress not the courts clarify the law.

The Priest bill has all of the necessary protections in it to every one.

I think it is a fine bill. I hope the committee will report it out as soon as possible. The passage of the bill will enable thousands of persons to get hospital care every year. It will mean that many mothers and babies who would not otherwise be able to have hospital care will be able to receive it.

And I want now to briefly draw certain basic differences as I see them between the bill that came from the Senate and H. R. 5628.

H. R. 5628 differs in the following respects:

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