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First, it limits the functions of the Federal Hospital Council to that of an advisory body rather than permitting it to have control of rules and regulations, and over the approval of State plans.

Secondly, it provides equal representation of public or consumer interest with that of the professional members of the council.

And it further provides that the consumer representatives shall be from both urban and rural areas.

Third, it protects the expenditure of public funds by providing a balance of power between the Federal and State governments.

It provides that standards of maintenance and operation must be laid down by the States in compliance with minimum general national standards.

Four, it promotes the quality of hospital service as well as further protecting the use of public funds by providing that the Surgeon General shall prescribe “general standards to assure that hospitals aided are available to all practitioners in the community who are licensed in the State in accordance with provisions necessary to safeguard the quality of hospital services."

I think that is a rather important provision, in view of the experience that has been had in certain areas in the United States in that in certain nonprofit institutions, some doctors have been denied the right to use those institutions even though they were technically capable and there was no attempt to rule them out of the hospitals on the ground of noncapability. And if the Government is going to be investing funds, it seems to me that that protection is necessary, from the standpoint of the consumer as well as the members of the profession.

Mr. PRIEST. And if the gentleman will yield a second.
Mr. BIEMILLER. I shall be very glad to.

Mr. PRIEST. You mention that they were technically capable. They were also licensed by the State in which they practice.

Mr. BIEMILLER. Correct.
Mr. PRIEST. As well as being technically capable.

Mr. BIEMILLER. Correct, Mr. Priest. Fifth, the bill requires the Surgeon General to make a full report to the Congress on the administration of the program, and allows him to include in his report legislative recommendations as to improve the program further.

Sixth, it deletes the provisions for appeal to the Federal court in the event that the Surgeon General refuses to approve a State plan or an application, and thus avoids judicial overriding of administrative discretion which Congress has entrusted to an official responsible for disbursement of Federal funds.

For those reasons, Mr. Chairman and members of the subcommittee, I repeat that I feel very strongly that the best bill before your committee is the Priest bill, and I very strongly hope that the committee will see fit to recommend it out as promptly as possible.

Mr. PRIEST. Are there any questions?

I, personally, certainly thank you for your support of the position that I have taken in this legislation. As chairman of the subcommittee, I have not felt that it was entirely within my province to plug for the so-called Priest bill as vigorously as you have plugged. I think the reasons you gave me are certainly the reasons I had in mind in introducing a bill, which, in most part, is similar to S. 191, but which differs in the six particulars that you mention and which, in my opinion, does present a piece of legislation that would give us a better bill, if we could get at least two or three of those major provisions into the bill.

Mr. BIEMILLER. I quite agree, and you state correctly the major provisions in terms of funds and the machinery for distribution of funds, the formulas, and so on, are identical, and for that reason I did not go into those matters because I assumed that they had been gone into before.

Mr. PRIEST. They had. We thank you, Mr. Biemiller.

It is possible that there is a witness present this morning whose name was not on the list.

At this point, if there is any one present who was scheduled to be a witness, who has not been called, will that person speak.

Will you identify yourself for the record ?

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STATEMENT OF H. B. ANDERSON, SECRETARY, CITIZENS MEDICAL

REFERENCE BUREAU, INC., NEW YORK, N. Y.

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Mr. ANDERSON. My name is H. B. Anderson, secretary, the Citizens Medical Reference Bureau, Inc., 1860 Broadway, New York.

What the Bureau stands for and why we oppose the centralization of all public health activities at Washington are set forth in detail in a book we have just published entitled “Public Health the American Way.” A copy of that book has been forwarded to all members of this committee.

The only possible justification we can see for a bill dealing with hospital construction is if it provided a formula for relieving the shortage of hospital beds in civilian hospitals which the States and local communities could not do for themselves. But this the bill does not do. The bill contemplates a long-range program and is not intended to meet emergency conditions. The delay in hospital construction is not due to lack of funds: it is a problem of labor and building materials. But the bill under consideration does not say one word about making building material more readily available nor does it say anything about solving labor difficulties.

I respectfully submit that there is not a State in the entire country which is today in such a state of insolvency that it must come to the Federal Government and barter its right to determine for itself its health and hospital needs for a matter of anywhere between $1,500,000 to $2,000,000 a year. Yet this bill provides that before any of the payment can be made to the States the States must submit plans for carrying out the purposes of the act for approval by the Surgeon General. It also provides that the Surgeon General, with the approval of the Federal Hospital Council and the Administrator, shall by general regulation prescribe the number of general hospital beds required to provide adequate hospital services to the people residing in a State, and the general method or methods by which such beds shall be distributed among

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intermediate areas, and the rural areas. Also the Surgeon General, by general regulation, is to prescribe the number of beds required to provide adequate hospital services for tuberculous patients, mental patients, and chronic disease patients in

base areas,

a State and the number of public health centers and the general method of distribution of such centers throughout the State, which shall not exceed 1 per 30,000 population. The Surgeon General is also to prescribe general standards of construction and equipment for hospitals of different classes and in different types of location.

In other words, the plan proposed in S. 191, as I see it, is that the States which have invested billions of dollars in hospitals and publichealth facilities relinquish their right to determine for themselves what their hospital and health center requirements are to be in return for a Federal dole of an average of between $1,500,000 to $2,000,000 to each State annually for a period of 5 years.

A few months ago it was announced in the press that 23 of the War Department's 65 hospitals and 5 Naval hospitals have been declared surplus. Also it was announced that the Veterans' Administration was in need of more hospital space but that the Army and Navy hospitals, except 7 hospitals, 5 of which were designated for temporary use only, were unsuitable either because they are not fireproof or are low, sprawling buildings and that the veterans agency prefers higher structures so that doctors won't have to walk too far to get to their patients.

I merely cite this incident to show that what appeals to one authority may not appeal at all to some other authority. I do not question but what the architects for the United States Public Health Service could draw up an imposing array of buildings for the entire country. But I also submit that with such a program there can be an enormous waste due to a preference for a particular type of construction.

I was interested a few weeks ago to read the following special dispatch in the New York Times, February 15, 1946:

JEFFERSON CITY, Mo., Feb. 14—The legislature was asked today to turn down any additional grants of Federal aid as a start toward a Däcional budget balancing program. Curtis J. Tindel of Texas County, a Republican, offered a resolution for that purpose which was referred to the House Appropriations Committee without debate.

Missouri has a big surplus in its treasury, he said, which should be used before the State calls on the Federal Government for funds.

The resolution applies to “additional” grants, he explained, and does not contemplate refusal of the millions of dollars annually poured into the State for old age pensions, aid to dependent children, highway construction, public health and educational programs.

It has been argued in support of this bill that a good many of the States are poor and that all the States are limited in the revenue which they can collect. On the other hand, I maintain that it is the Federal Government and not the States that is poor. Over a period of several years while the Federal Government was spending approximately $300,000,000,000 for the prosecution of an all-out war the States were building up a reserve instead of going further into debt. Right now New York State has a surplus of approximately $500,000,000.

The Citizens Medical Reference Bureau, Inc., is in hearty accord with the drive now being carried on in Congress to balance the budget. We are also in hearty accord with the following declaration by Representative Clarence Cannan, Chairman of the Appropriations Committee, in a communication directed to M. William Zucker, published in The New York Times, December 18, 1945:

Of course, no one can speak for Congress or for the future, but any program involving contributions by the Federal Government to States and municipalities in another PWA program is so impractical under our changed financial status

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'as to appear prohibitive. When we have settled all war accounts, interest on the public debt alone will exceed the entire average prewar budget. Any State or municipality in the Union is in better financial condition than the Federal Government.

I submit that the Bill S. 191 is simply the opening gun in a campaign by the United States Public Health Service to plan the hospital program of the country upon a national scale involving a future contemplated expenditure of billions upon billions of dollars.

Surgeon General Thomas Parran has testified upon a number of occasions that $2,000,000,000 will be needed for hospital construction, without allowing for upkeep. Also Surgeon General Parran even suggests that it would be a good thing if the health centers to be established would provide offices for the doctors of the community so that they can enjoy the use of all the facilities jointly. In a radio address November 10, 1944, Surgeon General Parran said:

No ... the "front line,” to use your expression, Mr. Cross, would be a system of health centers. They will become the field stations of the future system of health care. Here the laboratories and administration facilities of county and city health departments would be housed. The health center, in fact, the whole hospital system will be concerned both with prevention and treatment. It will be provided with well-equipped laboratories for the performance of many diagnostic tests. There will be X-ray facilities for the detection of tuberculosis, clinics for the treatment of venereal diseases, assembly rooms for health eduction. And, ideally, the center will provide offices for the doctors of the community so that they can enjoy the use of all the facilities jointly and have the opportunity to meet together, discuss their problems together share their knowledge in such a way that they operate as a team.

I submit that if we are to embark upon a program of building private offices and clubrooms for all the doctors of the country that it involves a possible future expenditure of billions upon billions of dollars.

The Citizens Medical Reference Bureau, Inc. is opposd to the passage of this bill because the health-center program, which the United States Public Health Service seems so desirous of having consummated, is so closely interwoven with a program of compulsory medication. The United States Public Health Service does not make

any

form of treatment compulsory. That is a matter for the States to do if they accept the Federal program and agree to cooperate.

But what the United States Public Health does do is to hold out the promise that through certain forms of mass diagnosis or mass treatment certain diseases can be wiped out. Then if the States are willing to cooperate in these campaigns they must find some way of inducing or compelling the people to be medically examined or treated and a mass of compulsory state laws are the natural result.

Take the venereal disease program which the United States Public Health Service inaugurated in 1939. I estimate that a total of something like 70 or 80 statutes have been enacted in the State legislatures providing for compulsory serologic tests of expectant mothers or applicants for a marriage license. And right now the State legislatures are being flooded with proposals for compulsory X-ray examinations in line with the Federal program for the alleged wiping out of tuberculosis.

I submit that the States should be free to work out their own methods for preventing tuberculosis or any other disease. There is

a wide difference of opinion among medical authorities about whether isolating large numbers of persons in sanatoriums actually aid in the prevention of the disease or not. Many of the States may feel they have all the facilities they need for detecting tuberculosis in a communicable stage and may have entirely different ideas about preventing the disease than a campaign for the X-ray examination of everybody, I have discussed this question of X-ray examination in detail in chapter V of the book "Public Health the American Way."

The Public Health Service emphasizes the need of clinics for the treatment of venereal diseases.

In that connection it may be stated that health departments generally have gone out of their way to provide clinics for the treatment of venereal diseases. However, I question how many health departments would be desirous of engaging in campaigns similar to that carried on by the United States Public Health Service in Birmingham, Ala., during the 6-week period beginning the middle of May 1945.

The campaign in Birmingham cost $207,000, exclusive of salaries of permanent personnel.

The Public Health Service sent a publicity man extraordinary to Birmingham who sent out spot announcements for the radio stations, fed stories to the newspapers, planned advertisements, supervised the placing of huge signs on downtown lampposts, and kept a watchful eye on the entire program.

By promising to wipe out syphilis in Birmingham it was possible to work up a great deal of enthusiasm for such a campaign. But we are told that Birmingham still has cases of the disease.

In my opinion the success of any campaign of this kind cannot be measured by the number of persons made disease conscious or by the number of persons lined up at a treatment center. In my opinion, it is a question of whether or not such campaigns tend to build up a higher standard of citizenship. The point is that there is a wide difference of opinion as to just what methods should be used for preventing a disease of this kind and that is a matter which should be left to the States to decide without using a Federal hand-out as an inducement for a city or State to cooperate in the Federal program.

In the radio address I previously referred to, Surg. Gen. Thomas Parran referred to the fact that some 10,000,000 men and women in the Armed Forces now receive complete medical and hospital care, He further stated that "Many of them came from families for which such care has never been available.” “In peacetime,” he said, “they will demand it for themselves and for their families."

In reply to that statement I wish to point out that in the armed services medical treatment is compulsory whereas in civilian life the people have always demanded the right to select the method of treatment and the practitioner of their choice for the alleviation or prevention of disease. This is a fundamental right and it is one that must be preserved.

Mr. Priest. We thank you, Mr. Anderson, and appreciate your appearance here.

Mr. William M. Colmer, a Representative from the State of Mississippi, is tied up in the Rules Committee and cannot appear this morning as he had desired to do.

And without objection, he may submit a statement to be printed as though given orally.

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