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Dr. Parran. I hope my response, Mr. Chairman, was equally appropriate to the hearing.
I am testifying only on S. 191; as Mr. Brown has expressed it, this is a bill which stands on its own feet.
Mr. HARRIS. Of course, the whole subject is related to the matter that is under consideration, and I think it is apropos to this discussion.
Mr. Brown. If it is our understanding that we are confining ourselves absolutely to the provisions of this bill, and that the way in which it may or may not fit into this general program as suggested by the President is not to be considered, then, of course, the effect of the President's letter has been considerably damaging, to say the least. .
Mr. HARRIS. You may proceed.
Dr. PARRAN. Finally, Mr. Chairman, I should like to bring to the attention of the committee another situation, which is of an emergency nature that has arisen since the bill was considered by the Senate Committee. As you know, about 50,000 doctors and dentists have been released from the Army and Navy. Like other veterans, they are finding great difficulty in securing housing, but they are confronted with an equally difficult problem in securing office space. Unless a doctor can establish or reestablish his office, he cannot practice his profession. His much-needed services are not available to his community. From all over the country, I have reports of our returning medical veterans unable to serve their communities simply because they can find no office space. As originally drafted, S. 191 was designed to encompass the provision of office space for physicians, particularly as a part of the rural health center.
The definition in the bill was somewhat restricted as approved by the Senate Committee.
This matter is now of such immediate importance that I would urge the committee to scrutinize carefully and if necessary broaden the definitions in the bill of a "hospital” and “health center" with a view to ensuring that, wherever needed, office space for physicians and dentists—with preference to veterans—be included in the health facilities built with aid under this legislation.
Mr. HARRIS. That would be interpreted to mean, Doctor, that, as Mr. Brown suggested, leading to the broader so-called socialized medicine program.
Dr. PARRAN. By no means, Mr. Chairman, the veterans have come back; their offices have been rented to other people. The offices' rents have doubled or more what they were in some places. They have no place from which to hang out their shingle. It is a most acute matter that is boiling up all over the country.
Mr. BROWN. I would not agree absolutely with what the general said for the need for these—for office space for doctors. There is need for office space and need for housing for doctors and veterans all over the country. There is also need for suits for the veterans to wear. I have had a lot of veterans tell me they could not find a suit of clothes to fit them anywhere. However, I am not so sure that the Federal Government should buy clothes or make clothes, and give to the veterans. Most veterans who fought in this war for the perpetuation of a representative form of government do not want a paternalistic government to give them their clothes; they want the opportunity to buy their own, and decide for themselves as to what color and what
style they shall have; and I think probably a lot of doctors are in the same position. At least my mail indicates that, as I have received letters from them.
That brings into my mind this question, Dr. Parran: Have you or any one in the Public Health Service any assurances from anybody in the Government that we can get the materials we need to build these hospitals, the labor, and so on?
Dr. PARRAN. I do not feel competent to answer that question, except to say that the general impression, as a citizen, that I have, is that first priority will be given immediately to the housing of veterans. It seems to me that from a health point of view, the next priority should be given to insuring that the returned doctors, the displaced doctors, as it were, displaced by the war, have an opportunity to practice their profession.
Such a broadening of the definition would not imply socialized medicine.
There are many instances now in which hospitals provide some office space for doctors, or in buildings adjacent to the hospitals under whatever rental arrangement they may agree upon. A hospital could submit, as a prior project, the construction of space which would be rented to the doctors on whatever basis the hospital and the doctors agree upon.
The matter in each case would need to originate locally. It would be a local request, no Federal dictation or Federal buying of suits of clothes and distributing to the veterans. This would be something for which if, and as needed, there would be a local demand and local agreement, and a project submitted by a hospital, voluntary or public.
Mr. WINTER. Would those doctors be subject to the rules and regulations of that particular hospital?
Dr. PARRAN. That would be entirely up to the doctors and the hospital. Generaly speaking, they would be the doctors who serve on the staffs of those hospitals.
Mr. WINTER. I am interested in what you say about these doctors not being able to find office space. Where does that condition exist prevalently?
Dr. PARRAN. I think it exists prety generally all over the country, Mr. Winter. It is acute in the metropolitan areas and in the smaller towns.
I must acknowledge that I have no statistical information. The situation is changing rapidly. A lot of doctors have come out of the Army just within the past month or two.
Mr. WINTER. I represent a district with nine counties, more or less of a rural area; a great many of our doctors have served in the service of the country. They are returning, and I know of no single doctor that does not have an office space.
Dr. PARRAN. In that event, then such a broadening of the definition would have no effect, and all of the money available for that part of your State would be available for building of beds for patients. If, on the other hand, the local community itself, with the approval of the State agency, thinks that the problem is acute, it could be dealt with.
Mr. WINTER. Under what theory do you advocate the Federal Government should provide funds to build office space for doctors?
Dr. PARRAN. Doctors serve in hospitals both full and part time. Some of their services are to charity patients and some to pay patients.
Mr. Brown. But the hospitals do not take care of their private offices for them down town, although they do furnish them facilities to use at the hospital.
Dr. PARRAN. I would assume that the hospital in such circumstances then would charge rent to the doctors.
You might ask, why should the Federal Government aid the hospital in providing an income-producing property.
Mr. Brown. You know, doctor.
Dr. PARRAN. That is a question which might fairly be asked. We can only say that we are aiding the hospitals in building beds for patients which they also will rent to patients.
Mr. Brown. Members of Congress, doctor, have problems as well as the Surgeon General. I agree with you fully as to the need for hospitals. I agree with you fully as to the shortage that exists for office facilities for doctors all over the country, and the need for housing, not only for veterans but for other fairly good American citizens, too, because I have had letters from some of the mothers of boys who died in the service of their country that say that they cannot get any consideration at all for a home. Perhaps those boys that died in the service would be just as anxious to have their mothers have roofs over their heads as they would have to have their buddies have roofs over theirs.
It is a broad, general problem. I had a letter, yesterday, or the day before, from two veterans of this war who came back into a community of about 4,000 where they had a local laundry that had been damaged by fire; the man had been trying to run it throughout the war and could not get help and he was aged, so he just quit the laundry business following the fire. Just said "Forget it."
Those two veterans cannot go back to work and cannot render laundry service to that community because they are unable to purchase 1,500 feet of flooring needed to complete the job and to put the laundry in operation. I also have letters from other men who had been in the armed services, veterans, who say it is just as important to erect a little factory that they want to start up, so they may earn a living, to have a place to work, as it is to have a home. So we have those problems on our hands, too. We have to give some consideration to that angle, and we have many questions that come up here as to what cases should be given priority and which should not.
I can understand how every agency of the Government sees their particular problem first.
I want to take this bill if I can, Mr. Chairman, and take the suggestions that the Surgeon General has made; I would like very much to have an opportunity to read the testimony further, too, but do you have any other amendments to this bill besides that two that you mentioned :
Dr. PARRAN. No other amendments occur to me at this time.
Mr. BROWN. Are those the only differences between the Priest bill and this bill? I have not had an opportunity to compare them section by section.
Dr. PARRAN. I am told that there are other differences between H. R. 5628 and S. 191 in addition to what I have mentioned, and also, my
last suggestion was not encompassed in the Priest bill (H. R. 5628).
Mr. BROWN. I understand that was not in there.
I have one other question in connection with these about these local health centers.
Do they—or could they be self-supporting?
Dr. PARRAN. No, Mr. Brown; they cannot be. In general, the basic purpose is to provide the headquarters or the outpost of the local health department. Mr. Brown. And how would they be supported ?
Dr. PARRAN. As a part of the budget of the county health department or city health department.
Mr. Brown. But the financing for the local health center out in the rural community would come out of the county health fund. Have you ever checked or analyzed some of the county health funds of the United States and the amount that is available ?
Dr. PARRAN. I think we have pretty good data on that score. You will recall that they are authorized under Public Law 410 to give grants-in-aid for such work, both for public health work, for venereal diseases, tuberculosis, a considerable amount of State and Federal are going in aid of that.
Mr. BROWN. A great many States do give State aid, and I understand the Federal Government under the Public Health Act, does furnish certain aid for certain purposes, but mostly, as I remember and recall, for training, experimentation, and research, rather than for direct aid; is that correct?
Dr. PARRAN. Oh, no, Mr. Brown. The substantial part of Federal money goes into direct services to the people, paying part of the salary of the country nurse, paying part of the cost of the child health clinic, part of the cost of the venereal disease clinic, and the nurse there. The sanitary and milk inspector, and such.
Mr. Brown. What do you think would be the increased cost to maintain these health centers you want, both to the Federal Government and to the local political subdivision, I mean to them?
Dr. PARRAN. Per se, no increased cost, I think.
We would hope that the headquarters of the Health Department, instead of being in the basement of the County Court House, would be in a decent community health center.
In other places, they are renting very inadequate space. If this space were built with public funds, local and Federaì, such rental would be saved.
Mr. Brown. What would one of these health centers cost?
Mr. Brown. I mean the smallest ones you have illustrated in your book there. They have 8 beds, or 10 beds, and 20 offices.
Dr. PARRAN. The rural center may cost as high as $30,000 or $40,000, varying from that up to $100,000.
Mr. Brown. The average cost would run what? As I look at the building, it would probably run, equipped and all, at least $60,000 to $75,000, would it not!
Dr. PARRAN. Something like that. Then some of these large centers, district centers for metropolitan areas, would be substantially larger.
Mr. Brown. Let us talk about these small public health centers.
Dr. PARRAN. Yes, sir. This represents the simplest form of health center, functional one-story building:
Mr. Brown. That would cost, equipped, somewhere around what, Doctor?
Dr. PARRAN. May I ask Dr. Hoge if he would answer that question?
Dr. Hoge. That should be built and equipped for around $50,000, perhaps.
Mr. BROWN. What is that?
Dr. SHAFFER. It will serve around 20,000; that is, the whole county or 2 counties or 3 counties.
Mr. GILLETTE. How many beds?
Dr. HOGE. That may or may not have beds, depending on the local circumstances. Ordinarly, this would be for public health work and there may
be beds. Mr. WINTER. How many doctors would be available in that institution?
Dr. PARRAN. Most of the doctors would not be working there full time; perhaps no doctor working there full time, but there would be periodic clinics for venereal and tuberculosis examination and baby clinics. They would come up from the central health department or from the region.
Mr. Brown. A nice building like that would, certainly, need a janitor. And you would want some nurses. And, of course, the doctors, while they were there on part time, would have to be compensated or should be. I do not think they should be asked to furnish their services free. I am trying to find out what it would cost to do this thing and how the cost could be taken care of. I want everything we can get in the way of Public Health Service for the people if we can take care of it financially.
Dr. PARRAN. These health centers would not be built in advance of the communities' prior decision to furnish certain specified services. This would merely be the housing.
Mr. BROWN. I understand. I have watched through the years, you and I, Doctor, when the Federal Government dangles out a little bag of money, everybody begins to get the idea they want to get it somehow or other, and they issue bonds to get the local money to match Federal funds,
and I know a lot of projects that have been built just that way. They are having an awful lot of trouble maintaining them now, because, as my mother used to tell me, their eyes were larger than their stomachs.
Dr. PARRAN. As a part of the state plan, Mr. Brown, there must be a certification that sufficient and complete maintenance will be provided, not only for the hospital but for the health centers.
Mr. WINTER. Who pays for that?
Dr. PARRAN. In the case of a health center ordinarily county funds would furnish the non-Federal part.
Mr. Brown. What do you think it would take altogether to support a center like that, or that kind of a program; how much money