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60% provide medical assistance, 60% provide mental health services and 39% operate hospitals. These are in addition to the "traditional" roles of county health functions such as immunization programs, VD clinics, baby health clinics, family planning and drug and alcohol treatment.

Census data shows that counties spent over $2.4 billion for hospitals

and $3/4 billion for health services in 1972 as opposed to $1.3 billion for hospitals and $300 million for health services in 1967. Counties are committed to providing and planning for better health services as well as assisting the states and the Federal Government in controlling the rapidly rising cost of health care.

County officials need to be involved in the health planning process not only as a provider and a consumer, but as a policy maker. City and county officials are the ones most often contacted by citizens demanding health services or complaining about health care costs. The reason is obvious, we are more accessible and accountable to them as citizens and voters.

Experience has shown not only in the health field, but in other fields independent, quasi-public boards are not effective planning organizations. One has only to look at the record of old manpower planning agencies (CAMPS); the community action agencies (as a planning agent) or the current CHP's to know the problems and failures of independent, quasi-public agencies. I am suggesting that there are three basic reasons for the failure of these types of organizations:

1) lack of meaningful role for local elected officials;

2) no accountability to the local electorate for the action or inaction

3)

of the agency;

no formal relationship between these single purpose agencies and the comprehensive sub-state planning agencies.

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NACO is in agreement with the alternate bill as outlined by Governor Noel with one exception. We feel that a governor should first use regional planning agencies or single units of government if available to him before he selects option C - private non-profit corporations as local health planning agencies. I understand that in a number of states regional planning bodies are not in existance or that local governments are not providing significant health service I would suggest that a governor be allowed the third option if this is the case in his particular state.

If the private non-profit organization is formed local elected officials should be in a majority of the policy makers on that governing board. We want the governor to have as many options as necessary as long as local elected officials have a major role in the policy formulation of that agency.

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There are three changes which we (the cities, counties and states) are recommending. The first two Governor Noel already mentioned deletion of agency opproval of federal funds and that the states should govern and distribute those federal funds. The third change we recommend is when a governor selects a single purpose unit of local government as a health planning agency, he should allow that unit of local government final approval of federal projects grants coming into that area. This allows for continuity from the current procedure to the new state administered program.

Mr. Chairman, the inclusion of a Health Services Development Fund will be a major drawing card for the local health planning agencies to use to encourage development of either private or public health services which a local community has not afforded to this point in time. While this program is not tied to other categorial grant programs it is important to establish a base amount so that each planning agency will have confidence of funds in each of three authorized years. A minimum amount of funds per state would be adequate with

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each state guaranteeing their health planning agencies a minimum fund from which to draw upon each year. NACO urges the committee to remove the prohibitions

on the use of these funds for established programs, payment of health services and construction of health facilities.

We would urge the committee to authorize the same amounts of monies as are currently authorized under the RMP, CHP and Section 1122 Certificate of need agencies. As Governor Noel mentioned, a Federal "maintenance of effort" would assure that this new health planning system would be adequately funded.

In summary, Mr. Chairman, the National Association of Counties on record is in favor of the comprehensive approach to areawide planning. This means that planning for such functional activities as health, manpower, transportation, environmental protection and for such client groups as the young, the old, the poor, minorities, etc. should be placed under the umbrella of multi-jurisdictional organizations such as COGs and sub-state planning councils that are recognized under A-95, which is a Federally mandated system. NACO fully supports new health planning legislation if the principles of self-determination accountability and credibility at the local level are a part of the new system. We look forward in working with you and your staff to insure the success of what you are trying to achieve in H. R. 2994. Thank you, Mr. Chairman.

Mr. NOEL. Thank you, Jack.

I next have the privilege to introduce the mayor of Alexandria to speak on behalf of the National League of Cities and the U.S. Conference of Mayors, Charles E. Beatley.

And in introducing the mayor I want you to know that Alexandria is where I lived when I went to Georgetown Law School, and I would like to talk to you about the housing you make available to law school students.

Senator KENNEDY. I will let you settle that some place else. [laughter.]

Let me say he is not only a distinguished mayor but a marvellous pilot. I had a very safe trip with Mayor Beatley. And I want the good citizens of Alexandria to know that he would not let me get out of his airplane without carrying a tabloid telling what a wonderful community Alexandria is. He is constantly on the job, and he is a credit to the Airline Pilots Association. I think the recognition given him by that association should be commended. It is good to know that they support this kind of effort on your part, Mayor Beatley, and I want to welcome you to this committee.

STATEMENT OF CHARLES E. BEATLEY, JR., MAYOR, CITY OF ALEXANDRIA, VA.

Mr. BEATLEY. Senator, I was certainly delighted to have you on board my aircraft not too long ago, and I certainly did present you with the tabloid telling what wonderful things are being done in Alexandria.

Mr. Governor, thank you very much for pointing out the sum of our defficiencies, but perhaps this is what happens in college days.

In any case, Mr. Chairman, I am Chuck Beatley, mayor of Alexandria, Va. On behalf of the National League of Cities, the U.S. Conference of Mayors, and the U.S. Conference of City Health Officers, I very much appreciate the opportunity to appear before you in concert with my colleagues from the Council of State Governments and the National Association of Counties to discuss this important legislation.

First, let me express our appreciation for the openmindedness that this subcommittee has shown this very complex health issue. As locally elected officials, we share the sentiments of this subcommittee and, like you, we feel that there are many legitimate interests at stake as we contemplate modifications to the existing health planning mechanisms. Some of the interests are in conflict with each other but our presence here in joint testimony suggests that we are confident that these differences can be taken into account in the legislative process. I think this is a first when we come together with some kind of common denominator. There are some variations, but nevertheless we are standing together shoulder to shoulder.

We stand ready to assist you in any way we can in making health, health planning, and health care more accessible and functionally responsive to the general public.

We join our colleagues, the National Association of Counties, in general agreement with the statement presented earlier by the Na

tional Governors' Conference. My remarks though, will be devoted to certain aspects of S. 2994 that we believe to be important matters in health planning and regulation from the point of view of city governments.

As mayor of Alexandria, and as a professional commercial jet airliner pilot, I often feel fortunate to view the world from two perspectives. To illustrate, let me suggest that as a pilot I get a bird's eye view of the world and as a mayor, my view may be compared with that of a worm-nothing derrogatory towards mayors on that. However it is a low-level viewpoint.

Though enemies, neither would choose to subordinate his viewpoint and each would fight to protect his position. In the health field, as mayors we are often in the position of the worm, fighting for a role in the health planning and program areas and it is important that our interests are preserved and protected as discussions take place on national legislation that either increase or decrease our level of direct involvement.

Of the several officially proposed legislative approaches to the health planning and regulatory issues involved, we favor, in greater degree, the provisions contained in S. 2994. We do not agree with everything but we do see the broader picture coming into focus on this bill.

More than the approach of the administration or the House bill, it expresses the proper relationship between the mechanisms of health planning and regulation, on the one hand, and the objectives of health care and economy, on the other. Moreover, the bill seems to express a proper appreciation for the importance of each of those elements. S. 2994 sets up mechanisms for guarding public health and planning and providing health facilities and services, while assuring quality care at reasonable costs.

We really are in an area where this is crucial. I am sure everybody feels this same way.

I would like to say of equal importance though is the question of accountability to the general public both as consumers and providers of health care.

We believe that there should be greater and greater emphasis on the responsiveness to consumers. We have begun to emphasize the consumer more and more each year.

Thus, we strongly believe that national legislation that allows for the greatest flexibility at the State, regional, and local level will, in the end, best serve the unique and differing circumstances characterizing individual jurisdictions. This is no less true in the health field than in all others in which city governments are involved.

As public officials responsible for formulating and executing public policy at the local level, we have a strong aversion to over-compartmentalizing functional planning and management. Too often, this aversion is born of an acute awareness of how each element must relate to every other one, lest all the elements fall, like a house of cards, for lack of mutual support.

We local officials are really quite cognizant and sensitive to deal with the categories of functions in our local government in a similar basis, and if the planning process applies to land use, the same kind of process should apply to health facilities.