Page images
PDF
EPUB

in title II, "Medical Care by the Federal Government." Do you know what happened to that study?

Mr. STAATS. Yes. Yes, we have recently reported on legislation which would extend care to self-employed merchant seamen.

That bill, as you know, would have extended these benefits to the self-employed who were ruled noneligible in 1954 by the General Council of HEW.

Mr. ROBERTS. These would be principally the owner-operators, would they not?

Mr. STAATS. They would be owner-operator situations, that is

correct.

Mr. ROBERTS. But still engaged in fishing, either in navigation or in helping to handle the intake?

Mr. STAATS. That is correct. We have two points in mind in our review of this program. One is the question of entitlement. We felt that this was an area which needed review in terms of the long background here, going back to 1798.

Beginning, I believe, in 1884, this program was self-financing through a tonnage tax levied on all vessels entering into a U.S. port. Then, subsequently, the tonnage tax was not earmarked. It went into the general fund. That tonnage tax, estimated at $5 million annually, is still levied but is no longer earmarked for the hospitals. The hospitals are being financed out of general appropriations, with direct costs of care for seamen amounting to an estimated $25 million annually.

The question in part is the extent to which there should be a user charge. In other words, to what extent should there be a self-financing arrangement of one kind or another, either levied against the shippers, or a combination of the tonnage tax and individuals paying a part of the cost for this service?

As you can see, it is a substantial amount of money that is involved here at the present time. A merchant seaman is defined to include many people who we do not feel were intended in the purposes of the original act.

For example, an individual operating on the Great Lakes, operating a tour boat is entitled to free medical care. An individual who operates for a municipality, say, a garbage scow, dumping garbage out in the middle of the lake, is covered and given free medical care.

These are the kinds of activities and questions on coverage that we felt needed reexamination. The other question, and a very separate question, is the question of who should provide this medical care? To what extent should it be handled through the Public Health Service hospitals directly, and to what extent should it be provided in other Federal hospitals?

In many instances now this care is not easily available to a merchant seaman. In many cases he may have to travel more than 200 or 300 miles, and he has to do this at his own expense in order to have medical care available to him.

We felt that there should be a review of the extent to which such care could be provided in other Federal hospitals. The intent is still the same but the President in his message on health last year asked for a study on how this care could be made more easily accessible to the merchant seamen.

This matter is under review at the moment and discussions are underway between us, the Veterans' Administration, and the HEW. The reason why the Veterans' Administration is involved is that they have the largest and most widely distributed hospital system available for the purpose.

Mr. ROBERTS. Up until the ruling by the Solicitor to the effect that if the owner-operators were not covered this care had been extended, I believe, since about, say, 1804.

Mr. STAATS. It started originally in 1798 and, I believe, the hospital system itself was set up in 1894. It is a very old program.

Mr. ROBERTS. I was interested. Not so long ago there was a statement that had been provided me by Mr. Spal, who recently passed away, one of our very valuable staff members, to the effect that President Adams had advocated this care and it was one of the first basic factors in the jurisdiction of this Committee on Interstate and Foreign Commerce.

It was really the thing, I think, that started us in the field of health. It was very interesting to me, this being one of the oldest committees of Congress, that this is the one of the things he gave us, health jurisdiction.

All right, sir.

Mr. STAATS. Funds for health training, including grants and direct Federal outlays, also represent a crucial and growing area of expenditures, totaling nearly $360 million in 1964.

While HEW has the preponderant share, the Department of Stateincluding AID and the Peace Corps-the Department of Agriculture, and the Department of Defense spend significant amounts for training.

Finally, the Federal Government in 1964 will devote nearly $700 million for construction of health facilities, excluding those for research purposes. Roughly half of this will be spent by agencies other than those of the Department of Health, Education, and Welfare.

In summary, chart II indicates that the VA and the Department of Defense have the major portion of the direct federally operated, patient-care activities among the Federal agencies.

In contrast, HEW looms large in all the other five categories of expenditure. The Department's proportion is particularly large in the training, research, and preventive and community service health

programs.

The trend in obligations by type of program for the 3 years 1962-64 is shown in table B in the special analysis, which shows the total figures for each category and separately for HEW and for all other agencies.

For HEW all categories except patient-care services are increasing at a substantial rate. For other agencies as a group some categories are increasing while others are declining.

Table C classifies the obligations for 1964 for each agency by cate gory. Data for all 3 years for each of the principal agencies are also included in the special analysis.

I would like to turn, Mr. Chairman, to the discussion of organization and coordination of Federal health activities.

It is evident that the mission related character of the health programs operated by the various Federal agencies strongly influence the organization of health activities in the executive branch.

For many of the Federal agencies the health or health-related programs are only a means of carrying out another governmental function.

The Armed Forces must have healthy personnel; and under recent legislation the civil agencies of the Federal Government help their employees to obtain prepaid health care.

As part of its responsibilities to veterans, the VA provides hospital and health care services. The international agencies carry on health aid programs to achieve their economic development or military assistance objectives.

In contrast, it is largely in HEW, notably in the Public Health Service, that health is viewed as a primary mission. In the Public Health Service, the input of resources is devoted largely to basic health resource development-through research, training of personnel in shortage categories, and construction of community health facilities— or to the strengthening of broad preventive and community public health capabilities.

A large part of these HEW funds is disbursed through grants-inaid to States and localities, unlike those in most of the other agencies. HEW also makes large amounts of grants to universities and to individuals for research purposes.

Although the health and health-related activities within the executive branch are numerous and diverse, our survey indicates that there is a remarkable amount of interchange of information and coordination among the various agencies, both through day-to-day working arrangements and through more formal devices such as contractual arrangements and interagency committees.

To cite some examples: The Department of Defense and its constituent units are represented on 20 boards, committees, and similar organizations functioning in the health field on which HEW is also represented.

The Department of Agriculture is included in at least eight committees or interagency groups in which HEW participates. Veterans' Administration personnel are members of 27 NIH national advisory councils and study sections and VA is also represented on a number of interagency committees.

AEC is represented with HEW on such significant groups as the Federal Council for Science and Technology, the Federal Radiation Council, and on the National Committee on Radiation Protection. Extensive interagency relationships have been established between the Agency for International Development and HEW.

These include memberships on interagency committees, bilateral contractual arrangements for technical consultation, support and training services, and various other joint project agreements.

Some 76 Public Health Service people have been loaned to AID. Day-to-day consultations between the two agencies run the gamut from the policy to the operating levels.

Several agencies in the Executive Office of the President play a major role in the interdepartmental coordination of health activities within the executive branch.

The Bureau of the Budget assists the President in carrying out his responsibilities for overall management of the executive branch and

This matter is under review at the moment and discussions are underway between us, the Veterans' Administration, and the HEW. The reason why the Veterans' Administration is involved is that they have the largest and most widely distributed hospital system available for the purpose.

Mr. ROBERTS. Up until the ruling by the Solicitor to the effect that if the owner-operators were not covered this care had been extended, I believe, since about, say, 1804.

Mr. STAATS. It started originally in 1798 and, I believe, the hospital system itself was set up in 1894. It is a very old program.

Mr. ROBERTS. I was interested. Not so long ago there was a statement that had been provided me by Mr. Spal, who recently passed away, one of our very valuable staff members, to the effect that President Adams had advocated this care and it was one of the first basic factors in the jurisdiction of this Committee on Interstate and Foreign Commerce.

It was really the thing, I think, that started us in the field of health. It was very interesting to me, this being one of the oldest committees of Congress, that this is the one of the things he gave us, health jurisdiction.

All right, sir.

Mr. STAATS. Funds for health training, including grants and direct Federal outlays, also represent a crucial and growing area of expenditures, totaling nearly $360 million in 1964.

While HEW has the preponderant share, the Department of Stateincluding AID and the Peace Corps-the Department of Agriculture, and the Department of Defense spend significant amounts for training.

Finally, the Federal Government in 1964 will devote nearly $700 million for construction of health facilities, excluding those for research purposes. Roughly half of this will be spent by agencies other than those of the Department of Health, Education, and Welfare.

In summary, chart II indicates that the VA and the Department of Defense have the major portion of the direct federally operated, patient-care activities among the Federal agencies.

In contrast, HEW looms large in all the other five categories of expenditure. The Department's proportion is particularly large in the training, research, and preventive and community service health

programs.

The trend in obligations by type of program for the 3 years 1962-64 is shown in table B in the special analysis, which shows the total figures for each category and separately for HEW and for all other agencies.

For HEW all categories except patient-care services are increasing at a substantial rate. For other agencies as a group some categories are increasing while others are declining.

Table C classifies the obligations for 1964 for each agency by category. Data for all 3 years for each of the principal agencies are also included in the special analysis.

I would like to turn, Mr. Chairman, to the discussion of organization and coordination of Federal health activities.

It is evident that the mission related character of the health programs operated by the various Federal agencies strongly influence the organization of health activities in the executive branch.

For many of the Federal agencies the health or health-related programs are only a means of carrying out another governmental function.

The Armed Forces must have healthy personnel; and under recent legislation the civil agencies of the Federal Government help their employees to obtain prepaid health care.

As part of its responsibilities to veterans, the VA provides hospital and health care services. The international agencies carry on health aid programs to achieve their economic development or military assistance objectives.

In contrast, it is largely in HEW, notably in the Public Health Service, that health is viewed as a primary mission. In the Public Health Service, the input of resources is devoted largely to basic health resource development-through research, training of personnel in shortage categories, and construction of community health facilitiesor to the strengthening of broad preventive and community public health capabilities.

A large part of these HEW funds is disbursed through grants-inaid to States and localities, unlike those in most of the other agencies. HEW also makes large amounts of grants to universities and to individuals for research purposes.

Although the health and health-related activities within the executive branch are numerous and diverse, our survey indicates that there is a remarkable amount of interchange of information and coordination among the various agencies, both through day-to-day working arrangements and through more formal devices such as contractual arrangements and interagency committees.

To cite some examples: The Department of Defense and its constituent units are represented on 20 boards, committees, and similar organizations functioning in the health field on which HEW is also represented.

The Department of Agriculture is included in at least eight committees or interagency groups in which HEW participates. Veterans' Administration personnel are members of 27 NIH national advisory councils and study sections and VA is also represented on a number of interagency committees.

AEC is represented with HEW on such significant groups as the Federal Council for Science and Technology, the Federal Radiation Council, and on the National Committee on Radiation Protection. Extensive interagency relationships have been established between the Agency for International Development and HEW.

These include memberships on interagency committees, bilateral contractual arrangements for technical consultation, support and training services, and various other joint project agreements.

Some 76 Public Health Service people have been loaned to AID. Day-to-day consultations between the two agencies run the gamut from the policy to the operating levels.

Several agencies in the Executive Office of the President play a major role in the interdepartmental coordination of health activities within the executive branch.

The Bureau of the Budget assists the President in carrying out his responsibilities for overall management of the executive branch and

« PreviousContinue »