I just want to put that on the record, because I think it ought to be brought out here that what we get in the way of landslide testimony here is a selling job and snow job claiming that something can be done immediately. Mr. SKUBITZ. Mr. Chairman, will my colleague yield? Mr. SPRINGER. Yes. Mr. SKUBITZ. Was $320 million authorized and $320 million appropriated? Mr. SPRINGER. Fifty-nine and 200. Mr. SKUBITZ. But how much money was appropriated? Mr. SPRINGER. $85,200,000. Mr. SKUBITZ. That is all they spent. How could they spend any more if more wasn't authorized? Mr. SPRINGER. The fact is they didn't spend all that was appropriated. They appropriated more than $85 million. Thank you, Mr. Chairman. Mr. ROGERS. Thank you. I do think it might be brought out at this point that I would commend the administration of the program in the fact that they haven't just gone out and spent money. So I think this is rather commendable, that they have held up some 8 million on last year because they felt they were not at a stage to spend it. So this is commendable, and I would want to put that on the record, too, that we don't want them, just because we may authorize something on it may be appropriated, that expect them to go out and spend it unless they are at that point where it could be done effectively. So I think whether we reach goals that we may have set is not necessarily the determination on the spending of the money. We want to make sure that it is appropriately spent and even though the goals may have been set above that. So I think the administration of it has not been in error in that regard. Dr. RUHE. May I comment on that? I think we would support this fact. We have been reassured and encouraged by the way this program has been administered. I think in defense of the program, one thing can be said, that in the early stages, very careful attention has been given to the planning and the preparation for the operational stage of the program. This has been one of the things which has kept the expenditures down at the present time. But as the program gets moving into the operational phases, I think it is reasonable to expect that the costs would increase greatly. We feel that the program has been administered very well, and with restraint and good judgment. Mr. ROGERS. Thank you. Mr. SKUBITZ. That brings me back to the question I raised a few moments ago, the necessity of limiting these authorizations and having the agencies come back and present their case and prove their point. If we authorize for 3 years, they don't have to come back. From that moment on they go before the Appropriations Committee Mr. ROGERS. This is right. Dr. RUHE. There is one problem in that, if I may. That is, from the standpoint of the region which is attempting to recruit personnel, if there is any question whether the program is going to be continued for the indefinite future, it would be extremely difficult to get good people to change their careers and come into this program. Mr. SKUBITZ. Doctor, you sound like a Government bureaucrat. We hear the same statement time and again we must have a 3- or 4-year program, or we can't get the people. But for some reason, the Government has no trouble hiring people. Mr. ROGERS. It may be the doctor is looking at what happened to the Congress on only a 2-year contract, and he is disappointed. [Laughter.] Mr. HARRISON. I would like to comment on Mr. Skubitz' question, The association would generally support, if it was the committee's good judgment, an authorization for a single year which would require the program people to come back and give the committee an opportuntiy to examine the program again. If that was your judgement, and we would support that movement. Mr. SKUBITZ. You had better stay with the chairman. I am the low man on the totem pole. [Laughter.] Mr. ROGERS. As a matter of fact, Mr. Skubitz, you might be interested to know that we did a special study on HEW and recommended yearly authorizations. Mr. SKUBITZ. I am glad to hear that. Mr. ROGERS. We haven't been able to move it in committee yet. Mr. ROGERS. Our next witness is Dr. William Likoff, immediate past president, American College of Cardiology, from Bethesda, Md. We are very pleased to have you with us, Dr. Likoff. STATEMENT OF WILLIAM LIKOFF, M.D., IMMEDIATE PAST PRESIDENT, AMERICAN COLLEGE OF CARDIOLOGY; ACCOMPANIED BY WILLIAM D. NELLIGAN, EXECUTIVE DIRECTOR Dr. LIKOFF. I am pleased to introduce William Nelligan, executive director of the college. I appreciate the privilege of appearing before this committee to present the views of the American College of Cardiology regarding bill H.R. 15758. The goals and philosophy of Public Law 89-239, the progress recorded by the regional medical program during its short life and the future promises embodied in this endeavor are pertinent to your current considerations and, therefore, prompt this testimony. Medical science in this country is favored by superb talent, competence, and abundant resources. This committee, however, is particularly aware that the distribution of these assets, specifically in terms of patient care, is shamefully uneven. The basic goal of Public Law 89-239, the authority for the regional medical program, is to bridge this unequal gap between science and service and to provide an efficient health care system which will assure the transmission of the best in scientific knowledge to all people of this country suffering from heart disease, cancer, and stroke, or struggling to avoid these catastrophies. The concept regulating the regional medical program is remarkably simple and in the best tradition of this country's genius for effective action. It holds that modern medical advances can be made available to all people when needs are identified at a regional level by individuals involved in regional affairs and when available resources and manpower are properly exploited through cooperative arrangements linking discovery with learning and application. Critical analysis of the activities of the regional medical program uncovers an unusual record of accomplishment toward that goal over a relatively short period of time. Federal funds have stimulated the planning for a health care system in approximately 50 regions encompassing about 90 percent of this country's population. Operational programs have been activated in 11 additional regions. Solicitations for planning and operational grants for areas not yet involved are being constantly prepared and reviewed. The speed with which Public Law 89-239 has exercised its impact and the wide area of its maturing influence is most impressive almost denying the complexities of establishing a new administering organization and staff within the Public Health Service and the difficulties in assembling for planning and action representatives of diverse scientific and consumer groups in a myriad of local communities. The first dynamic engagements with the problems of organization, defining regional needs in health care and interrelating local resources for their correction have revealed a number of specific facts. Those who have worked in the field developing a program for a specific region, almost without exception sense that institutions and men representing medical, paramedical, and consumer interests welcome the challenge and opportunity to serve. They are applying themselves unstintingly to the search for sound administrative structures and for effective voluntary cooperative arrangements which will assure the success of the program. They share a positive view about the likelihood of obliterating the void now separating the conversion of knowledge to service. They appreciate local needs and they are creative in their plans to meet them. From early experience it also appears that the funding provisions of the act are adequate and that the Public Health Service is awarding these funds judiciously and in keeping with the needs and sophistication of the applications from the petitioning regions. However, and in contrast to some of the statements made to this point, the community is extremely sensitive to the limitations imposed by the fact that the program has not been established on a continuing basis. The paradox of contesting with long-term needs and long-range objectives under the umbrella of a short-term act is uncomprehensible. It impairs the harnessing of manpower; it constricts programs to the immediate; dedication is diminished; promise is aborted; potential threatened. In a frank acknowledgement of clear fact, Public Law 89239 has evoked the type of robust response that deserves the assurance of continuing support and inclusion of logical areas of involvement not heretofore embraced. At least a portion of these are recognized in H.R. 15758. Certainly the provisions to involve areas outside of the 50 States is consistent with our traditional obligations; those improving implementation through interregional cooperative, those seeking involvement of Federal hospitals and providing for construction funds are necessary logistically and functionally. The American College of Cardiology enthusiastically endorses the objectives and philosophy of the regional medical program because they embrace an unchallenged need and seek to use forces which require only release and coordination. We support the planning and operation of every regional program where we possess manpower and resources. The college is certain the program will elevate the health of the Nation. It pleads for a favorable action on bill H.R. 15758. This amendment to the Public Health Service Act extends and expands the medical regional program to a new and amplified potential and hopefully to the status of the most distinguished medical program conceived in our time. I am grateful for the opportunity of expressing these views. Mr. ROGERS. Thank you very much, Doctor. We appreciate your testimony. Did your associate have any statement? Mr. NELLIGAN. No, sir. Mr. ROGERS. Doctor Carter. Mr. ROGERS. I might say that the committee, in adopting a 3-year program rather than a 5- or 10-year program, feels that this is one way for this committee to carry out its responsibilities to the Congress and the American people, because otherwise we have no review of the program. Dr. LIKOFF. I understand that philosophy, Mr. Chairman, but I do wish to tell the committee, and particularly Mr. Skubitz, that we in the field have found it difficult to construct long-range, vital organizational programs and planning in view of the uncertainty from time to time of the funding required to support these ventures. Something we plan for a decade ahead cannot be accomplished on 2-year appropriations. How you get Government workers under these conditions, I don't know. We are having difficulty. Mr. ROGERS. I am sure it would be desirable to set programs for as much time as we wanted with as much money as was wanted, but we have to equate the economy of the Nation. But this is the committee's function, and that is what we will do. We are grateful for your testimony in support of this legislation. It will be helpful to us in our consideration. Our next witness is Dr. Clark Millikan, of the Mayo Clinic, who will appear and give testimony for the American Heart Association, Inc. Dr. Millikan, we are delighted to have you here, and will be pleased to have your testimony. If you would like to put your statement in the record and just sum up for us, it would be acceptable, or if you prefer, read it. STATEMENT OF DR. CLARK MILLIKAN, CHAIRMAN, COUNCIL ON CEREBROVASCULAR DISEASE, AMERICAN HEART ASSOCIATION Dr. MILLIKAN. Mr. Rogers and members of the subcommittee, it is not only an honor, but a responsibility, to take part in the construc tion of the continuing legislation. I would prefer, actually, to just make some comments. Mr. ROGERS. That will be done. Without objection, Dr. Millikan's statement will be placed as part of the record following his remarks. Dr. MILLIKAN. I represent the American Heart Association, being chairman of the association's council on cerebrovascular disease. This program has turned out to be a unique opportunity and a practical, recognizable entity for cooperative and collaborative arrangements, not only between the university centers and practicing physicians but between government and nongovernment agencies and personnel. The Heart Association, for instance, has taken an extraordinarily active part all over the Nation, not only at the level of regional advísory committees but in smaller community affairs. Last week there was a meeting in New York at which over 400 volunteers were present, and one of the firm decisions arrived at at that meeting was to encourage further the participation of Heart Association personnel, which can bring a great deal to the implementation and the purposes of the past bill and the new bill. This exemplifies the kind of feeling and the loyalty, for instance, that is being generated by the very wise provisions of this act, and we heartily endorse the continuation of these basic principles, including the business of originating ideas at the local level and having administration remain at the local level. Commenting about the matter of the finances, $65 million is a suggestion for fiscal 1969, and as is brought out, there is to be some holdover. You are aware that there are now actually about 11 operational programs, and within the next few months there will be a total of 30 to 35 operational programs. It is extraordinarily important to consider that we are thinking in terms of a graph of continuity here. And as this program develops effectively, gaining momentum, it is mandatory that we not put a fence in front of it at any point in time with the attendant loss, in possible instances, of personnel. This whole program relates to people, whether at the administrative end or the practicing physician end, or at the patient end. And if we do something which cuts back the momentum in the year 1968 to 1969, we have lost more than 1 year of progress, and so I would emphasize the need for the continuity of fiscal support for this whole business. Now, on the matter of construction money, that has come up in reference to the new bill. It would seem highly important that there be authorization for this. As Dr. DeBakey mentioned and Dr. Farber added, there are areas of activity for which new construction funds will undoubtedly be necessary at the level of 2, 3, or 4 years from now, which should be evaluated at that point in time. It does not need to be done now in terms of assigning an amount of money. But it should be looked at precisely later on. But the cardiac intensive care unit, or a stroke unit, or a matrix which requires space that is not the issue at the moment. But for adequate planning in the future there should be the authorization |