activities-teaching, medical service, and research-and that all three must be supported if the health needs of this Nation are to keep pace with its dynamic growth and ever-increasing demands. So grave is the need that it would seems that our colleagues in the House and Senate cannot fail to act upon the measures which have been so long delayed. The time for deliberation-the need for deliberation-has passed, but, regrettably, the legislation has not. Two Congresses have passed into history, but the specter of total breakdown in application of health knowledge looms ever larger. I urge everyone in this chamber to unite in an effort to get this Congress to act on these vital matters-we must not betray the American public; we cannot evade our responsibility.

Mr. ROBERTS. Thank you for your appearance and testimony, Mr. Fogarty.

Mr. FOGARTY. Thank you, Mr. Chairman.

Mr. ROBERTS. The next witness is our colleague from Florida, Hon. Charles E. Bennett, who has introduced H.R. 180. Mr. Bennett, we will be glad to hear you at this time.

STATEMENT OF HON. CHARLES E. BENNETT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA

Mr. BENNETT. Mr. Chairman, thank you for this opportunity to testify on the Health Professions Educational Assistance Act of 1963, which I was happy to join in introducing (H.R. 180). This committee, I believe, has done excellent work in pointing up the urgent need for increased numbers of doctors and health personnel in this country, so I will not add to the many statistics that have already demonstrated this ever-growing problem. I would, however, like to add that, in my work on the Armed Services Committee, it has been apparent for some time that this national problem also affects our military mission in that procurement of adequate doctors for the services has become very difficult. It was to alleviate this difficulty that I introduced H.R. 67 in the 84th Congress to provide for Armed Forces medical scholarships. However, if the capacity of medical schools is not increased, benefits from a scholarship program are very limited. The very security of our country therefore requires that we tackle the whole problem as soon as possible.

The approach of H.R. 12, the chairman's bill, H.R. 180, and other identical proposals is doubly helpful, I believe, in that the smaller, less affluent, medical schools can greatly increase their capacity. These schools in many cases may be persuaded to concentrate on preparing graduates for practice in rural and semirural areas where the need is most critical. However, it takes time to bring about an increase in doctors, even if we act quickly to provide Federal Assistance. The Association of American Medical Colleges points out that it takes 6 to 10 years to develop a medical school and 5 to 9 years after college to complete a medical education. In spite of this they warn that 3,500 additional physicians will be needed each year by 1975.

I want to commend the committee on their early attention to this urgent problem in this Congress. I am in hopes that our other colleagues will join also in securing this Federal assistance that should no longer be delayed.

Mr. ROBERTS. Are there any questions? If not, we thank you for your appearance and testimony, Mr. Bennett.

Mr. BENNETT. Thank you, Mr. Chairman.

Mr. ROBERTS. The next witness is our colleague from New Mexico, Hon. Joseph M. Montoya. Mr. Montoya.

STATEMENT OF HON. JOSEPH M. MONTOYA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW MEXICO

Mr. MONTOYA. Thank you, Mr. Chairman, for this opportunity to present my statement in support of H.R. 12, the Health Professional Educational Assistance Act of 1963.

The need for this legislation is great, and the introduction of H.R. 12 in the 88th Congress and the hearings which your committee is holding is a recognition of this need.

If we are to reverse the declining percentage ratio between doctors, dentists, and patients, we must enact legislation granting assistance to colleges and universities as well as scholarships to worthy qualified young people wishing to enter these professions. The President, in his state-of-the-Union message, stated that over the next 10 years we must increase the capacity of our medical schools by 50 percent and our dental schools by 100 percent.

I earnestly believe that unless the facilities and the opportunities for medical, dental, and professional health personnel education are expanded to keep up with our population growth, the limited capacity of our professional schools will not provide the number of doctors, dentists, and nurses necessary to give our citizenry the medical and dental care they need to maintain health. We must insure that such treatment is made readily available to our people by educating enough physicians, dentists, and nurses to get the job done. The security and integrity of our Nation are more dependent upon our people's health than upon any other single factor. We cannot afford to neglect this obligation.

Many young people today are unable to enter the medical profession because their financial resources are limited. Those who do enter this profession have to devote a number of hours each week during the academic year to outside work in order to earn funds for their educational needs. This time should be spent in mastering the knowledge with which they are confronted in order that they may become well qualified as physicians, dentists, or nurses. The scholarship section of this bill is vitally important since we must increase the number of qualified applicants to schools of medicine, dentistry, and nursing.

In the State of New Mexico we have neither a medical school nor a dental college. This situation exists in a State with a population of over 1 million people. I think you can easily recognize the great need of my State for the establishment of schools of medicine and dentistry. The University of New Mexico is taking the necessary steps to develop a School of Medicine, and should this bill be enacted, the university would be eligible for matching funds under the act. The University of New Mexico is among the first institutions to plan and deve new medical school in response to the Surgeon General's expression of the Nation's need. The new school will be

the health agencies in the State, and its teaching

and research programs will be of national and conceivably international significance.

As you see, we have an immediate need throughout the Nation for the initiation of the programs outlined in H.R. 12, and it is my sincere hope that this legislation will be favorably acted upon. Thank you. Mr. ROBERTS. Are there any questions? If not, we appreciate your testimony, Mr. Montoya.

Mr. MONTOYA. Thank you, Mr. Chairman.

Mr. ROBERTS. The next witness is our colleague, Hon. Jeffery Cohelan of California. Mr. Cohelan.

STATEMENT OF HON. JEFFERY COHELAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA

Mr. COHELAN. Mr. Chairman, I appreciate this opportunity to indicate my strong support for H.R. 12-the Health Professional Educational Assistance Act-and urge that it be approved by the committee, and passed by the Congress without delay.

The need for this legislation-for the Federal Government to cooperate with the States and private medical institutions to increase the supply of trained health manpower-is well known to this committee. During the last few decades, we have made exciting discoveries and advances in medical science. Today, for example, we are able to prevent or cure diseases that were the scourge of previous generations. Today, by the techniques of modern surgery, we are able to save countless lives for which previously there was no hope.

Yet, none of this knowledge, none of these advances, and none of these skills can truly be profitable to us until we have an adequate supply of well-trained medical personnel. Todav, unfortunately, that supply does not exist, and the carefully documented statements and studies which have been presented to this committee indicate clearly that the problem will grow more acute in the near future, unless prompt action is taken.

As the President indicated in his health message to Congress this year, and as this committee recognized last year in its report to accompany H.R. 4999, merely to maintain the present ratio of health personnel to an ever-expanding population will require a substantial expansion of our training facilities-an expansion which will, over the next 10 years, increase medical school admissions by 50 percent, double the number of dental graduates, and increase nursing personnel by 25 percent.

My own State of California presents, I believe, a good example of this problem. We now have a population of approximately 171⁄2 million persons--a population which is swelled every day through outof-State migration by 2,000. From this daily influx of 2,000 comes 80 percent of the new physicians which California licenses every year. Yet, despite this sizable number—a number which of course depletes the supply in other areas of our country-we are unable to maintain even the present ratio of physicians to population.

In California, to meet our own needs alone, we must, in the next decade, double the number of medical and dental students. Last fall, California's medical schools-both public and private-admitted 484 freshmen. By 1972, this figure must be in excess of 900 just to maintain the present ratio.

California is making a substantial and a determined effort on its own behalf to meet this requirement. This year, almost $500,000 of the State's budget has been earmarked for higher education, with a small, but a vital part for medical education. Two public bond issues have been proposed and accepted by the people to expand educational facilities. Steps are being taken to enlarge the State's two public medical schools and to inaugurate a third. The private schools are struggling against increasingly rising costs, to maintain their present student levels, and they have indicated their willingness to expand opportunities for admission if new funds can be found.

But these efforts by California alone will not be enough, particularly if we are to ease our present heavy drain on the health personnel of other States, and if the United States is to lessen its drain on the health manpower of other countries.

The Federal matching assistance provided in H.R. 12 would provide an urgently needed supplement to the demonstrated efforts of California. It would go far toward meeting our Nation's critical health manpower requirements, and in promoting the welfare of this and future generations of Americans.

Mr. ROBERTS. Are there any questions? If not, we thank you for your appearance, Mr. Cohelan.

Mr. COHELAN. Thank you, Mr. Chairman.

Mr. ROBERTS. Our next witness is Mr. Clinton Fair, who will appear in place of Mr. Andrew J. Biemiller, the Department of Legislation, AFL-CIO.

I believe he is to be accompanied by Miss Lisbeth Bamberger, assistant director of the AFL-CIO Department of Social Security.

STATEMENT OF CLINTON FAIR, LEGISLATIVE REPRESENTATIVE, AFL-CIO, ACCOMPANIED BY LISBETH BAMBERGER, ASSISTANT DIRECTOR, AFL-CIO DEPARTMENT OF SOCIAL SECURITY

Mr. FAIR. Mr. Chairman, my name is Clinton Fair, a legislative representative from the AFL-CIO. I am accompanied by Miss Lisbeth Bamberger, assistant director of our social security department.

I am sorry Mr. Biemiller cannot be present. He enjoys appearing before this committee, because he is specifically interested in the subject before you, but more than that, he has a number of friends on the committee.

We come before you today because there is a doctor shortage in America that is growing steadily worse-a doctor shortage that cannot be dealt with effectively unless the Congress of the United States enacts legislation now to provide Federal assistance to medical schools and medical students.

The problem is that simple and that urgent.

We shall not repeat the testimony we presented to this committee during the last session. It can be found on pages 433 to 438 of the published hearings.

It is clear from the committee's report that the majority of the members are as convinced as we are of the acute need for additional health personnel. It is clear that the majority of the members of this Committee came to the same conclusion we have reached-that this

need cannot be met without the Federal assistance as proposed in H.R. 12, introduced by the distinguished chairman of this committee. Perhaps we can be of greatest assistant to this committee by avoiding the temptation of reviewing once more the massive evidence of the necessity for the passage of this legislation at the earliest possible time. Rather, let me simply assure you of the AFL-CIO's strong and firm support of your endeavors to secure prompt and favorable action on the bill before you now.

The doctor shortage is more than a phase of our 132 million members. They, like other parents and family breadwinners in communities all over the country, are up against the problems created by the doctor shortage every day of their lives. Their convictions about this problem were forcefully expressed at the most recent AFL-CIO convention, when the delegates unanimously adopted a resolution reiterating the concern of our members with the physician shortage, and characterizing the training of additional health personnel as "among the most pressing of America's health needs."

I should like to make one specific comment on the provision in H.R. 12 for student loans. We believe a scholarship program would be preferable. We believe, further, that if a loan program with a forgiveness feature is to be substituted, authority should be provided for 100 percent forgiveness rather than only 50 percent. Otherwise, talented young people from the lower income groups will continue to be excluded from the possibility of medical training.

Provision for 100 percent forgiveness in some loans could be achieved by increasing the rate of forgiveness from 10 to 20 percent a year or by some other method the committee may find effective in encouraging trained personnel to serve in capacities where monetary remuneration has traditionally been relatively low, including service with a governmental or other nonprofit agency, or in geographical areas of need.

To return to the bill as a whole, the need for legislation to provide Federal assistance to medical, dental, and public health education is so compelling, so well-documented, and so immense that it is impossible to justify a single further day of hesitation or delay.

We therefore congratulate your committee on its prompt calling of these hearings, and we hope that not only this committee but the entire Congress will act with a sense of urgency to make sure that when this session of the 88th Congress is over, programs will be underway to deal with a problem which is so steadily increasing in severity.

Mr. Chairman, the chairman of this committee, I think, reliably reports a feeling in this country that sometimes we extend our programs too long.

But with regard to the construction part of the bill, may I give my experience as a legislative secretary to a Governor? If one of our State institutions, one of our universities, is to expand a facility, it takes a look at its own total program to see what it will do. For example, there will be preparation on the part of the medical school for its program of expansion. There will be the appearance before the board of regents, followed by the university's appearance before the budget director of the State. The sale of the same program must be made to the Governor who must then balance all of his capital