Senator DONNELL. I think that is contemplated under the bill. That is to say, physicians who are permitted under the law in a particular State to practice would be the only ones who could administer the treatment.

Now, without going into the great detail of it, I want to get your idea as to what you think about the practicability and advisability of having all the children in our country, or substantially all of them, entitled to treatment from publicly employed physicians. Do you think that that is practical?

Dr. OPPENHEIMER. I do not think that the physicians are publicly employed under this. It is not my understanding. A physician happens to be paid through the Government in connection with the agreement, but he is not publicly employed. He is chosen by the patient. There is an agreement on the part of the Government to pay him for those services to that particular patient. But he is not publicly employed in the sense that I usually understand that term.

Senator DONNELL. That, of course, would be primarily more a legal question than any other as to whether there is, legally speaking, a public employment. But at any rate, the physicians would be paid by the State for the services rendered and they would be designated by the State as those who would be the physicians from whom the selection would be made.

Dr. OPPENHEIMER. I would not understand it that way, Senator. Senator DONNELL. You would not?

Dr. OPPENHEIMER. I would understand it that physicians who meet certain qualifications, such as license to practice in the particular State, or in relation to the specialists, special qualifications as to training and experience, who elect to participate in this program would do so. They would be free to do it or not, as they chose.

The State would not choose the physicians any more than under the EMIC program has there been any choice of physicians on the part of the State.

Senator DONNELL. In any event, to quote the bill: "Where no such selection is made," that is the selection by the patients, as I understand it, the child or mother of the child, "the State plan shall set forth the method by which care will be made available."

Certainly in those cases the State would determine which physicians would render the services, would they not?

Dr. OPPENHEIMER. I would interpret that to mean something like this: There are no physicians available in a particular community, let us say, or there are no physicians who wish to participate in this plan, then it will be up to the State to find a way by which the children or mothers of children can get care. That may be through providing salaried physicians who meet certain qualifications who would provide that care, it might be through a clinic and hospital service, it might be through a university, a medical school service.

It would depend upon the community and its resources and the interests, combined interests, shall I say, both of the Department which is administering the bill and the profession which would be working with them on it.

Senator DONNELL. Then as to those physicians in that case who are salaried, the salaries would be paid them by the State and it would be under a contractual relationship between the State and the physician.

Dr. OPPENHEIMER. They would be full-time physicians. It is hardly even a contract. For instance, I have on my staff full-time physicians. I have a full-time pediatrician, for instance, who functions at the crippled children's unit in connection with the crippled children's services. He is on the staff as a full-time person and functions in that way.

Senator DONNELL. He is employed by your organization?

Dr. OPPENHEIMER. Yes.

Senator DONNELL. And the physician under this particular part of the plan, covering where no selection has been made by the mother or child, would be employed by the State?

Dr. OPPENHEIMER. Yes.

Senator DONNELL. There can be no discussion on that, can there? Dr. OPPENHEIMER. No.

Senator DONNELL. What I would like to know is, I realize that you think this is a good bill and I want to get your judgment. Dr. OPPENHEIMER. The purpose of the bill is excellent.

Senator DONNELL. No doubt I think we all agree that the purpose of any bill which undertakes to provide better care for mothers and children is an admirable purpose, but there may be very serious differences of opinion as to the best way to accomplish that purpose, as we have seen evidenced here by the witnesses today.

Now, I want to get you to tell us how you think, in practice, this plan would work. Take, for instance, the State of Maryland, if every child in that State were entitled to service at the hands of a physician who was to be paid by the State of Maryland, just how do you think it would work? Do you think it would be a practical plan, or do you think there would be difficulties of administration, and do you think politics might enter into it, or do you think inefficiency might develop on the part of the physicians? Any of those subjects.

Dr. OPPENHEIMER. I think there always has to be eternal vigilance to maintain good standards of care. I think, of course, in any program, a large program of this kind, there are always administrative difficulties, particularly in the beginning, which have to be ironed out, and I think difficulties, of course, develop as you go along, but I think it is the part of the development, shall I say, of public service, that an attempt is made always to work them out in the best interests of the public and of good service.

I do not see why it should not work. I think there will be many administrative headaches to start with. I think there will be many irritations as there always are in situations of this kind. But I think if people want to make it work it could work and would work to the advantage of child health.

Senator DONNELL. Are there quite a number of countries which have plans of this sort?

Dr. OPPENHEIMER. I do not know at this time.

Senator DONNELL. You do not know what the experience elsewhere has been?

Dr. OPPENHEIMER. No; I do not.

Senator DONNELL. I think that is all.

Senator PEPPER. Dr. Oppenheimer, from your own personal experience as Director of the Bureau of Maternal and Child Welfare in the District of Columbia, are adequate funds now available for you to do

the work that you feel should be done for the mothers and children of the District?

Dr. OPPENHEIMER. Oh, no!

Senator PEPPER. What is the result of your not having adequate funds?

Dr. OPPENHEIMER. The result is that very important services which should be developed are being postponed.

Senator PEPPER. As a practical matter, does it not mean that probably more mothers die in childbirth than otherwise would, and more children die in childbirth?

Dr. OPPENHEIMER. I think that is true, and of course, likewise there is a good deal of handicap in illness and defect which is not taken care of.

Senator PEPPER. And you think that it would actually mean not only the saving of lives of mothers and children but also a diminution of the handicaps under which the mothers and children would labor if legislation of this character were adopted and funds made available?

Dr. OPPENHEIMER. I do not think there is any question about it. Senator PEPPER. Doctor, you spoke about having on your staff a full-time physician that is paid out of these public funds. Have you noticed that the quality of his medical services have been appreciably impaired because he happened to be on a full-time basis?

Dr. OPPENHEIMER. Not at all. In fact, I have a group of full-time people. I only mentioned this one person. But I have a group of full-time people on my staff at the present time.

We developed that in order to meet the war emergency. It is increasingly evident that their services are excellent, their interest is a full-time interest in the job, and it works beautifully.

That does not mean that we still do not have a desire for the services of some of the part-time people who are interested here. They bring something that is very vital and important. But in terms of basic services, basic clinic services and so on, we find that a full-time person is absolutely needed.

Senator PEPPER. Now, Dr. Oppenheimer, would you tell us just about the imposition of a means test in matters of this sort? Have you found out of your experience that they are practicable and desirable?

Dr. OPPENHEIMER. I would like to say here that I think, of course, the means test, the kind of means test that a program of this sort might necessitate, would be related to the amount of money that was available for the services. Of course, the means test is very difficult to apply with real fairness to a large number of the people who need these services, need to profit by them. I am speaking particularly now of the crippled children.

Many of these children need a very great deal of long-time care, they need a large number of very specialized kinds of treatments, and many of these children do happen to come from families of moderate incomes, and the toll on their income and the effect on their total family life, and on other children, because of the efforts of the parents to take care of these children with special problems, is often very tragic.

So that I think that the application of the means test, as usually thought of, is very difficult and often works a hardship.

The medical need, of course, is the criteria which should be used, and it is often very difficult to know what that medical need is in advance. That, of course, has been very interestingly shown to us in connection with the EMIC program. The type of care that many of the maternity patients, and the infants who have had care, have been given, many serious emergencies have arisen, and the very fact that consultation was available without question, that all of the special laboratory and X-ray and other types of examination were available without question, that hospitalization was available for as long as was necessary, that special nurses were available immediately if necessary, has been, as far as we are concerned, one of the most satisfying aspects of that program, because many people could receive the care they needed.

I would venture to say that the satisfaction that a number of the physicians who have participated have found in that aspect of the program has been a very great satisfaction. They have told me so themselves.

Senator PEPPER. In other words, Doctor, it has been your experience that it is better, on account of the difficulty of the application of the means test, to allow maybe a few people to get the benefit of such a program as this, who might without any hardship whatever be able to obtain the services otherwise, than to impose the means test on all who shall seek these services?

Dr. OPPENHEIMER. I think so. And of course, if it is necessary to impose a means test it should be a very liberal one, so that the real interests of the child can be considered in toto.

Senator PEPPER. And the public having the vital interest of the child that society always has, is, of course, vitally concerned that the parents shall not err on the side of incapacity, perhaps so that the State shall lose a citizen, or shall become a handicap which the State eventually shall have to contribute to.

Dr. OPPENHEIMER. Yes.

Senator PEPPER. Do you have any further questions, Senator Donnell?

Senator DONNELL. No, sir.

Senator PEPPER. Thank you very much, Doctor.

STATEMENT OF DR. C. WILLARD CAMALIER, AMERICAN DENTAL

ASSOCIATION

Senator PEPPER. Dr. C. Willard Camalier, American Dental Association.

Dr. CAMALIER. Senator Pepper, members of the committee, I am a local dentist, and past president of the American Dental Association, and submit this statement on behalf of the legislative committee of that organization.

Senator PEPPER. What is your address?

Dr. CAMALIER. 1726 Eye Street NW.

I think I can save the committee a little time by filing this statement for the record and then discuss the outstanding points. Senator PEPPER. Thank you.

(The statement is as follows:)

THE AMERICAN DENTAL ASSOCIATION STATEMENT PRESENTED AT THE HEARINGS ON THE PROPOSED MATERNAL AND CHILD WELFARE ACT OF 1945 (S. 1318), BEFORE THE SENATE COMMITTEE ON EDUCATION AND LABOR

(C. Willard Camalier, D. D. S., past president of the American Dental Association, and chairman of its war service and postwar planning committee)

I am Dr. C. Willard Camalier, past president of the American Dental Association and chairman of its war service and postwar planning committee. I am presenting this statement on behalf of the legislative committee of the American Dental Association, relative to S. 1318.

The American Dental Association, whose headquarters are in Chicago, has a membership of 56,000 dentists. This represents more than two-thirds of the 75,000 dentists registered in the United States. The association is comprised of 58 constituent societies in all of the 48 States, each territory and possession, the Army, the Navy, the United States Public Health Service, and the Veterans' Administration. Within the constituent societies there are 440 organized district dental societies located in all parts of our country. Each of the constituent societies annually selects delegates to attend the sessions of the house of delegates, which is the policy-making body of the American Dental Association.

During many of its sessions in past years the house of delegates of the association has given careful attention to the dental health problem in this country. As a result, a number of broad policies have been adopted by the house of delegates which the dental profession believes must form the framework for any plan designed to promote dental health.

The basic idea behind these policies is that an attack on the dental-disease problem must be made through prevention and effective dental-care programs for children. It is for this reason that the American Dental Association has a special interest in S. 1318.

The proposed bill (S. 1318) is designed apparently to make funds available to the S ates to provide medical, nursing, dental, and hospital services to all mothers and children who elect to participate in the benefits of the program. While the American Dental Association recognizes the need for an expansion of health services for mothers and children, the association does not believe that the provisions of the bill will permit the establishment of sound methods for promoting dental health. The American Dental Association, therefore, is opposed to the enactment of S. 1318 in its present form.

The American Dental Association has adopted four principles as a guide to the establishment of dental health programs. The four principles are:

1. Research: Adequate provisions should be made for research which may lead to the prevention or control of dental disease.

2. Dental health education: Dental health education should be included in all basic educational and treatment programs for children and adults.

3. Dental care: (a) Dental care should be made available to all regardless of income or geographic location. (b) Programs developed for dental care should be based on the prevention and control of dental diseases. All available resources should first be used to provide adequate dental treatment for children and to eliminate pain and infection for adults. (c) Dental health is the responsibility of the individual, the family, and the community, in that order. When this responsibility, however, is not assumed by the community, it should be assumed by the State and then by the Federal Government. The community in all cases shall determine the methods for providing service in its area.

4. In all conferences that may lead to the formation of a plan for dental research, dental health education and dental care, there should be participation by authorized representatives of the American Dental Association.

For a considerable number of years the American Dental Association has taken an active part in planning for an expansion of community dental health services that are based on the above four principles. Some progress has been made in most of the States in which dental divisions in State health departments have been established through the efforts of the component societies. However, State and community dental health programs have not been as productive as they might be owing chiefly to a lack of funds and other facilities to carry out experiments and demonstrations in methods for preventing dental disease, in educational technics, in methods of payment for dental services, and in the employment of