Senator DONNELL. Yes. Miss LENROOT. That is, on page 3, the section concerning the factors of allotment. You will note that item 3 speaks of the financial need for, the State for assistance in carrying out the State plan. Senator DONNELL. Yes, ma'am. Miss LENROOT. This B fund, as we call it, because it is under paragraph (b) Senator DONNELL. Yes. Miss LENROOT (continuing). Does not require matching, but the third item, the financial need of the State for assistance in carrying out the State plan, assumes that in alloting the money consideration would be given to the extent to which States were able to pay out of their own resources for some part of the program, and that actually a State's financial contribution might be considerably in excess of the $5,000,000, which they were oblighted to match. Senator DONNELL. Thank you, Miss Lenroot. Senator PEPPER. Just one or two questions, Miss Lenroot. It is your experience, is it, that the funds that are presently available for maternal and child-welfare programs in the country are grossly inadequate to meet the need? Miss LENROOT. It is, Senator Pepper. Senator PEPPER. And you feel that the failure to provide adequate funds for the various services that are contemplated in this bill very detrimentally affect the public interest? Miss LENROOT. I do. Senator PEPPER. In terms of the lives and health and usefulness of the mothers and children? Miss LENROOT. That is correct. Senator PEPPER. And you found that the EMIC program that was in progress during the war rendered a great public benefit, did you, by experience? Miss LENROOT. I believe it did. Senator PEPPER. Although it was limited to certain grades of servicemen, nevertheless there was no means test applied in the case of an individual mother or a child? Miss LENROOT. No. Senator PEPPER. And for the reasons you have given you feel it unwise to provide a means test in these programs? Miss LENROOT. Yes, I do. Senator PEPPER. Recognizing, I am sure, and seeing the extreme difficulty of drawing a line that will define a fair means test? Miss LENROOT. Yes. Senator PEPPER. And that if you do try to draw one, because of the difficulty in defining it, the net effect is that mothers and children who should get medical and other care provided in this bill, do not get it? Miss LENROOT. That is correct. Senator PEPPER. And it is better, if we must err, to err on the side of saving lives and health and usefulness of mothers and children rather than saving dollars? Miss LENROOT. It seems to me so. Senator PEPPER. Now, Miss Lenroot, yesterday a question was raised as to whether this program will cost too much. Do you consider it is a question as to whether we spend mothers and children or whether we spend dollars? Miss LENROOT. I do, Senator Pepper. I think that nothing can be more important to our Nation and ultimately to its economic stability and its capacity and ability to take its place in the order of world affairs than the physical and mental health of its population. I regard physical and mental health and education as two essentials, and I do not believe that the amount that would be required at a maximum to support these services, after they were fully developed, would be too much of a drain on our resources. I think that the benefits in human happiness and usefulness, even measured by an economic yardstick would be exceedingly worthwhile. Senator PEPPER. Is it your belief, out of your knowledge and experience in this field, that if we had had an adequate child-health and welfare program in this country, say, for the last quarter of a century, that a great many men who were found by Selective Service unqualified to serve their country in the war would have been eligible for service? Miss LENROOT. Unquestionably a very great number of them. Senator PEPPER. And do you feel if we had had such a program in effect for the last quarter of a century that it would not have been necessary for the Government to spend a lot of money and use a lot of personnel and so on in correcting many defects in the men it did accept in the armed forces? Miss LENROOT. That is right. Furthermore, it would not have been necessary to take as many fathers of young children and disrupt as many homes as we had to under Selective Service if a larger proportion of our young single men had been in good physical condition. Senator PEPPER. This program would, for example, allow for the inspection of the health of all school children? Miss LENROOT. That is right. Senator PEPPER. If a school child needed dental care the dental care would be provided? Miss LENROOT. That is correct. Senator PEPPER. If it needed eye care, the correction of eye strains and so on, that would become possible for the child? If the child had a tendency toward some physical weakness, whatever could be done to eliminate that would be done? If a child has some abnormality that required an operation in order to correct it, instead of the defect beoing continued through life whatever could be done to correct that defect would be done? Miss LENROOT. Yes. Senator PEPPER. And in that way the country thus would gain greatly in the increased productivity of a healthier citizenry than it would if such corrections were not made? Miss LENROOT. Yes; surely so. Senator PEPPER. You do not regard this as an expenditure that is extravagant, but an investment in not only lives and in health, but in the greater economic productivity of the coming generation of this country? Miss LENROOT. That is correct, Senator. Senator PEPPER. Just one other question, Miss Lenroot. You in no sense of the word are opposing the President's reorganization plan? Miss LENROOT. I am not. Senator PEPPER. Or trying to obstruct it in any way? Miss LENROOT. No. Senator PEPPER. You feel, however, that if it is deemed wise by the President and Congress that the Children's Bureau should be located in the Federal Security Agency instead of the Department of Labor where it is now, that it is still not only possible but proper that the Children's Bureau should be retained as an entity? Miss LENROOT. That is correct. Senator PEPPER. And that it should be given the principal responsibility for the planning and administration of the program within that agency that would have to do with children and especially with mothers in the period of childbirth? Miss LENROOT. That is my opinion, Senator Pepper. I would like to say, however, that I think there are great possibilities for the fiscal and administrative drawing together of the various aspects of these programs under section 10 of the reorganization plan without invalidating the responsibility for continuation of the program leadership and standards-responsibility for the content of the programwhich I think should be retained in an organization dealing with all aspects of child welfare. Senator PEPPER. Dr. Eliot. You are Dr. Martha Eliot, Assistant Chief of the Children's Bureau, Department of Labor? Dr. ELIOT. Yes, Senator Pepper. STATEMENT OF DR. ELIOT, ASSISTANT CHIEF OF THE CHILDREN'S BUREAU, DEPARTMENT OF LABOR Senator PEPPER. Dr. Eliot, how long have you been with the Children's Bureau? Dr. ELIOT. I have been with the Children's Bureau since 1924. Senator PEPPER. Since 1924; and would you give us just a sketch of your background? Dr. ELIOT. Well, I am a graduate of the Johns Hopkins Medical School. After that I had some 42 years' experience in hospitals. The first year of experience was in general medicine in the Peter Brent Brigham Hospital in Boston. Following that I went to St. Louis, where I was assistant resident in the St. Louis Children's Hospital. Following that I was 1 year in the Massachusetts General Hospital, Boston. Then I went to the New Haven Hospital, where I was resident in the pediatric service for nearly 21/2 years. Following that experience I became a member of the staff of the Children's Bureau, still having my headquarters in New Haven, Conn., where I carried on research work in the field of preventive pediatrics for the Children's Bureau and at the same time retained my position as a member of the faculty of the pediatric department of Yale School of Medicine. In 1935 I came to Washington to take up my duties as Assistant Chief of the Children's Bureau. Senator PEPPER. Thank you very much. Will you proceed with your statement, please? Dr. ELIOT. I would like to point out first, as Miss Lenroot did last, that I have not been advised whether this bill to which we are addressing ourselves today is in accord with the program of the President and therefore I am not speaking for the administration, but for myself. I am not proposing to present before this committee a full statement in support of titles I and II of S 1318 because, on May 1, 1946, I presented such a statement in support of the maternal and child-health section of the National Health Act, S. 1606, title I, part B, and at that time described the need to expand the State maternal and child-health and crippled-children's programs. I have also recently presented testimony before the subcommittee of the physically handicapped of the House Committee on Labor describing the need of children and mothers in this country for better medical service. Senator PEPPER. May I interrupt just a moment? Since we are dealing with delinquency of children, I have been handed a newspaper clipping from New York, dated June 21, United Press: A natural for any age. Moirshe Byrone was found guilty in police court tonight of disorderly conduct. Police said he was shooting craps. Byrone is 101. Now, go right ahead. Senator DONNELL. Now do you want to change the definition of a child to an age of 104? · Senator PEPPER. 104. Dr. ELIOT. However, I do want to emphasize today, as I did then, that I believe that the maternal and child-health services provided under this bill should ultimately be a part of the national health program and should be coordinated with and fitted into such a broad program when enacted. The preamble to this bill S. 1318, which Senator Pepper has proposed as an amendment, states this position, and I want to make clear my support of it. If Reorganization Plan No. 2 becomes effective, the various grants-in-aid programs will be more fully coordinated and the way will be opened for effective implementation of the purpose of Senator Pepper's preamble when the national health program becomes law. In the meantime, if S. 1318 is enacted, health services to children and maternity-care programs can be developed further in all States. The basis for such expansion exists in each of the States and Territories and in the District of Columbia through State programs developed with Federal aid under title V of the Social Security Act. I would like to submit at this point for the record a summary of the provisions of titles I and II of S. 1318, covering maternal and child-health and crippled-children's service. Senator PEPPER. It will be received. Dr. ELIOT. I think it will make the record complete if it goes in at this point. (The document referred to is as follows:) PROVISIONS OF TITLES I AND II OF THE MATERNAL AND CHILD WELFARE ACT TITLE I. MATERNAL AND CHILD HEALTH SERVICES Purpose. The purpose of this title is to enable States to provide services and facilities for (1) maternity care; (2) preventive maternal and child-health work, including mental health; (3) school health services; (4) diagnostic serv ices and care of sick children; (5) dental care of mothers and children; and (6) correction of defects and conditions likely to interfere with the normal growth and development and the educational progress of children. Each State will develop its own plan for expanding services over a 10-year period, including demonstrations and the training of personnel (sec. 101). Conditions for approval of State plans.-The Chief of the Children's Bureau is required to approve any State plan which meets the conditions specified in the act. These include: 1. The State health agency shall administer or supervise the administration of the State plan. The plan must be coordinated with the agency's general public-health and medical-care program. 2. The services and facilities provided shall be available to all mothers and children who elect to use them. There must be no discrimination because of race, creed, color, or national origin, and no residence requirements. 3. There shall be such methods of administration as are necessary for the proper and efficient operation of the State plan, including-(a) personnel standards on a merit basis; (b) standards for professional personnel rendering service, and for hospital and other institutional care and services, to be developed by the State agency in consultation with professional advisory committees; (c) free choice of physician, hospital, clinic, or health service agency meeting such standards, and the right of physicians, hospitals, or clinics to refuse to accept cases; (d) maintenance of high quality of care by providing for adequate compensation for persons and institutions giving care, providing opportunity for postgraduate training for professional and technical personnel, and by the satisfactory distribution and coordination of preventive, diagnostic, consultative, and curative services; (e) payment to physicians on a per capita salary, per case or per session basis, or in the case of consultations or emergency visits on a fee-for-service basis, and purchase of care from public or voluntary hospitals or other health-service agencies included in the State plan on a basis related to the cost of providing such care. 4. There shall be opportunity for fair hearing before the State health agency for beneficiaries of the program, as well as those furnishing services, on matters affecting their interests. 5. There shall be financial participation by the State, provision for dissemination of information regarding the services and facilities available under this title, and cooperation with medical, health, hospital, nursing, education, and welfare groups and organizations in the State. There shall also be provision for State general and technical advisory groups (sec. 103). 6. A State plan adequate to carry out these purposes must be in effect in all political subdivisions of the State by July 1, 1955. Financing.-$50,000,000 is authorized to be appropriated for the fiscal year ending June 30, 1946, and for each year thereafter a sum sufficient to carry out the purposes of the title. Such part of $5,000,000 is to be allotted to each State as the number of children under 21 years of age in such State bears to the total number of children under 21 years of age in the United States. This amount is to be matched dollar for dollar by the State. The remaining amount of the sum appropriated each year is to be allotted taking into consideration such factors as (1) the number of mothers and children under 21 years of age in the State for whom the service and care are to be made available and the cost of furnishing such services and care to them, (2) the special problems of maternal and child health, and (3) the financial need of the State for assistance in carrying out the State plan (secs. 101, 102, 104). Federal advisory committee.-In formulating the general policies for administration, the Chief of the Children's Bureau is directed to consult with (1) a conference of State health officials, and (2) an advisory committee composed of professional and public members, and, as necessary, technical advisory committees, which he would appoint (sec. 105). TITLE II. SERVICES FOR CRIPPLED CHILDREN Purpose. The purpose of this title is to enable States to provide services and facilities for the care and treatment of children who are crippled, otherwise physically handicapped, or suffering from conditions which lead to crippling or physical handicaps. Each State will develop its own plan for expanding services over a 10-year period, including demonstrations and the training of personnel (sec. 101). Conditions for approval of State plans.-These are in general the same as those under title I, except that prior to July 1, 1951, administration or supervision may |