3. The doctors and public would not respect such a service because all Government services reak with graft and are outrageously inefficient. You should know better than I if these arguments are fair or insulting. If the former, why are we proud of our representative democracy? If the latter, why do people use them or permit their use by others? For example, the testimony which Dr. Joseph Wall submitted to this committee concerning S. 1606 and concerning S. 1318 to the Subcommittee on Aid to the Physically Handicapped of the House Committee on Labor, to which I referred in my statement before that committee, is an extraordinary reflection of a respectable and intelligent citizen's respect for his government. To acquiesce in his condemnation of your and public agencies' integrity and intelligence and his fantastic insinuations of your and their intent is not only a gross injustice to you and all the other individuals concerned but also a shocking commentary on the state of the Nation and the future promise of democracy. I am sure Ahis personal statement does not reflect the considered opinion of the American Academy of Pediatrics. I am equally sure that much of the similar testimony presented by physicians does not represent the considered opinion of the majority of American physicians. Instead, it must be a reflection of a group response to emotions aroused by the propaganda cleverly presented by leaders who dominate the group. In considering this legislation we must rely on such facts as are available. The record shows that the progress and manner of developing voluntary medical (not hospital) insurance is unpredictable. A Government medical-care program on the other hand can be carried out according to a well-devised plan, the expansion along that plan being taken step by step over a period of 10 or more years as administrative experience and personnel and medical facilities warrant. I, therefore, because of the record favor definite, carefully planned legislative insurance introduced conservatively and under the control of experienced administrative agencies, the Bureau of the Budget, the Congress, and the people instead of voluntary plans that may be run by we know not whom and give we know not what kind of service at an unpredictable cost and an unpredictable future time. Senator CLAUDE PEPPER, EXHIBIT 2 [Telegram] ROCHESTER, MINN., June 21, 1946. United States Senate, Washington, D. C.: I sincerely regret that absence of two of my associates makes it absolutely impossible for me to get away at this time. In answer to your request to submit a statement, I wish merely to point out what I consider the most fundamental section of bill S. 1318 and the one that has received the most adverse criticism from the medical profession. I refer to subsection 3, section 103, title 1, which provides that as services and facilities are furnished under the plan they shall be made available to all mothers and children in the State or locality who elect to participate in the benefits of the program and that there will be no discrimination because of race, creed, color, or national origin and no residence requirement. This is the first time that a bill has carried this broad concept of national interest in the health of children that will make available to all children the best of preventive and curative medical care. The present study of child-health services now being conducted by the American Academy of Pediatrics with the help of the Public Health Service and the Children's Bureau had as its objective to make available to all mothers and children in the United States of American all essential preventive, diagnostic, and curative medical service of high quality which, used in cooperation with the other services for children, will make this country an ideal place for children to grow into responsible citizens. This survey should show what and where personnel and facilities are needed and S. 1318 should make it possible to meet these State and local needs by Federal grants-in-aid to the States that need help. The right of every child to an education has been accepted universally for many years, but let no one suppose it did not raise tremendous opposition from the private school at the time of its introduction. Just as every American child has a right to an education, so S. 1318 states for the first time that every American child has a right to health. The idea is not entirely new. As early as 1913 the eminent pediatrician, Dr. Emmett Holt, Sr., said in an address: "We are coming to see that the child belongs to the State in respect to health also and the right of a mother to neglect her child may come to be regarded as an offense against society much as we now regard absence from school. What parents will not do voluntarily, the State will compel them to do or will step in and do for them." More recently Dr. Borden Veeder, a former president of the American Academy of Pediatrics, said in an address: "I can see no way in which the promise that if an American child is entitled to an education he is entitled to health can be refuted." The acceptance of the fundamental principle of the national interest in the health and welfare of all children places S. 1318 in the forefront of the progressive health legislation. HENRY F. HELMHOLZ. EXHIBIT 3 [Telegram] CLAUDE PEPPER, United States Senate: MARGAREE, NOVA SCOTIA, June 19, 1946. Am unable at this great distance where all data are lacking to reply to your request as you wish. In general am in favor of bill S. 1318 with certain modifications as suggested in the resolution of the Pepper bill passed at the last meeting of the Academy of Pediatrics. E. A. PARK. Hon. CLAUDE PEPPER, EXHIBIT 4 YALE UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PEDIATRICS, New Haven 4, Conn., May 23, 1946. United States Senate, Washington, D. C. MY DEAR MR. PEPPER: On March 18, 1946, I sent a letter to President Truman, a copy of which is enclosed. This letter explains my convictions upon the very important matter of preserving the Children's Bureau intact, regardless of the particular executive department in which the Bureau might be placed. Therefore, I view with grave concern the announcement of Reorganization Plan No. 2, in which it is proposed to transfer the Children's Bureau to the Federal Security Agency in such manner that the integrity and present powers of the Bureau are not safeguarded and protected. There is nothing in the proposed plan which prevents dismemberment of the Bureau; we should then have a Federal Government without a single, strong, unified organization representing and focusing all our interests and services for the children of this country. I have sent the following telegram in protest to President Truman: "Strongly urge modification of Reorganization Plan 2 regarding permissive dispersion of Children's Bureau functions. Absolutely vital to welfare of Nation's children that all activities in their behalf be integrated in one Federal organization. Request you maintain by law authority of Children's Bureau in all respects as at present including powers granted under title V of Social Security Act." I hope you will strive to have Reorganization Plan No. 2 modified in the manner I have indicated as regards the Children's Bureau. Your very truly, GROVER F. POWERS, M. D., MARCH 18, 1946. The PRESIDENT, The White House, Washington, D. 0. DEAR MR. PRESIDENT: I am writing to you concerning the Children's Bureau of the Department of Labor. For many years I have been familiar with the work of the Bureau not only in connection with my personal work as a children's physician and as a teacher of pediatrics, but also as a member of long standing of one of the advisory committees of the Children's Bureau. My view of pediatrics is that this medical specialty is concerned with the whole child. One cannot wisely assume responsibility for the treatment of sick children without being concerned with disease prevention, mental hygiene, education, and socio-economic status. This point of view the Children's Bureau, to its great credit, has always stoutly supported. In my opinion there are good reasons for retaining the relationships which the Children's Bureau shares in and with the Department of Labor. There are also good reasons-perhaps decisive at this particular time when medicalcare programs are being developed-for coordinating the Children's Bureau as an entity with the Public Health Service, the Department of Education, and kindred health and welfare services into a new executive department of Cabinet rank. The fundamental point I wish to emphasize is the importance of keeping intact the broad facilities and responsibilities of the Children's Burean as now organized-responsibilities and services which take into account all important phases of child life. I would add that because of traditional orientation, interest, and experience no agency of the Federal Government except the Children's Bureau is well equipped to administer these broad services in behalf of children. Admitting faults unavoidable in a new and wartime undertaking, the emergency maternity and infant-care program was successful in its main objective and has furnished the administrators in the Children's Bureau with a wealth of experience not possessed by any other group in this country at this time. I trust, therefore, that if a new executive department is established, the enabling order or legislation will stipulate specifically that the integrity of the Children's Bureau as now organized is to be retained. In this way there will continue to be recognition of the essentiality of an administrative unit which guards and cherishes all of the broad interests of children and serves as the channel through which these interests find national focus, expression, and action. Respectfully yours, GROVER F. POWERS, M. D., EXHIBIT 5 Hon. CLAUDE PEPPER, YALE UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PEDIATRICS, United States Senate, Washington D. C. MY DEAR MR. PEPPER: I have your telegram of June 17 inviting me to testify at the hearings on S. 1318. A previous engagement in St. Louis prevented my accepting your invitation. I wish, however, to be recorded as one of those supporting S. 1318 as an important piece of legislation furthering improvement in maternal and child health and welfare in this country. I do not believe in the application of the means test in the furtherance of medical services to women and children. I am well aware of the fact that many of my pediatric colleagues feel differently on this subject, but it seems clear to me that if we are going all-out to achieve the optimum in maternal and child care, there should be no limitations on the opportunity to receive and render service. I have already written to you specifically on the subject of the preservation of the integrity of the United States Children's Bureau. In S. 1318 it seems to me the Children's Bureau is admirably and worthily recognized as the exponent in the Federal Government of all that pertains to the health and welfare of mothers and children. This is a very strong reason for my support for S. 1318. I hope there will be favorable action on S. 1318 by the Congress at this session. I wish to express my appreciation of your strong support of the Children's Bureau and for your sponsorship of legislation for the improvement of maternal and child health and welfare. Sincerely yours, GROVER F. POWERS, M. D. Hon. CLAUDE PEPPER, EXHIBIT 6 NEW YORK UNIVERSITY, DEPARTMENT OF PEDIATRICS, New York 16, N. Y., October 30, 1945. United States Senate, Washington, D. C. DEAR SENATOR PEPPER: I appreciate your sending me the copy of your bill, S. 1318, which I have read with interest. I am in favor of it and I believe its enactment would represent a forward step in the medical care of children in this country. My one criticism of the bill is that it tends to build up public-health authority in an agency that is now quite separate from the Public Health Service. The Children's Bureau has now largely become a public-health agency. It should have been transferred from the Department of Labor to the Public Health Service some years ago. Despite the present cooperation which obtains be tween these two agencies I am convinced that the program we are both interested in could only be strengthened by combining these two agencies. Sincerely yours, L. EMMETT HOLT, JR., M. D. EXHIBIT 7 PLAINFIELD, N. J., January 14, 1946. Senator CLAUDE PEPPER, Senate Office Building, Washington, D. C. DEAR SIR: Please support maternal and child-welfare legislation at this session of Congress as embodied in Maternal and Child Welfare Act of 1945 (S. 1318) and National Health Act of 1945 (S. 1606). I hope for the inclusion of the provisions of S. 1318 in title I, section B, of S. 1606. Dr. ROBERT W. ROGERS. EXHIBIT 8 ARMY SERVICE FORCES, THIRD SERVICE COMMAND, Valley Forge General Hospital, Phoenixville, Pa., July 30, 1945. Hon. CLAUDE PEPPER, Senate Office Building, Washington, D. C. DEAR SENATOR PEPPER: Thank you for having the summary of the provisions of the proposed Maternal and Child Welfare Act of 1945 sent to me. For several years, as a member of the Advisory Committee for Services to Crippled Children, I have had the advantage of seeing the smooth-running efficiency and the excellent results of the Children's Bureau. It is gratifying to know that you are working for continuance and expansion of the work, and I shall hope to continue my association with the committee and to help in any way I can. Respectfully, JAMES B. BROWN, EXHIBIT 9 THE UNIVERSITY OF ROCHESTER, SCHOOL OF MEDICINE AND DENTISTRY AND STRONG MEMORIAL HOSPITAL, Hon. CLAUDE PEPPER, Rochester 7, N. Y., January 26, 1946. Senate Office Building, Washington, D. C. MY DEAR SENATOR PEPPER: The Senate bill 1318, a broad measure for giving health care to children, includes consideration of dental care. I should urge that this measure be supported. Very truly yours, HAROLD C. HODGE, Associate Professor of Biochemistry and Pharmacology. EXHIBIT 10 Hon. CLAUDE PEPPER, THE FAULKNER HOSPITAL, Jamaica Plain 30, Mass., November 5, 1945. The United States Senate, Washington, D. C. DEAR SENATOR PEPPER: I have your letter of October 24 with the copy of Senate bill 1318. My delay in answering has been due to the fact that I am very much interested in the subject and have taken the time to go over the bill carefully and also discuss it with others who are interested. The opinions which I give below are my own. In addition a subcommittee of the Committee of Physicians for the Improvement of Medical Care, Inc., is working on a study and criticism of the bill. I happen also to be chairman of that committee, and eventually you will receive the feelings of that committee in regard to the proposed legislation. Let me start out by saying that I am thoroughly in sympathy with this type of legislation. I am a great believer in a national health program, even to the extent of developing all at one time a program similar to that contained in the WagnerMurray-Dingell bill. I realize, however, that there is great opposition to this program and I can appreciate there may be some advantage in introducing one or more new features at a time into the delivery of medical care to the American people which might eventually be included in a national health program. S. 1318 is a splendid example of such a possibility. The success of the EMIC program during the war has made it clear that Government assistance can improve maternity service and the care of infants throughout the country, and I trust that the extension of this service into peacetime such as S. 1318 provides for will be tried out. There is always the chance that I may not have interpreted the wording of the bill correctly, but there are certain points which I hope will be included in the final draft of the bill. I believe that the Chief of the Children's Bureau should by law have to consult with the State health departments on all important matters rather than just on certain ones. I believe that provision should be made so that the advice of the advisory councils can be published at the Government's expense, because in this and similar legislation public opinion is the final check on the administrator, and as the recommendations of the advisory councils do not have to be followed, it is important to see that their recommendations receive good publicity. It should be made clear what payments go to hospitals and what payments go to physicians. The great majority of hospitals in the country permit pysicians to have private patients in the open wards. In other hospitals it is assumed that a patient in the open ward cannot be charged a professional fee. These hospitals are limited in number and are becoming less and less as time goes on. There must not be confusion on this point. A physician should be reimbursed for the care of the patient irrespective of what accommodations the patient has in the hospital. It must not be permitted for physicians to receive supplementary payments from patients, and this should be specifically stated if it is not. Provision should be made for proper payment to the State advisory councils for their services. I believe there should be one advisory council in each State rather than one for maternal and child-health services, one for services for crippled children, and one for child-welfare services. Close relationship between all these groups is essential. It may be desirable to have subdivisions of one advisory council, but care should be taken that there are not specific advisory councils quite independent of each other for each of these services. I am sorry that fee for service as a method of payment cannot be eliminated entirely, but I realize that for special services it is difficult to pay on a salary or per capita basis, and also in instances where a physician takes on only a small number of patients receiving benefits under this law it will be difficult to pay the physicians fairly on some other basis. However, every effort should be made to have the great amount of this work done on a salary or per capita basis. These are just a few of the thoughts which go through my mind in regard to this legislation, and I will be glad to have you use them in any way that you wish. 88975-46 -15 |