I think that the best approach is that the Congress ought to say that, "This is the part we are going to pay in this from now on, either 20 or 30 or 10 percent-and when you buy a package you know when you are talking about it to your legislature that 10 years from now it is not going to be something else.

I think it is a great disservice to give anybody 90 percent one year, and then say 3 years from now we are going to cut it to 50-50, to 40-60 or something like that. Perhaps you are cognizant of the problems of a department of welfare, welfare matching of State aid, where there are seven or eight different percentages allocated for a task within that one funding program.

It would be so much simpler if we were really going to get 60 percent from now on instead of 90-10, 50-50, 70-30-all these various figures. So I would propose if there is any planning, that you plan to give the same ratio across the board.

Then the State can manage to stay right with that same theory and the legislature would know that 3 years from now they are still going to have to put up 20 or 30 or 50 percent, whatever it is.

Mr. BROWN. Would you prefer to have a reduced ratio if it were a constant ratio?

Governor SMITH. I would rather have a reduced constant ratio than to have the great lure, if you want to put it that way, of 100 percent for 2 years and then 50-50. The end result is that you get a great demand from communities and various people, saying, "Well, here, you have to take advantage of this," and then 2 years later you ask, "Where are you going to find the $5 million to keep this going every year from now."

Then they rear up and say, "We can't do it," and we just create another problem.

Mr. BROWN. You think they don't think of this in advance.

Governor SMITH, I know they don't. I have been on that side of it. I have been caught in that same thing. I think it would be a much better proposition to fund it at a flat percentage rate across the board, and know that this is what it ought to be.

Mr. BROWN. I think this is one of the great problems we face. I am not sure I agree with you thoroughly that the Federal funds should be appropriated for all the States and local communities in the country, but I think it is a fact we have to consider. If I may ask one other question in this connection, I have had a little concern about the criteria which are in this legislation left in the hands of the Secretary of Health, Education, and Welfare to write a future date for the funding of the Federal grants to the States.

Would you share my concern that this gives the Secretary great power which may establish criteria that wouldn't adequately take into account the problems of West Virginia, for instance, versus Ohio or Pennsylvania or Colorado?

Governor SMITH. I would look at it the other way. I believe that this is the only way that you could take care of the problems of West Virginia versus Ohio, by leaving the criteria to the Secretary of HEW

to set.

Mr. BROWN. You think it would be helpful to have the Secretary establish some broad criteria in advance so that

Governor SMITH. I understand they are now working on a proposal for guidelines. We have had our representatives meeting with

them. As long as the State will counsel and advise and get into the act I think it is fine, but if they abrogate that privilege then, of course, you create another problem.

Mr. BROWN. You would want the assurance then that the States will have the opportunity of counsel and advice, that the Secretary will listen to that advice?

Governor SMITH. Yes; hopefully.

Mr. BROWN. Thank you.

The CHAIRMAN. Mr. Adams.

Mr. ADAMS. I have no questions, Governor Smith, but I do want to compliment you on an excellent statement and also to state how much those of us who are on this committee admire the courage and the ability of West Virginia's contribution to this committee and to the Congress.

We appreciate your being here and particularly we appreciate the fact that the Governors of the States are now beginning to accept the position that they have a substantial executive function in terms of the Federal programs and, frankly, we would like very much to shift the administration of many of these programs to the States, and this is one of the first steps in doing it.

We appreciate your being here. I think your statement is excellent. That is all that I have, Mr. Chairman.

The CHAIRMAN. Thank you, Mr. Adams. Mr. Kuykendall.

Mr. KUYKENDALL. I say to the honorable Governor of West Virginia it is wonderful to have you with us. I particularly admire several of your statements about both your willingness and determination and I think ability to handle several of these problems on the State level. I happen to have a personal liking for your statement that you are against price fixing in any form.

It doesn't have anything to do with these hearings, but I like it. I would like for you to take off the Governor of West Virginia cap and put on your cap of your position in the Governors' conference if you will. You spoke of the requisites of the program that you would like to have being fixed in such a way as to not penalize a State that was able to move forward quickly and the fact that the funds ought to be available over a long and permanent period of time and you mentioned the Federal highway fund as being an example of the way you thought it would work.

I happen to agree with you, but we have a problem here that I would like you to comment on if you would.

In the matter of health it is not like a highway. Except for the times that I drive through your beautiful State on vacation I don't really worry much about your highways, but your people's health, whether they be in West Virginia or Michigan are my concern.

Now, as I say, I don't worry about your State. That is an understatement; yes. I think this committee would feel pretty much the same way. It is not one of those things that we ignore. Even if the State doesn't live up to its responsibility we still feel the plight of these people, so do you feel that the example of States like West Virginia in the Governors' conference is going to serve to motivate these other States to rapid enough activity to really take care of the program as it was intended?

Governor SMITH. I would say that the fact that the Governors' conference has established an office here in Washington to try and keep

better informed reflects my belief that every Governor is more constantly aware of what the other States are doing.

For example, there is an example of a good sense of motivation in education. An example is usually the best way of teaching. I think that because of those States that take an active interest, the others will adopt it as soon as possible. As far as the conference is concerned, there is usually a free and frank discussion of what we are doing in each State with the other Governors.

All of us have learned something from each other, so I think there is the forum to learn what we are doing and how effectively it works. For example, if in Michigan there are certain things there I would like to do I will follow the work George Romney might be doing, or what Mills Godwin is doing in Virginia, or Otto Kerner is doing in Illinois. There is a mutual exchange.

That is one effect. I don't think motivation alone is all that it would be. "Here is a fellow doing a good job. Why don't you do as good a job as he does?"

Mr. KUYKENDALL. That is pretty potent.

Governor SMITH. Sometimes it is. Philosophically they don't agree, but otherwise

Mr. KUYKENDALL. But to get to another question, in the matter of Hill-Burton funds we are all aware that the Hill-Burton funds are pretty much intended for general hospital beds and we have a very outstanding children's hospital in Memphis. They went out and raised $2,100,000 hoping to get matching funds on Hill-Burton. This hospital is one of the Nation's pioneers in the open-heart surgery of

children.

Because of this you might say narrow specialty, it simply doesn't look like they are going to get the funds. They are sitting there with half of the funds raised.

Do you feel that Hill-Burton should expand into these areas of specialized hospitals for specialized care?

Governor SMITH. I think that the Hill-Burton concept was devised so many years ago to have general hospitals. At the time it was appropriate to that particular time, but since the initial impact of HillBurton, hospitals have become more specialized. Because of the fact that the hospital you mention is a children's hospital it serves a great segment of the population, not only in that area, but of the Nation. The Hill-Burton fund ought to be available for the construction of any hospital or any unit that pertains to taking care of the people. Mr. KUYKENDALL. I have to agree with you. I was quite frustrated. We are kind of stuck, you might say. You didn't mention this. The distinguished doctor from Georgia mentioned it yesterday and I had to leave before I had a chance to ask him this question.

He mentioned in their statewide conference planning in Georgia a study of fluoridation. Has this been mentioned? Have you studied it at all in your State?

Governor SMITH. We have had quite a debate about fluoridation. Mr. KUYKENDALL. There is always a debate about fluoridation. Governor SMITH. The State health department through its sanitation department made an analysis, made recommendations, and we publish a statement in regard to it, but as far as what it will do and so forth there is no objection raised by the State health department and there is no control placed on it.

Mr. KUYKENDALL. I was actually intending to ask you is this case more political, and I am sorry I didn't get a chance to ask the doctor yesterday, if you had arrived at any ideas as to how to solve this political hotbox on fluoridation.

Mr. Pickle is gone. I grew up close to Mr. Pickle's district. One of these areas had natural fluoridation and, like myself, you see people down there 60 and 70 years old without a cavity. I happen to be one of those who have not had cavities and I am sure a champion, and yet I can always start a fight on the streets of Memphis by just bringing up the term.

I am hoping you have some answers.

Governor SMITH. No; we have the same fights.

Mr. KUYKENDALL. Thank you.

Mr. WATKINS. Will the gentleman yield?

The CHAIRMAN. Yes.

Mr. WATKINS. I say that there is a mutual admiration between the Governor and my distinguished colleague on the question of rate fixing. For a matter of clearing the record, my opinion wasn't on rate fixing, but there is one thing that I would like to call to my colleague's attention and also to the great Governor of the State of West Virginia that there better be some control of the expanding costs of these hospitals or you are going to break the whole wagon down, and I am sure that I don't put it in a form of price fixing, but there must be a real interest from the States to find out and set costs on these hospitals or all of the programs are going to start falling, because hospital costs jumping from $22 a day to $60 a day need some explanation and if I were Governor I think I would want to know it.

Governor SMITH. Thank you.

The CHAIRMAN. Mr. Devine.

Mr. DEVINE. I have no questions. I would like to welcome Governor Smith here before the committee and, having heard the comment of my fine colleague from Pennsylvania, I heard someone say the other day that if everybody climbs in the wagon who is going to pull it. Thank you, Mr. Chairman.

The CHAIRMAN. Governor, I again want to say that we appreciate your coming. Since this bill is known as a partnership for health I am hoping that other Governors of the United States will come in and testify as you have and answer questions.

I think you have done an excellent job in fielding all of these questions on a broad front-just as fine a job as any person who has ever come before the committees. I want to congratulate you and say you have added immensely to this record. We appreciate your taking the time and coming up and giving the benefit of your advice.

I think it will mean a great deal when we start marking up the bill. Governor SMITH. Thank you very much Mr. Chairman. If there is any additional information that we can furnish to the committee for the record at any time, I hope you will call on us.

The CHAIRMAN. Thank you very much.

Our next witness is Dr. J. B. Stocklen, National Tuberculous Association.

Mr. VAN DEERLIN (presiding). Welcome to the hearings, Dr. Stocklen. Will you proceed with your statement, please.

STATEMENT OF JOSEPH B. STOCKLEN, M.D., REPRESENTING THE NATIONAL TUBERCULOSIS ASSOCIATION

Dr. STOCKLEN. Thank you, Mr. Chairman and members of the committee my name is Joseph B. Stocklen. I am a doctor of medicine and I am a resident of Cleveland Heights, Ohio, which is a suburb of Cleveland.

My official position is tuberculosis control officer for Cleveland and Cuyahoga County. I am here today to present testimony on H.R. 6418 for the National Tuberculosis Association. I am a member of the board of directors of that organization. I filed a statement with the committee and will try to give a very brief summary of the content of this

statement.

The National Tuberculosis Association is the oldest voluntary health agency in the United States, and has affiliated associations throughout the country. Our specific interest, of course, is in the control of tuberculosis and other respiratory diseases, but we pride ourselves on a long record of being interested in general health.

We know, for example, that tuberculosis occurs in poor populations where the incidence of other disease is high and when we have a population which is relatively free from other diseases, we don't have tuberculosis. The National Tuberculosis Association supported the legislation which led to Public Law 89-749, because we were fully aware that persons had to be free not only of tuberculosis but other diseases to have a healthy population.

Our support was only qualified to the extent that the new grant program would allow for continuation of sufficient funds to lead toward our goal of eradication of tuberculosis. The Public Health Service several years ago recognized the complexity of the problem of tuberculosis, the fact that it is a disease which occurs in one of two ways.

In the first place, some persons who become infected with the disease, that is, inhaling the organisms that float around the air, come down with it immediately, and this is particularly true of children, but other persons come down from old infections.

In other words, a person may have a dormant infection for 50 years and then come down with the disease without ever having come in contact with it again. Since we have 30 million infected people in the United States, eradicaton of tubuerculosis is going to require a program of long surveillance. So in 1963 the Surgeon General of the Public Health Service appointed a Task Force on tuberculosis control whose function was to outline the type of campaign needed to eradicate this disease.

Persons in public health recalled that some years before, medical science had perfected a cure for syphilis. This was probably as effiective a cure as we had for any disease. One large massive dose would render the person not only noninfectious, but also cure him.

We became complacent about syphilis and I think you know what happened. The disease increased and is continuing to increase. This failure led to recognition that it wasn't enough just to know the medical facts about a disease, but that the social facts identified with a disease must also be taken into account,