NATIONAL CYSTIC FIBROSIS RESEARCH FOUNDATION, Hon. HARLEY O. STAGGERS, Chairman, Interstate and Foreign Commerce Committee, DEAR MR. CHAIRMAN: The National Cystic Fibrosis Research Foundation would like to convey to your Committee our complete support of the objectives of Public Law 89-749, Partnership for Health Act of 1966, and H.R. 6418 (S. 1131), the Partnership for Health Amendments of 1967. We feel that Public Law 89-749 was a significant step in creating a more effective partnership among the Federal and State and local units of government in the field. One important provision of Public Law 89-749 was the authorization of project grants for studies to develop new methods or improve existing methods of providing health services (section 314e, clause 3). There is an urgent need for the development of new methods to improve the existing methods for the prevention and control of chronic diseases. Of particular concern to our Foundation, is the problem of chronic respiratory diseases of children, including the pulmonary manifestations of cystic fibrosis. It is our feeling that developmental project grants can make a significant contribution to the solution of these grave health problems. We note that, by the terms of H.R. 6418 (S. 1131), this clause is stricken from Section 314e and transferred to a new Section 304 of the Public Health Service Act. It would be our interpretation that the new language dealing with "development of new methods or improvement of existing methods of organization, delivery, or financing of health services," is intended to cover developmental projects related to the prevention and control of chronic diseases. However, we are concerned that this language may not be sufficiently explicit to assure the availability of project grants for this important developmental work. We therefore recommend that the language of the New Section 304 be made more explicit in this regard, or at least that this meaning be spelled out by the Committee in its report accompanying the Bill. We also note that the new Section 304 established a ceiling of $20 million on funds to be appropriated to carry out projects under this authority. It appears that this ceiling might make less money available for necessary developmental projects than might have been available under Clause 3 of Section 314e. In view of the urgency of the problems of the prevention and control of chronic respiratory diseases in children and other chronic diseases, we earnestly recommend that the Committee raise this ceiling. We would appreciate it if you would make this letter part of the hearing you are holding on the legislation. Thank you for your kind consideration. MILTON GRAUB, M.D., President. Hon. HARLEY O. STAGGERS, LOUISIANA TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, New Orleans, La., May 15, 1967. Chairman, House Interstate and Foreign Commerce Committee, House Office Building, Washington, D.C. DEAR CONGRESSMAN STAGGERS: We would like to add our voice to that of the National Tuberculosis Association, for whom Dr. Joseph B. Stocklen testified before your Committee on May 4, 1967, regarding the need for increased authorizations for project and formula grants for comprehensive health services. We understand that H.R. 6418 provides for an increase in authorization for each of the grant programs from $62.5 million to $70 million for fiscal 1968. In our opinion, the proposed increase in authorizations is not sufficiently large to assure the amount of support needed for maintenance of accelerated tuberculosis control-in accordance with the Surgeon General's TB Task Force recommendations of a couple years ago—and for increasing the number and scope of chronic respiratory disease programs, truly a serious need throughout the United States. We urge you and your committee members to give these programs the priority and attention they need. With many thanks for your interest and consideration, I remain, Hon. EDWARD J. GURNEY, W. FINDLEY RAYMOND, Executive Director. CENTRAL FLORIDA TUBERCULOSIS & U.S. House of Representatives, SIR: We strongly feel that the proposed increased authorizations for the Public Health Service grants programs, from 62.5 millions to 70 millions under H.R. 6418, are not sufficiently large to assure the support needed for maintenance of accelerated tuberculosis control and for increasing the number and scope of chronic respiratory disease programs. Our views are based on the recommendations of the Surgeon General's Task Force Report on Tuberculosis. We are in support of these recommendations for funds and believe they are consistent with the goals of our organization and are vitally needed to implement programs and maintain progress. Increased federal financial is also urgently needed for the initiation and expansion of activities to control other chronic respiratory diseases. We are in accord with the testimony presented by Dr. Joseph B. Stocklen on May 4, 1967. We request that our views be transmitted to members of the House Interstate and Foreign Commerce Committee. Sincerely yours, Hon. DANTE B. FASCELL, JOHN W. COLLINS, FLORIDA TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, Jacksonville, Fla., May 23, 1967. House of Representatives, House Office Building, DEAR MR. FASCELL: H.R. 6418 is currently being considered by the House Interstate and Foreign Commerce Committee. This legislation would provide for an increase in formula and project funds under the Comprehensive Health Planning Act (89-749) from $62.5 million to $70 million for fiscal 1968. If Florida is to continue with its intensive tuberculosis eradication program and initiate new programs for the control of other respiratory diseases, then it is vital that sufficient funds be authorized by Congress. As pointed out to you in earlier correspondence, the Florida State Board of Health has Special Tuberculosis Project Grants pending in the amount of $745,000 for fiscal 1967-68 and a $836,000 project for fiscal 1968-69. Tuberculosis is still a very serious problem in our state and it would be most unfortunate if the Federal support for these eradication efforts was cut at this time. By supporting an increase from $62.5 million to $70 million as requested in H.R. 6418, you would also be supporting the initiation and expansion of programs to control chronic emphysema and other respiratory diseases which are beginning to take a terrible toll among Florida's citizens, particularly among men in their most productive years. Emphysema has risen from the 15th cause of death in Florida in 1956 to the 7th cause in 1966. The number of deaths in 1966 in Florida was 1,257, and for every death that is directly attributed to emphysema it is reliably estimated that this disease is the secondary cause of two other deaths. Members of this association would be most grateful if you would contact your fellow Congressmen on the House Interstate and Foreign Commerce Committee and urge their support of this legislation which will mean so much to the health and welfare of Florida. Sincerely, R. A. CARUTHERS, President. HARVARD MEDICAL SCHOOL, Re: H.R. 6418. Hon. HARLEY O. STAGGERS, Chairman, Interstate and Foreign Commerce Committee, Rayburn House Office Building, Washington, D.C. DEAR CONGRESSMAN STAGGERS: I understand that you will be considering in your Committee the above noted bill. I sincerely hope and urge that in your consideration of Comprehensive Health Planning you will include a consideration of patients suffering from alcohol problems. As becomes increasingly evident the ramification of the serious complications deriving from unrecognized and untreated alcoholism, continues to multiply and increase in severity. Therefore, I believe no real Comprehensive Health Planning can take place until and unless alcoholism efforts are incorporated in this planning. Sincerely, MORRIS E. CHAFETZ, M.D., Director, Alcoholic Clinic and Acute Psychiatric Service; Assistant Clinical Professor in Psychiatry. HEALTH FACILITIES PLANNING Hon. HARLEY O. STAGGERS, Chairman, House Interstate and Foreign Commerce Committee, DEAR SIR: We understand that the House Interstate and Foreign Commerce Committee is considering amendments to the Comprehensive Health Planning Legislation, P.L. 89-749. Our purpose in writing is to invite your attention to the fact that there are some area wide planning councils operating on a statewide basis. Public Law 89-749 makes specific reference to metropolitan and regional planning councils but does not specifically refer to statewide planning councils. We believe that this is an oversight which should be corrected. We are enclosing a copy of our 1966 Annual Report for reference. It points out that one of the major efforts of the Health Facilities Planning Council for New Jersey, which is non-profit, has been directed toward the establishment of twelve regional planning councils. Ten of these councils are already incorporated and there is an active interest in the remaining two regions to form their own councils. If planning grants are to be made to metropolitan and regional planning councils only, to the exclusion of statewide planning councils, where they exist, it appears that this would be a disservice to the planning problem. For example, the twelve regional planning councils in New Jersey which we will soon have developed ostensibly could apply for and obtain planning grants under the Comprehensive Health Planning Legislation. This would, in our opinion, create duplication and the unwarranted expenditure of unnecessary funds. It is our intention in New Jersey to provide sufficient staffing on a statewide basis to make it possible to do the staff work for all or most of the regional planning councils, leaving the Boards of the regional planning councils to operate primarily on a policy level. This would make it possible to coordinate at one level sufficient staff, both in depth and professionally oriented, to do a commendable job. On the other hand, if twelve regional planning councils are to be supported by federal funds in New Jersey and if each of them applies for a grant-in-aid, it is conceivable to expect that they could not raise sufficient funds to provide adequate in depth staffing to effectively carry out satisfactory planning programs. Our suggestion is intended to direct your attention to the desirability of including statewide planning programs by name in the legislation. Statewide planning councils plan for every portion of the state, whereas metropolitan and regional planning councils are geographically limited in their planning and, in many instances, will leave large geographic areas of states completely unplanned for. This cannot happen under a statewide planning council as it is being developed in this state. We feel sure that you will recognize the desirability of our approach. Your consideration of this policy is earnestly recommended. Sincerely, EDWARD A. MOONEY, Executive Director. Hon. HARLEY O. STAGGERS, GROUP HEALTH ASSOCIATION OF AMERICA, INC., Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: I am writing to express to your Committee the support of Group Health Association of America for HR 6418, the "Partnership for Health Amendments of 1967", now being considered by the Committee on Interstate and Foreign Commerce. We support this bill in the broad context of Public Law 89-749, as interpreted through regulations and policies now being developed by the Public Health Service. We trust that you will incorporate this communication in the record of your hearings on HR 6418. I should also like to take this opportunity to record our Association's full support of the broad, systematic approach to comprehensive health planning which was initiated in Public Law 89-749, the Comprehensive Health Planning and Public Health Service Amendments of 1966. The rapidity of your Committee's response to the urgency of the need when this legislation was considered last year gave us no opportunity to express our endorsement at that time. To identify our Association and explain our vital concern that the Comprehensive Health Planning Program achieve its full potential, I should state that GHAA is an organization of group practice prepayment plans distributed over the country, which are primarily sponsored by or oriented toward consumers. These plans have their own medical staffs and facilities, with which they provide medical services on a prepaid basis to an enrolled population of more than five million. In supporting HR 6418, we wish to comment on four aspects of the Bill and the programs it would inaugurate: (1) The need to assure that the planning process lead to effective action in the public interest, rather than to delaying or obstructing action under the influence of some special interest group; (2) The need to assure that planning machinery and processes deal effectively with interstate metropolitan areas and regions, rather than being rigidly segmented and circumscribed by State lines; (3) The need to secure true consumer representation on advisory councils and other planning bodies to ensure that the planning process really serves the consumer interest; (4) The need for Federal licensing of clinical laboratories operating in interstate commerce. Our first concern is that the new partnership for comprehensive health planning should result in action that improves the availability, efficiency, and quality of total health services to the people of the community. Planning also must give due scope to experimentation and innovation in ways of providing health services. and to evaluating traditional as well as new operations. Most essential is constant vigilance to prevent planning from becoming a substitute for action. There have been times when planning has been so used. particularly when action is opposed by a special interest group. The history of opposition to prepaid group practice facilities as a result of medical society influence in state Hill-Burton planning bodies is a familiar example. Delay through a multiplicity of overlapping or layered planning bodies can actually have the effect of a veto on introduction or expansion in a community of new or better methods of organizing health services, such as group practice prepayment. A second matter for concern is the inadequacy of States as the sole geographic units for health services planning for the interstate metropolitan areas that dot the nation. Also, in States with urban and rural areas of opposing political philosophies competing for State and Federal support, a State government of one political character may shortchange its opponents with respect to health resources. Effective planning for interstate metropolitan area health services, as authorized in Section 314 (b), requires vigilance in the Federal administration and particularly on the part of Public Health Service Regional Health Directors to assure that planning resources of the States concerned are appropriately committed for these areas. Guarding against favoritism toward one area over another for political reasons requires that planning be oriented primarly to the health needs of people rather than to the interests of one or another segment of the medical care industry. We understand that the new partnership for Federally-aided planning complements and builds on such specialized planning as that of the Regional Medical Programs and Area-Wide Facilities planning under the Hill-Burton program. Without appropriate safeguards, however, comprehensive planning through the newly defined Federal-State partnership could carry over all the old problems of planning that is initiated at the State or non-Federal level and that involves conflicting jurisdictional Interests. This leads to our third point that a major safeguard in Public Law 89–749 is the requirement for establishment of a State Health Planning Council, a majority of the membership of which consists of "representatives of consumers of health services." The extent to which this council is wisely selected and effectively used is, in our view, the key to comprehensive health planning and the spur to action in the public interest. We are therefore particularly concerned with the implementation of this requirement, and specifically with the determination of who may be considered a "consumer representative." Some confusion in resolving questions about consumer interest occurs at times from the use of such aphorisms as "everybody is a consumer," or "the consumer interest is synonymous with the pubic interest," or "anyone who is not a professional (in this case a health professional) is a consumer." Actually, a consumer as an individual may be a banker or an industrialist who might not be considered by informed consumers as their representative. Also, the public interest is a composite of the whole range of special interests-industry, services, professions, as well as consumers-which make up our society. We therefore feel the need for some elaboration, either in legislative history or possibly in the statute, of the nature of consumer representation. The Public Health Service has undertaken some clarification in its draft "Information and Policies on Grants to States for Comprehensive State Health Planning under Section 314(a)" dated April 11, 1967. With respect to consumer representatives, the draft policies state: "Although State or local public officials may be considered, most consumer representatives should be private citizens. No person whose major occupation is the administration of health activities or performance of health services can be considered as a consumer representative. This requirement also excludes as consumers all persons engaged in research or teaching in health fields. Its intent is best illustrated by several examples: "1. A member of a voluntary health agency's board who is not in a healthrelated occupation would qualify as a consumer; an executive of such an agency would not. "2. A president or other official of a labor union who has only general responsibility for health programs would qualify as a consumer; the director of the union's health and welfare program would not. "3. An Urban League official or organizer who deals only generally with health concerns would qualify as a consumer; a League official with major responsibility for organizing for health services would not." This statement will help political leaders and planning officials understand the intent of Congress that comprehensive health services planning be oriented to the consumer who is to be served. We are concerned, however, that the lines drawn may be too rigid and may in fact tend to insulate the consumer from the expert representation he so sorely needs. To exclude teachers and researchers in health fields may deprive the consumer of a representative who is exceptionally well qualified for the very reason that he views the health services system broadly rather than from the orientation of a provider of service or the administrator of an institution or a health agency. The "health program" of most unions consists of purchasing insurance for health benefits for a specific amount of money arrived at through collective bargaining and overseeing the operation |