planning apparatus. At this time, Mr. Chairman, I ask that the table I have prepared showing the mental health programs that will need assistance through Public Law 89-749 be made a part of this hearing record. (The table referred to follows:) (STATE-LOCALNATIONAL MENTAL HEALTH PROGRAM ANALYSIS AND COST ESTIMATE Dr. MILLER. You will note, Mr. Chairman, that the total 160 programs thus far, if put into action over the next 7 years, would need $539,183,660 of State and local support and $326,958,660 of Federal grant support as now projected by the States. The Federal grant support for 1 year would average about $47 million, projected among the programs solicited. The total proposed health services authorization for fiscal year 1969 is for $70 million. The minimum 15 percent for mental health is $10.5 million. The disparity between what is needed and what is practical for the Congress to grant to the States considering the pressures from the national defense effort and other vital budget demands is obvious. We wish to emphasize our support of all sections of H.R. 6418 including the 5-year extension of the comprehensive health planning grants, the increased authorization of $7 million for fiscal 1968, the extension of areawide health planning authority for 5 more years, the extension of authority for project grants between studies and demon strations, and the extension of authority for 5 years of comprehensive health services. We support the request for $70 million for formula grants in H.R. 6418 for the fiscal year and support as fully the $70 million for project grants which will make it possible throughout the country to carry out demonstrations, pilot efforts, explorations of new areas. However, it is to be hoped that in the near future when we can once again turn full national attention to our critical domestic needs, the sums allocated to the partnership for health program for formula grants will approximate, and this is an approximation, $1 per capita for $217 million per year. When the Federal share of the partnership for health program reaches that level, the Government will have taken another substantial step toward realizing the goal recommended to the Congress in 1960 by the Joint Commission on Mental Illness and Health which was created by Public Law 84–182. The Joint Commission, in making its final report to the Congress, said: "We recommend that the States and the Federal Government work toward a time when a share of the cost of State and local mental patient services will be borne by the Federal Government, over and above the present and future program of Federal grants-in-aid for research and training." Extension and expansion of Public Law 89-749, Mr. Chairman, could be considered as an action toward such sustained support, and we fully endorse such action. We call for favorable consideration by your committee of H.R. 6418. The CHAIRMAN. Thank you, Dr. Miller. Mr. Schnibbe, do you want to make a comment ? Mr. SCHNIBBE. No, I have no statement, Mr. Chairman. Mr. ROGERS. Thank you, Dr. Miller, for your statement. Although we are delighted that you are supporting the bill, it seems to me that you are still supporting the idea of categorical designation which is somewhat contrary to the block grant approach. You don't think that the State people can put a proper evaluation on this to have a State comprehensive plan so that mental health can get a proper proportion in that State? Dr. MILLER. As you know, this is perhaps one of the most difficult questions for us, and I am sure for the Congress. We endorse the principle and we endorse as a direction the provision to the States under this law of funds which can be spent at the discretion of that State. It is our opinion that at this time because of both the scope and size of the mental health and mental retardation programs in the States and because of the administrative arrangements within the States and because of what may be still some different kinds of problems within the mental health and mental retardation field, that it is proper to maintain this general distinction. I might add that even a category for mental health services in degree might seem to be a departure from block. Mr. ROGERS. I think the Congress is willing to go along with this pro forma, but to develop these trends I think you are going to have to come into a total picture a little better and also I would not want to give the impression that the States are only getting about $135,000 average on mental health. Really the program is larger than that. I understand your category there. Actually the money has not decreased, although you say it has decreased from relation to other funds. Dr. MILLER. The amount has increased, but not substantially. Mr. ROGERS. We passed this community mental health bill. I think that is a substantial increase. Dr. MILLER. Very much so. Mr. ROGERS. Everything I can remember we have been increasing at least from the point of view of the Federal Government, and I don't want to leave the impression with the people here that the totals have been going down rather than up. I am sure this is not your intention, but I just wanted to make that clear. Dr. MILLER. Quite true. Mr. ROGERS. Thank you. Thank you, Mr. Chairman. Dr. MILLER. May I say that it is our view that with the experience of comprehensive health planning and a growing ability to relate the many parts of the program which are broader even than mental health or health agencies, that we would hope that the competency of the States to deal in a truly comprehensive way with a single fund would be an area to which we would strive. Mr. ROGERS. Fine. Thank you very much. Thank you, Mr. Chairman. The CHAIRMAN. Dr. Miller, you think under the present circumstances then that this probably should not be combined right away, is this right? Dr. MILLER. That is our opinion. The CHAIRMAN. We should work it in gradually if we are going to do it. Dr. MILLER. I would say that each year we would have a better base to know how these things could be more fully integrated. The CHAIRMAN. I want to thank you for coming and giving us the benefit of your views. Certainly the magnitude of this burden on the community is great, and we, I think, as the Congress, recognize this. This is a burden, and we are trying to do something about it. There is a separate bill, besides this one, on the mental health program. Dr. MILLER. Right. We very much appreciate it. The CHAIRMAN. Thank you very much. The committee will stand recessed until 2 o'clock this afternoon, and those witnesses who did not get on, if they want to submit their statements for the record, can do that or come back at 2 o'clock. The committee now stands recessed until 2 o'clock. (Whereupon, at 12:15 p.m., the committee recessed, to reconvene at 2 p.m., the same day.) AFTER RECESS (The committee reconvened at 2 p.m., Hon. Paul G. Rogers presiding.) Mr. ROGERS. The committee will come to order. The next witness will be Dr. Lewis E. January, professor of medicine, University of Iowa, and the President of the American Heart Association, Inc., accompanied by Mr. Rome A. Betts, executive director; and Dr. Thomas W. Mattingly. We are delighted to have you gentlemen with us and appreciate your indulgence in changing your time of testifying from the morning session to the afternoon. So we will be delighted to have your testimony. STATEMENT OF LEWIS E. JANUARY, M.D., PRESIDENT, AMERICAN HEART ASSOCIATION, INC.; ACCOMPANIED BY ROME A. BETTS, EXECUTIVE DIRECTOR; AND DR. THOMAS W. MATTINGLY, MEMBER, LEGISLATIVE ADVISORY COMMITTEE AND COORDINATOR OF THE REGIONAL MEDICAL PROGRAM FOR THE METROPOLITAN WASHINGTON AREA Dr. JANUARY. Thank you, Mr. Rogers, Mr. Blanton. Mr. Betts is the executive director of the American Heart Association; Dr. Mattingly is a member of our legislative advisory committee and he is the coordinator of the regional medical program of Metropolitan Washington area. We represent the American Heart Association, sir. We appreciate the opportunity to express our views to you. We filed a copy of our formal testimony with the clerk and we wish to speak somewhat more briefly. The American Heart Association warmly supports the basic objectives of the Comprehensive Health Planning Act, Public Law 89-794, which is before your committee for renewal and possible modification. We definitely do endorse the goals of coordinated planning, the expeditious and the economic use of Federal grants in the health field and the elimination of overlap. We endorse the principle of greater flexibility in planning for and in providing for health services to the extent that they may be required by the various States. We do not know whether or not your committee plans to revise the language of this act. We believe, however, that there are pitfalls that must be avoided to make certain that planning is efficient as well as effective. Therefore, we respectfully urge, as we did last year in testifying before the Senate Committee on Labor and Public Welfare, that the shortcomings which we feel endanger fulfilling the purposes of the act be made a matter of record. The American Heart Association favors the concept of planning by the very-best-qualified experts available, and this, indeed, is provided in the act at the State level. But Public Law 89-749 does not provide the Surgeon General with an advisory council, a device which, in our opinion, has well served the National Heart Institute for many years and which more recently was adopted in the legislation which authorized the regional medical program, Public Law 89-239. Therefore, we do recommend that the Surgeon General have access to advice and guidance from a group of health and public welfare specialists in reaching the important decisions on health planning envisioned in this act. Such an advisory council would, among other things, lift from his shoulders the obligation to evaluate many of the individual elements in many separate State programs. If, on the other hand, as has been indicated, it is planned to administer this act through regional offices of the Department of Health, with the assistance of regional health planning councils, then we would feel that the result we desire would be achieved. This obviously could be the result of regulation rather than legislation. The American Heart Association feels a deep concern, sir, for all of the agencies which are designed to combat cardiovascular diseases, and we wish to make as sure as possible that the vital programs in research and study of the National Heart Institute and the Heart Disease Control Branch of the Public Health Service go forward while, at the same time, there should be no conflict with the regional medical program. We share the concern which has been expressed that we should avoid unnecessary duplication. We think, however, that it would be unfortunate to suspect duplication where, in fact, none existed. I mention this and use as an example the fact that some of us here today in testimony recently before another Congressional committee discovered that there was the belief there that the National Heart Institute myocardial infarction study program was a duplicate of the patient services oriented applied program of the regional medical group. In our view this is not true. But if this misunderstanding prevailed, highly valuable research would be interrupted, delayed or suspended at great penalty to the American people. We believe that the council of experts, the advisory council that I mentioned, which we support, would prevent this misunderstanding. As we read Public Law 89-794, there is no specific coordination spelled out between regional medical program officials and the State health planning council. We understand that this is planned, but we strongly recommend that either the act or the regulations for administering it should provide specifically for representatives from regional medical programs be included in the State Health Planning Councils. Also we think it would be wise to include representatives of the medical schools and of State medical societies in these State health planning councils, since, after all, in some instances the State medical society has been the group to take the initiative to organize regional medical programs. And in almost all places medical schools are intimately involved and oftentimes the center of such plans. We believe also that it is not sufficient to specify that a majority of the membership of these advisory councils shall consist of representatives of the consumers of health services. We do certainly agree that such council should be composed of a majority of nongovernmental personnel, but that the consumers of health services should specifically include representatives from the voluntary health agencies, among others, because we believe that many of the major voluntary health agencies have special competency in health affairs. What I have said about the State advisory councils would apply equally, of course, to the regional or to the national advisory council, whichever the case might be. We further believe that the State health planning councils should have the authority to approve as well as to advise on plans of the state health agency. And we recommend that either the act or the regulations provide for this and also for consultation between State health planning councils and State health agencies in the preparation of the periodic review of State health plans. |