He is going to make a statement on behalf of the National Association of Counties.

Mr. Janes, I would like to take this opportunity to welcome you to the committee. We are grateful to you and your very fine national organization for the interest that you manifest for the hearings. Thank you very much.

STATEMENT OF COMMISSIONER ROBERT P. JANES, CHAIRMAN OF THE BOARD OF COUNTY COMMISSIONERS, HENNEPIN COUNTY, MINN., APPEARING FOR THE NATIONAL ASSOCIATION OF COUNTIES; ACCOMPANIED BY C. D. WARD, GENERAL COUNSEL

Mr. JANES. I am real pleased to have the opportunity to participate in the hearings before this committee.

Before I begin I would like to just briefly mention that I have along with me sitting on my right, your left, Mr. C. D. Ward, who is general counsel for the National Association of Counties which you know is the voice of the counties in Washington and he will be assisting me today.

In addition to being chairman of the Hennepin County Board of Commissioners of Hennepin County, Minn., I am chairman of the National Association of Counties' Committee on Health and Education on whose behalf I am appearing here today.

The Comprehensive Health Planning and Public Service Amendments of 1966 and the proposed Partnership for Health Amendments of 1967 address themselves to one of the critical needs of our grant-inaid programs; that is, an attempt to restructure them so as to simplify their administration and to maximize the utilization of the resources they make available.

The basic principle of combining related categorical problems is endorsed by the National Association of Counties and we urge its extension and expansion as a method of alleviating the torturous problem confronting local officials of being aware of approximately 400 different Federal grant-in-aid programs, their application procedures, their complex requirements, the confusion which exists up and down the line in their administration and the additionally complicating factor of there being nowhere near enough money to go around.

COMPREHENSIVE PLANNING

As of this date, there are something in excess of 40 Federal programs having to do with comprehensive planning of some sort or the other. Oftentimes separate "comprehensive planning programs" are carried out in the same locality with little, if any, coordination.

Unquestionably, the situation should and can be improved. It is our hope that the legislation you are considering today can be instrumental in doing so. As was pointed out in the Senate committee report accompanying S. 3008 last year, the act intends that the State health planning agency be the mechanism through which individual specialized planning efforts can be coordinated and related to each other.

The agency is also to serve as a focal point with the State for relating comprehensive health planning in areas outside the field of health such as urban development, public housing, et cetera. It is our view that

having the State health agency undertake this coordinating function is an essential element of the legislation. It is important to note that the law provides that the agency to do the State planning and coordination is an instrumentality of the State itself and is not a private nonprofit organization.

However, on the local level the legislation provides a serious dichotomy by providing that the comprehensive area wide planning may be done by an agency other than a public body, that is, a private, nonprofit planning agency.

We feel that this is a mistake, in that, rather than encouraging a coordinated approach, it facilitates the further fragmentation of our local efforts. No nonprofit planning agency has the capability to coordinate health planning with those other related functions outside the health field in that they will have neither the responsibility nor authority for them.

In the American county platform, the official policy statement of the National Association of Counties, we have long recognized the need and the desirability of relating the health programs with our other related activities of our local governments.

The preamble to our health and education section reads as follows: The National Association of Counties recognizes a broad definition of health and stresses the interdependency of the generally accepted health services with the other services rendered by the counties. It urges that the county health de partments be involved in the planning and development of the health aspects of related services and programs. A list of some areas of concern, which should not be considered as all inclusive, is as follows: welfare, education, water resources, county planning, air pollution, water pollution, public works, jails, recreation, hospitals, economic opportunity, civil defense, mental health, sanitation and refuse disposal.

It is our recommendation that the Partnership for Health Amendments for 1967 add the following amendment to the project grants for areawide health planning:

In the absence of substantial reasons to the contrary, all project grants are to be made to public agencies composed of officials appointed by and responsible to the elected officials of the local governments participating in such health programs.

In order to obtain the maximum benefit, health programs should be coordinated with one another as well as with many other programs being carried out by our general purpose units of local government. This can best be done by having the areawide planning carried out under the auspices of the local governments. This would in no way preclude the inclusion of representation from sources other than governmental on the planning body. We appreciate the fact that there are many factions, groups, interests, et cetera concerned with and responsible for health other than the local governments.

However, I think it is obvious that local government does bear the primary health responsibility as well as the responsibility of the other related programs previously mentioned. We are confident that in organizing any local planning agency, the local elected officials will obviously be concerned with and sensitive to representation from the appropriate consumer groups.

The law presently provides that on the State level, the State health planning council shall include representatives from a variety of in

terest groups, notwithstanding the ultimate authority for their appointment being invested in an elected official, that is, the Governor. A similar type of advisory council could be provided for our public areawide planning agencies with the membership appointed by the appropriate elected official.

We are pleased to note the amendment now under consideration which would require 70 percent of the grants for comprehensive public health service to be spent for health services in local communities. We do urge, however, that this committee consider how this provision will, in effect, be implemented. Will the State plan of services provide merely that 70 percent of the funds be used within communities, with no regard to established local plans, including those developed through project grants for areawide health planning? Will it be possible to superimpose a State plan of services over a local plan? The National Association of Counties strongly feels that an acceptable areawide, metropolitan, or local plan, particularly when carried out under planning funds authorized by this legislation, should be made a part of the State plan, thereby assuring the funds spent by the State for service in local communities will aid in implementing the plans developed by the local governments. We urge that the legislation make explicity clear that local plans approved by the State agency be incorporated into the State plan.

With respect to section 2(a) (2), we are in agreement with the objective of avoiding duplication of facilities and services. However, it would be our opinion that where an areawide health planning program exists, it would be more appropriate for it to develop a program for capital expenditure for replacement, modernization and expansion rather than having the State directly assist in such a program as is presently provided. The State would still retain a review of the local plan if they are included as an integral part of the overall State plan as we have suggested above.

In essence, if we are to have an effective coordinated comprehensive health program at the local level, the locally elected officials must have not only the responsibility, but the authority as well.

That concludes my formal remarks, Mr. Chairman. I would like to take this opportunity to thank you for the courtesies extended to me and I appreciate again the opportunity to appear before you with this statement.

Mr. KORNEGAY. Thank you very much, Mr. Janes. We appreciate your appearance here.

I would first like to call on another great Minnesotan, Congressman Nelsen.

Mr. NELSEN. Thank you.

I wish to thank the gentleman for his statement. I noted with a great amount of interest the recommendations that you make. Having formerly served on local levels of government in the State legislature, I am sure that you, as I, are encouraged by the trend apparently developing at the national level to recognize the merit in block grants to States with comprehensive planning under which the States assume a greater amount of responsibility and more freedom of action. Under the suggested language that you propose here you again will harness still farther down the line more of the State personnel to do a better job to meet the needs of the people at all levels of government.

I compliment you for your statement and I think it has some very, very constructive objectives and would serve a very useful purpose. Mr. JANES. Thank you, Congressman.

Mr. KORNEGAY. Mr. Blanton.

Mr. BLANTON. I have no questions.

Mr. KORNEGAY. Mr. Carter.

Mr. CARTER. I want to compliment the gentleman on his statement; I think it is very good. I liked particularly his use of local machinery to carry out this policy. I think it is much more effective and will be more effective than if we send people from Washington down there to see that the program was carried out.

I want to state that you have an outstanding representative, Mr. Nelsen. He is a member of this committee, a wonderful man. I just trust that you people in Minnesota appreciate him as we here do. Mr. KORNEGAY. Thank you.

Mr. Kuykendall.

Mr. KUYKENDALL. I want to compliment you on your position paper and to repeat what my colleague Mr. Nelsen said about, I think, the healthy trend of our recognition as part of the Federal Establishment of the fact that not only you have a function and ability but I see an increasingly recognition that you may have a greater ability in these fields than any other.

This morning the distinguished Governor of West Virginia testified before this committee about something that bothers me in the future. I see this as a coming trend and I welcome it, but in my concern about the necessity of reciprocal action on your side it was mentioned that the matching funds obligation on your side is becoming an increasingly great burden.

Mr. JANES. That is correct.

Mr. KUYKENDALL. Do you see enough of an awareness on the part of the State legislatures as well as well, in my county in Tennessee it would be called the county court; I don't know what you call it in your county-to be willing to face the taxpayers, to face the political ramifications of having to raise this money on the local level.

My question to you is, are you aware and do you see an increasing awareness of the fulfillment of this responsibility on your side? Mr. JANES. Congressman, I can only speak for Minnesota because this is where I am familiar. Yes, I do see this in Minnesota. It is a tremendous problem facing all levels of government very frankly. If I could just take a moment to perhaps comment again on the statement that you just made earlier, and that is that there is an increasing awareness of local governmental units, I think, to realize that they have responsibilities must have some of the tools to work with. and that we are extremely interested in being able to work with all agencies, be they at the Federal or State level.

I think this is part of the purpose of this bill.
Mr. KUYKENDALL. That is all, Mr. Chairman.

Mr. KORNEGAY. Thank you very much, Mr. Janes.

Of course, it is always a pleasure to see you and the National Association of Counties. We appreciate very much your fine contribution to these hearings.

Mr. JANES. Thank you very much.

80-641-67- -12

Mr. KORNEGAY. The next witness will be Dr. Thomas B. Turner, Association of American Medical Colleges.

Doctor, it is a real pleasure to welcome you to the Interstate and Foreign Commerce Committee. Dr. Berson, I believe, has testified. Dr. TURNER. Yes. We are having him with us.

Mr. KORNEGAY. We are pleased to see you on this occasion.
You may proceed.

STATEMENT OF DR. THOMAS B. TURNER, DEAN, SCHOOL OF MEDI-
CINE OF THE JOHNS HOPKINS UNIVERSITY, PAST PRESIDENT
OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES; AC-
COMPANIED BY DR. ROBERT C. BERSON, EXECUTIVE DIRECTOR
Dr. TURNER. Mr. Chairman, I am Dr. Thomas B. Turner, dean of
the School of Medicine of the Johns Hopkins University.

As the chairman has noted, with me is Dr. Robert C. Berson, Executive Director of the Association of American Medical Colleges.

Our association represents all the accredited medical schools and a majority of the major teaching hospitals in the United States. I have been asked to express our appreciation for this opportunity to tell you our thoughts with respect to both the bill, H.R. 6418, and the "Partnership for Health Act" of 1966, which it extends and expands. We have two things to say, gentlemen. We want to express our thoroughgoing and complete approval of the objectives and of almost all the content of the act and the bill.

Having done that, we will point out one serious flaw in the original act and in the present bill before us which could do serious damage to our schools of medicine and to our teaching hospitals, to their relations with the Government and to their ability to provide the doctors we need, a flaw which we believe reflects a confusion of terminology with potential results never intended by this committee or the Congress.

First, we are delighted to support legislation that aims at creating a much more effective partnership between the Federal and State and local units of government in the field of public health.

We agree that with few exceptions, State departments of public health have been woefully understaffed and underfinanced. The provisions of this legislation designed to enhance competence in those departments seem well planned to meet a longstanding need.

We agree, too, that comprehensive planning to meet public health needs on a statewide and local area basis is badly needed and that the fragmentation and imbalances created by a host of categorical grantsin-aid to State departments of public health can best be corrected through lump-sum grants with each State permitted to set its own priorities as regards its own public health problems.

We support State planned training of home-health aids and the establishment of home-health services.

We believe the provisions making possible an interchange of public health personnel between the States and the Federal Government to be imaginative and of great potential value.

All of those provisions were in the legislation enacted last year which this would extend and expand.