coming over the years. Not to apply our knowledge and skill is, in our estimation, a dereliction of duty and responsibility.

We, in Georgia, may by extrapolation illustrate the national need. We have carefully priced out nine high-priority programs and find that a realistic cost to meet these needs by 1971 is in the neighborhood of $20 million. Assuming that only one-third of this is a fair Federal partnership share, this would amount to $6 million and, as Georgia's usual share of a national amount is approximately 22 percent, the Federal appropriation should be in excess of $250 million for only these nine programs. But these nine are only part of the 50-odd health programs for which my department is responsible.

We urge upon you very seriously the consideration of increasing the level of appropriations authorized by Public Law 89-749 and contemplated under the bill presently before you to a level consistent with the health needs of the people of this Nation. It is our recommendation that Public Law 89-749 be amended so that the authorization for grants to provide health services, both for formula and for project, be increased from the present $125 million to at least $200 million for 1968, and that for 1969, $300 million be authorized; for 1970, $400 million be authorized; and for 1971, $500 million be authorized.

H.R. 6418 also proposes (on pp. 9 through 15) the licensing of clinical laboratories which engage in interstate commerce. Although our association has not had an opportunity to act upon this proposal, I feel confident that our constituent members, in great majority if not unanimously, support this proposal. I would like to suggest two points. however, which may need clarification. The first would make it clear that the Secretary would accept as meeting the letter of the law State laws or regulations relating to clinical laboratory procedures which are equal to or more stringent than those promulgated by the Secretary. Second, that the Secretary, via grants and contracts, provide financial assistance to official health agencies which are responsible for monitoring and consulting with these laboratories to the end that the health of our people can be safeguarded.

Now, Mr. Chairman, my colleagues here with me can speak from the standpoint of two other States, and if it is permissible, I would like for Dr. Heustis and Dr. Teague to speak briefly on this same

matter.

Dr. HEUSTIS. Mr. Chairman, my name is Dr. Albert Heustis. I am the State Director of Public Health for the State of Michigan. I have held this position under Democratic and Republican administrations since 1948. While I, in my position as State director of public health, am very much concerned with the overall costs, I do feel that we have an obligation to present to this committee and to the Congress accurate levels of health need so that the committee and the Congress can make the proper decisions. One of the great expenses which could be reduced through careful investment is that of health facility services. I use the term "health facilities" very broadly to include hospitals and all other related facilities. In some information and suggestions which we prepared for our Michigan Legislature on hospital licensing that would improve standards by providing the State health department some strengthened ability to work with doctors, so that the doctors themselves might decrease the amount of time that people spend in hospitals, we discovered that if we could save one-half day-one

half day on the average stay of patients in Michigan hospitals-we could have those that pay for that care of those folks $35 million

a year.

This, Mr. Chairman, would be equivalent in Michigan to constructing a 2,000-bed hospital. This, we believe, is the type of thing that State health departments are capable of doing. By working with physicians in hospitals, by providing the stimulation, the guidance, the consultation, and, yes, even the push that I think is necessary to do this job, this is an idea of savings possible.

Now, we just can't do this all by ourselves. We need some help. Another way that we can help decrease the costs of medical care is by working with physicians and with patients to help them understand that for all health problems they do not have to receive care in what we generally refer to as an acute general hospital. In the metropolitan area of our capital city, a survey was made just before I talked to a group of visiting nurses at their annual meeting, which showed that less than 25 percent of the physicians in active practice in the greater Lansing metropolitan area ever used the the facilities of those agencies that were providing home bedside care, home health services. Again, if State and local health departments can work with doctors to teach them and to help them to understand what these services can offer, and can work with services so that they can provide what the doctors need for the care of their patients under the control of their own private doctor, I think we can help to save some money. A third point in this general area is the yearly diagnosis of disabling chronic conditions. If we can help physicians through screening processes to suspicion-and I don't use the word "diagnosis", because diagnosis is a procedure for the physician-but if we can help them to suspicion those persons that have a greater chance of having some of our chronic disabling diseases, and can get to them the new technology that is now available, it certainly seems that we can accomplish something really important, costing a little money to be sure, but saving substantially greater amounts of money in the long run.

The fourth item that relates to improved health facilities services that would have a direct impact upon this cost where the really big money is, is improving the capabilities of nursing homes so that nursing homes may grow up to become more than storage facilities for our unfortunate older persons, but rather can take their true place in the whole framework of the health facility care institutions and really and truly carry on a more active service.

The second major point that I would make relates to strengthening services of local health departments, and one point with regard to the State health departments; that is, strengthening State and local health services. I read this chart on the plane coming down, and although it may not be readable to you, let me just describe it. This chart has several lines which go up almost to the top. They indicate for an entire year the incidence of measles. Just a short number of years ago a vaccine was developed. In fact, a couple of vaccines for measles were developed. We find a darker line that goes maybe a fourth of the way to the top of the chart that shows what happened last year. Then this year, with the help of Federal funds and with the help of funds appropriated by my own legislature and with the help of services provided by local health departments we vaccinated our children. This line is right smack along the bottom as far as it goes this year and

shows the improvement. If the committee is interested, I will get this in better shape. It just fitted right into what it seems to me you are interested in.

The second problem has to do with a fancy word—and I love to use it, because it shows that I did go to medical school and that I can use large words, even though I try not to-it is called phenylketonuria, and after I have said it once and impressed everybody, I like to say PKU. This is a disease in which a certain protein substance in newborn babies is not handled by the body easily and waste material from this protein substance builds up in the body and causes a certain type of mental retardation. Again using Federal funds and a combination of State funds and work by local health departments-and I bring out this partnership-we have been able this last year in Michigan to find seven youngsters with the potential of developing this disease. Let's talk about dollars and cents. We have an overall investment of perhaps $50,000 to $70,000 of everybody's money that is involved in the program which found these youngsters. We have a potential saving to everybody, again, of five youngsters at $5,000 a year in a mental hospital at a life expectancy of 20 years, $500,000. It seems to me that this is putting money where it will be a good investment, as far as health is concerned.

The last item has to do with a complementary activity to one in the bill. The bill proposes a system of interstate licensing of labortories, and I should like to report to the committee that in Michigan the State health department, the pathologists and the MD laboratory directors, the laboratory directors that are not pathologists have all agreed upon a State licensing bill; and this is now being considered by our own legislative committees. And, if we are to really carry out the intent of the Federal legislation of improving the quality of laboratory services available to the people, then again we need some help here. I would point out in closing that there are at least two other items before the Congress in one place or another that would call for the expenditure of rather large sums of money-large as far as I am concerned. There is one somewhere along the line that would call for family planning expenditures of, I think, $15 million or so. There is another that would call for doing something about alcoholism to the tune of $35 million or so, and then the laboratory field.

It is our strong belief in State health departments that you gentlemen can get more for the Federal dollars that you invest in health if you invest them in this comprehensive health planning and health services bill. Again I want you to appreciate that, even though I am fully cognizant of the money problems, my job is to present the need and to try to give you and the people that I deal with in my own State the assurance and the knowledge that the money that they entrust to me is spent efficiently and economically.

Thank you very much.

Dr. TEAGUE. Mr. Chairman, and members of the committee, I am Dr. Russell Teague, the health commissioner for the State of Kentucky. I have appeared before you on numerous occasions in regard to health legislation. I am delighted to be here today to talk to you about the implementation of Public Law 89-749 of the last Congress. You gave us an effective tool when you passed this bill last year, and we are here now to talk about the implementation of it. I endorse

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and agree with the statements made by my colleagues here that all of these subjects that they have discussed are important to us in Kentucky. The intent of this law is to build into the Federal-State-local partnership a planning mechanism that will assure that we do a complete program throughout the country. There are weaknesses in our system. We have known of these. There are no weaknesses that cannot be solved with careful planning, and with funds necessary to do it.

This law in itself, without planning money or without additional formula and project money, does not give us the tools. It just gives us a mechanism and a mandate.

The CHAIRMAN. Excuse me, sir. There is a very distinguished colleague of ours and a gentleman who knows this field very well, from your State, who has to leave; and he would like to say a word or two to you before he leaves.

Dr. Carter.

Mr. CARTER. Certainly I want to congratulate your group upon your excellent presentation, and I want to personally welcome our distinguished representative from the State of Kentucky.

I regret very much that I am going to have to appear before the Senate Public Works Committee. I certainly want to extend a welcome to you, Dr. Teague, and to your colleagues.

be

Thank you, sir.

Dr. TEAGUE. Thank you, Dr. Carter. It is nice to see you, sir. I will very brief and conclude my little statement since my colleagues have covered the problem so well. Congress has given the State and local health departments tremendous responsibility under titles 18 and 19 of the social security amendments. It is our job to see that high-quality care in our hospitals, nursing homes, and so forth, is carried out. We need to "beef up" our State and local health departments, and this bill before you today will give us the mechanism to get started on a plan that has long been delayed.

I am delighted to be able to come here and talk to you about this. Thank you, Mr. Chairman.

The CHAIRMAN. Thank you, sir.

Dr. VENABLE. Mr. Chairman, we will be glad to answer any questions, if there are any. Otherwise, our presentation is completed.

Mr. MACDONALD (presiding). Are there any questions for the panel? Mr. DINGELL. Yes, Mr. Chairman.

I believe Dr. Heustis addressed himself to the question of licensing of clinics and the testing laboratories, and things of this kind. Am I correct?

Dr. HEUSTIS. Yes, sir.

Mr. DINGELL. Doctor, how many States have testing, have these laboratory facilities now, and how many have licensing requirements? Dr. HEUSTIS. I cannot answer that, sir. We do not in Michigan, but we should have, and are going to try to get it.

Mr. DINGELL. Would it be fair to say that there are very few States that have that at this time?

Dr. HEUSTIS. Mr. Dingell, I am just not competent to answer that question. I do not know the national scene.

Mr. DINGELL. Speaking now on behalf of the Association of State and Territorial Health Officers, do you appear in opposition to the provisions dealing with such licensing in the legislation before us?

Dr. HEUSTIS. Indeed not, sir. The point that I was endeavoring to make and I am not certain whether other circumstances kept you from hearing the entire comment-was that I view what we were trying to do in Michigan as distinctly complementary to what this legislation would carry out. We are very much in favor of the licensing of interstate laboratories by the Federal Government. And then at least I in Michigan am very much in favor of the licensing of those laboratories that carry out services within the State. I would certainly hope that if in Michigan we developed standards for the licensing of our laboratories that these would be at least equivalent to those adopted by the Federal Government, and if any of our Michigan laboratories serve the people in Ohio or Indiana or Wisconsin, that the Federal Government would accept a certification by us.

Mr. DINGELL. Now turning to that particular section before us, I note that there is no requirement in the legislation as to what the licensing shall constitute and what tests shall be applied by the Secretary in the licensing. I wonder if you have any feelings on that point. More specifically, do you feel, as a matter of good draftsmanship and good legislation, that we should impose some rather clear directions upon the Secretary in terms of carrying out his licensing of these clinical laboratories?

Dr. HEUSTIS. Well, I have to answer that, sir, in the context of my Michigan experience. In my Michigan experience, I always suggest to our Michigan Legislature that they try to define the overall purposes that they would like to see carried out in broad, general terms, and if the State director of public health does not carry it out to their desires that they get a new director of public health.

Mr. DINGELL. My concern is that I can find no direction to the Secretary with regard to what tests, what standards, what qualifications he shall impose at this time. And the absence of those clear directions on this matter troubles me greatly, and I wondered if you would comment about the absence of those directions to the Secretary.

Dr. HEUSTIS. I do not share your troubled feelings. I have the feeling that the Secretary, as a reasonable man, will call together interested parties; that he will not develop them in a vacuum. This has been the tradition of the Public Health Service, as I have dealt with them over the years through many Secretaries and a number of Surgeons General. I have a hunch that if we try to write details in legislation we either get ourselves a bill that is tremendously complicated or else we do things this year that are not scientifically sound within a couple or 3 years.

Mr. DINGELL. We might also get the legislation declared unconstitutional, if we fail to give some standards.

Dr. HEUSTIS. You have just again left my area of competence, sir. Mr. DINGELL. It is fine to have you before us. We note your very long and fine service.

Dr. HEUSTIS. Thank you, sir.

The CHAIRMAN. Mr. Springer?

Mr. SPRINGER. Dr. Venable, are you the president of the Association of State and Territorial Health Officers?

Dr. VENABLE. Yes, sir.

Mr. SPRINGER. Are these gentlmen officers?

Dr. VENABLE. Yes, sir. Dr. Teague is the president-elect and Dr. Heustis is secretary-treasurer.