handling of their special problems through postgraduate education. A good program can go forward only as fast as trained personnel becomes available.

Unless there is a centralized responsibility for over-all planning, the objective of complete care for every child-preventive, diagnostic, and curative services linked together-will almost certainly fail. I want this kind of care for mothers and children to become a reality. I am sure there are many millions of parents in this country who agree with me in this. It is our goal to accomplish this in the next 10 years. I want to give you brifly just one example of what will be done under the maternal and child health program. Figures show that about 5 percent of the total number of babies born in any one year are born prematurely. Approximately 30 percent of the infant deaths in the first year are attributed to premature birth. There are many practical steps which are necessary if we are to save the greatest possible numbe of these babies' lives. There must be special nursery units equipped with incubators and special heating arrangements in all hospitals taking maternity cases. There must be incubators available in the health centers for use in the baby's home when he is not born in a hospital. Special ambulance service is necessary to take a premature baby to the hospital. Nurses and doctors must be given special training in the care of premature infants to provide the services needed. Specialists who can give consultant service must be within reach. It will be a responsibility of the State health agency, in accordance with its approved State plan under title I, part B, to see that each and every one of these steps are taken.

Under a national health program of which insurance is the cornerstone, it is of the utmost importance that there be a sustained effort on the part of public agencies to make sure that medical care of good quality is available for use. I am glad that the sponsors of this bill have included title I, part B, which provides grants to States for maternal and child health services under the direction of the Children's Bureau, which has been responsible for the setting of standards for maternity care and for the health and medical care of children under the Social Security Act.

I have been intimately acquainted over a period of years with the work of the Children's Bureau in the health and welfare fields, and know that its primary concern is the public interest. It has striven consistently for health and medical care of good quality for all mothers and all children and youth. The Children's Bureau is now responsible for the administration of the emergency maternity and infant care program under which well over 1,000,000 wives and babies of servicemen have been given care during the war. The Children's Bureau will bring to an extended maternal and child health program the wisdom of its past experience.

(Senator Murray resumed the chair.)

Senator PEPPER. I would like to summarize what these proposed amendments are.

In order to make the provisions of title I, part B, of this act more effective, to remove certain ambiguities, and to provide for better coordination in the administration of the provisions of title I, part B, and title II, certain amendments are proposed.

These amendments provide that

(1) The Children's Bureau and the State health agencies, through the provisions of title I, part B, will be responsible for providing and

maintaining services and facilities to promote the health of mothers and children, and by children I mean those under 18 years of age. including adequate maternal and child health services in the community.

(2) The cost of personal health services benefits for insured persons and their dependents, including maternity care and medical care of dependent children, will be met through the provisions of title II (within the limitations on those benefits) administered by the Surgeon General of the United States Public Health Service.

(3) The cost of maternity care and medical care of children under 18 years of age in noninsured families that elect to participate, and also the cost of supplementary personal health services for insured maternity patients and children, will be met through title I, part B. administered by the Children's Bureau and State health agencies.

(4) To the extent feasible, the Surgeon General will utilize, and the Chief of the Children's Bureau will make grants to, the same State health agency.

(5) The State health agency may provide personal health services under its approved maternal and child health plan through payment to persons or institutions furnishing care, through direct provision of such care, or through arrangements with the Surgeon General to utiliz the insurance system. Reciprocally, the Surgeon General may utilize the State agencies and make payments to them for personal health. services provided by such agencies for insured persons.

(6) Specific sums are authorized for the initial year of the materna. and child health services beginning July 1, 1946, in the amount of $50,000,000 for maternal and child health, and $25,000,000 for crippled and otherwise physically handicapped children, and thereafter the authorizations are for sums sufficient to carry out the purposes of the programs.

Let me interpolate here that some of the States which have separate crippled children's agencies, such as a crippled children's bureau. have complained that in the maternal and child-welfare bill we may be dispossessing them of their jurisdiction. We have let them know when we come to the actual formulation of this measure an effort will be made to wed them into the plan. We do not want to discourage the good agencies that already exist. We want to provide adequate coverage for all of the people by the supplementing, when necessary, of deficiencies in the present structure.

(7) Provision is made for the appointment of technical advisory committees to advise the Children's Bureau in its administration of the program.

(8) Provision is made to allow opportunity for fair hearing to any mother or person acting in behalf of a child or to any physician or agency participating or desiring to participate under a State plan

(9) Provision is made to allow a State agency receiving funds under two or more parts or titles of this act to pool such funds provided the State accounts for the funds to the Federal administrative agencies in a way that affords reasonable assurance that the funds are expended for the purposes of the respective parts or titles of the act.

I would like to submit as a part of my statement, the proposed amendments in technical form.

The CHAIRMAN. They may be carried in the record.

(The amendments are as follows:)

1. Page 13, line 24, insert after the word "children" the words "under 18 years of age."

2. Page 14, line 1, insert after the word "services" the following: "in the community, by providing supplementary personal health services needed by maternity cases or children entitled to personal health service benefits under title II of this Act, and any personal health services needed by maternity cases or children not entitled to such benefits."

Page 14, line 3. Insert after the word "demonstrations" the following: "research,".

3. Page 14, delete lines 5 and 6 and substitute the following: "to be appropriated for the fiscal year ending June 30, 1947, the sum of $50,000,000, and for each fiscal year thereafter a sum sufficient to carry."

Page 17, delete lines 3 and 4 and substitute the following: "authorized to be appropriated for the fiscal year ending June 30, 1947, the sum of $25,000,000, and for each fiscal year thereafter a sum sufficient."

4. Page 14, line 18, insert at end of line: "Provided, That to the extent feasible, the plan shall be submitted by the same State health agency as that utilized by the Surgeon General in furnishing services under title II, section 203 (e)."

Page 14, line 17, delete the word "the" before the word "State" and substitute the word "a."

Page 14, line 18, delete the word "the" before the word "State" and substitute the word "a."

Page 38, line 4, change period to comma and insert: “Provided, That the Surgeon General shall, to the extent feasible, utilize the same State health agency as that submitting, and having approved, plans under title I, part B, section 121." 5. Page 16, line 1, insert the word "community" before the word "services." Page 16, line 4, delete the word "and" at the end of the line, and add subsection (9), as follows:

"(9) provide that as personal health services are furnished under the plan they shall be available to all maternity cases and to all children in the State or locality who are not entitled to such services as benefits under title II of this Act and who elect to receive such services under the plan."

6. Page 16, after new subsection (9) insert new subsection (10) to read as follows:

"(10) provide for granting to any mother or person acting in behalf of a child whose claim with respect to care or services under the plan is denied, or to any physician or other person, organization, or institution, participating or desiring to participate in furnishing services or facilities under the plan, an opportunity for a fair hearing before the State health agency."

Page 16, line 5, change the numbering of old subsection (9) to subsection (11). 7. Page 24, line 3, insert after the word "members" the following: “and, as necessary, technical advisory committees."

8. Page 25, after line 2, insert the following:

"(d) Under a State plan approved by the Chief of the Children's Bureau with respect to section 121, personal health services may be provided through (1) payments to the persons or institutions furnishing such care, or (2) direct provision of such care, or (3) through arrangements by the State agency with the Surgeon General of the Public Health Service for services furnished under title II of this Act, on the basis of equitable payments to the Personal Health Service's account established under title II of this Act, or through any combination or modification thereof."

Page 25, line 3, change "(d)" to "(e)."

9. Page 37, line 3, insert the following at the end of the line: "including payments to State agencies for personal health services given in accordance with arrangements made by the Surgeon General with such State agencies under plans approved under title I."

10. Page 78, line 7, insert new section 301 as follows:

"SEC. 301. Whenever funds are paid to a single State agency under two or more parts of title I, or under one or more of such parts and also under title II, the State agency may commingle such funds and account therefor by such accounting, statistical, sampling, or other methods as may be found by the Federal administrative officer or officers authorizing such payments to the State

agency to afford reasonable assurance that such funds are expended for the purposes of the respective parts or titles of this Act."

Page 78, line 7, change numbering of "Sec. 301" to "Sec. 302."

Senator PEPPER. Let me add only that those amendments are proposed after long consultation and most sympathetic cooperation among the sponsors of the two bills. I happen to be one of the sponsors of the maternal and child welfare bill and am in favor of its passage, but I am equally strong in my support of the pending mea sure, the Wagner-Murray-Dingell bill, and we have worked together. the Children's Bureau and others who are sponsors of the maternal and child welfare bill, so that these amendments might be fitted into 1606, and if 1606 should be adopted, then it would cover, essentially, what appears in the maternal and child welfare bill, also.

If the unfortunate event should occur that 1606 should not be adopted, why then, of course, 1348, the maternal and child welfare bill can be considered as a separate matter.

Now, Mr. Chairman, I have just this: I realize there are a lot of people in the country who are conscientious in their opposition to this bill which you gentlemen have sponsored, yet I cannot believe that they have made a survey as our subcommittee has of the health. needs of the Nation and the deficiencies in the present structure for meeting those health needs. I cannot believe that they who value human life and emphasize human welfare would be unwilling to experiment, if needs be, with this proposed legislation correcting de fects as experience might disclose them, rather than to continue the inadequacies of the present system which not only every year an every month and every day and every hour, but every minute ar second, are taking a terrible toll of the lives and the health of th people of this Nation. And so I say: Godspeed your great efforts, an hope that the Congress will catch the spirit of the American people which is crying out for this legislation too long delayed and enact it at the first opportunity.

The CHAIRMAN. Thank you for your very able statement, Senator Pepper. I am sure it will be of real value to this committee.

It is now 10 minutes after 12, and we will suspend here.

Tomorrow morning we will meet again at the same time and in th same committee room, and Mr. Watson Miller, Administrator of the Federal Security Agency, will be the first witness, and will be fol lowed by Dr. J. W. Mountin, Medical Director of the United State Public Health Service.

We will suspend now.

(Thereupon, at 12:10 p. m., Tuesday, April 2, 1946, the committe recessed until Wednesday, April 3, 1946, at 10 o'clock a. m.)

I might add at this point, however, the suggestion, made in more detail in our report, that, whatever the particular formula for variable grants eventually adopted, the same provisions should apply for public health under this section and for the two other grant programs contained in title I. This appears necessary in order to avoid making any one program financially more favorable than the others and thus running the risk of throwing State plans out of proportion.

With the remaining sections of this title, the bill begins to address itself to the second part of the Government's' twofold task-that of assuring medical care to individuals-in this case for maternal and child health services and for medical care to the needy. Both of these are groups for which public responsibility has long been established in principle, and the necessity of measures to make this principle a reality has not, I believe, been seriously questioned. The Federal Government could contribute to no better cause.

If specific legislative provision is to be made for maternal and child health care and for services to crippled children, these measures for dealing with this need through grants-in-aid on a variable formula seem appropriate. We have, as you know, accepted the amendments to this portion of the bill proposed by Senator Pepper. I shall not, however, go into more detail with respect to these services, since I assume that our mutual agreement on them will be discussed more fully by the Secretary of Labor and the Chief of the Children's Bureau when they appear before you.

The proposal to make Federal financial aid available to the States to help them provide medical care for needy persons is generally sound and desirable. The provision that State and local agencies may arrange to have this care furnished to the needy through the health insurance system which the bill would establish seems to me particularly important. It would have the advantage both of encouraging better care for the needy, and of promoting more effective coordination among the several parts of the national health program.

PREPAID HEALTH SERVICES

But the main provision for individual medical care contained in the bill-and indeed the backbone of any national health program worthy of the name-is a system of prepaid personal health service benefits to cover the majority of the country's workers and their families.

The provisions for this purpose in title II are in accord with the President's recommendations and are, on the whole, workable. This applies to methods of administration as well as to the system of benefits itself.

SAFEGUARDS TO PERSONAL FREEDOMS

Appropriate safeguards, for example, would assure, as the President has rightly insisted, that people remain free to choose their own physicians and hospitals, that doctors remain free to accept or reject patients and to participate in the system full time, part time, or not at all. Speaking for myself, and with deep personal conviction, I