FAMILY PHYSICIANS GROUP, Woodland, Calif., August 26, 1970. Senator WARREN MAGNUSON, U.S. Senate, Washington, D.C. DEAR SENATOR MAGNUSON: I would like to address to you a few thoughts concerning your bill, S. 4106 (National Health Service Corps). I am quite in agreement with your intentions to provide more adequate medical care for our citizens now deprived of such, as well as to mobilize the strong feelings of public service evident in our young doctors and to rejuvenate the public health service. However, I feel the bill falls short of a very great potential to provide better health care and delivery to all U.S. citizens. The present bill would essentially provide the poor with a duplicate of our present fee-for-service, "cottage industry" type of individual, "handcrafted" medical care. This type of health care is under-organized, inefficient, and too expensive. (My opinions have been formed since graduating from medical school in 1962. I have been in general practice for the past 5 years.) Therefore, having been frustrated by, and seen the deficiencies of, the present system, I hate to see the poor saddled with the same system when, with proper planning, the poor can literally "leap-frog" ahead of our present middle- and upper-class system and end up actually years ahead of the present recipients of "mainstream" medicine. The remarks of Senator Kennedy concerning S. 4106 are most pertinent to my own sentiments-that much of the present M.D.'s time is wasted on procedures which could be done by a para-medical personnel. In a recent letter to the state medical association officers and my state legislators, I supported a California bill to provide for licensure of physicians' assistants. I feel that progress in such a direction, plus automation, is manditory to attain organization and efficiency in medical care delivery, and thereby lower the cost. Simply providing more physicians will probably not lower costs significantly. When I consider medical care delivery problems, I try to think in terms of very basic principles specifically that most problems (physical, emotional, social) about which patients consult a physician are common, benign, and self-limited. Physicians today are trained to be experts in uncommon, complicated, and lifethreatening illnesses. I could go on at length regarding this missmatch, including remarks about the usual arguments against having anyone but an M.D. treat any illness, but in short, the present system is as inefficient and costly as having every single ditch in the U.S.A. dug by Ph.D.s in Civil Engineering. If you can get 5 million dollars appropriated from the Congress to provide health care to the poor, I think you are missing a golden opportunity if you don't make this care more efficient and organized than our present health care delivery system. If effective, these pilot programs could be examples all medical care will duplicate, with lower eventual cost to all of us. I would appreciate hearing of the progress of S. 4106 and any changes which are made therein. DEAR SENATOR MAGNUSON: Thank you for sending me the details of your excellent proposal to help redistribute scarce medical manpower to those areas of the country, and segments of the population, who are not now covered. A National Health Service Corps should complement rather than supplant the private practice of medicine in much the same way as do our county and municipal hospitals, where they exist. Now that some form of National Health Insurance seems inevitable in the near future, the Corps should help to expose new professionals to satisfying public service in communities where many of them may wish to continue if the economic barriers to such practice are to be eliminated. The Act should provide a superb opportunity to experiment with paramedical personnel such as returned military corpsmen, pediatric nurse practitioners and nurse midwives. The team approaches that develop may establish models for physicians in other areas who wish to expand their capacities by delegating those routine activities that do not require the physician's judgment or performance. Your bill could facilitate such demonstration projects if it stressed this opportunity explicitly. Organizationally, I wonder if you would not strengthen the Public Health Service commissioned corps to a greater extent if you combined the positions of "Director" with that of Surgeon General. As written, the Surgeon General has nominal responsibility for the supervision and control of a "Director" who is appointed by the President with the approval of the Senate and who operates under the authority of the Secretary of Health, Education and Welfare. Why should this program not be an integral part of the commissioned corps of the Public Health Service in every respect? The advisory board and the interest the service corps will generate will certainly keep its activities responsive to the public need. Why is the answer to every new problem in America the creation of a new organization to meet it? Finally, as a concerned community physician, I would be pleased to help with the gestation, delivery and early development of the National Health Service Corps in any way that I can. Sincerely, CAPTANE P. THOMSON, M.D., Assistant Clinical Professor of Psychiatry and Community Health, School of Medicine, University of California at Davis. STATEMENT OF THE AMERICAN OPTOMETRIC ASSOCIATION ON S. 4106 Mr. Chairman and members of the Committee: the American Optometric Association appreciates this opportunity to present its views in support of S. 4106, the legislation to establish a National Health Service Corps. We believe establishment of a National Health Service Corps would be a major step in solving the problems of maldistribution of health care cited by Senator Magnuson and other sponsors of this bill. The Nation's 18,000 optometrists actively engaged in practice today are located in 5,438 cities and towns of all sizes. However, even with this excellent geographical distribution, there are still too many areas-both urban and ruralwhich lack convenient access to professional vision care. Enactment and implementation of S. 4106 would appreciably broaden the delivery of vision care, as optometrists presently serve alongside members of the other primary health care professions in the Public Health Service Commissioned Corps. There is little doubt that revitalization of the Commissioned Corps would result from enactment of S. 4106. The career incentives it proposes, coupled with equitable special pay provisions pending action in the House Armed Services Committee, would serve to make an optometric career in the Commissioned Corps sufficiently challenging to attract a ready supply of vision care professionals. Selection or assignment of these individuals to the National Health Services Corps would help meet the vision care needs of the disadvantaged in rural areas and poverty-ridden areas of the inner city. Utilization of Public Health Service facilities where others are lacking or inadequate could be one of the most praiseworthy benefits of S. 4106. The American Optometric Association views this legislation as an excellent opportunity to demonstrate the workability of a joint effort between the public and private sectors within the framework of a comprehensive health care plan. We hope the Committee Report will take cognizance of the merits of utilizing existing optometric centers as facilities to which members of the National Health Service Corps might be assigned, particularly for providing vision care to the economically disadvantaged. Such relationships between the Corps and other types of existing health facilities should also be encouraged. The American Optometric Association supports enactment of S. 4106, and subscribes to the views expressed in earlier testimony by the Commissioner Officers Association and the American Public Health Association. Enactment of S. 4106 would represent a major step toward filling some of the glaring gaps in health care which plague some areas of our Nation today. We believe enactment of this legislation would create excellent opportunities for better utilization of existing non-profit optometric centers and similar facilities maintained by other health professions. The American Optometric Association urges approval of S. 4106. UNITED FARM WORKERS Co-op, Hon. RALPH YARBOROUGH, Senate Office Building, DEAR SENATOR YARBOROUGH: I wish to add my voice to those supporting the proposed National Health Service Corps. We Mexican-American agricultural workers in the Yakima Valley of the state of Washington are working hard to improve our medical and health care. We have recently received a grant to start a health center in Toppenish, Washington and we are aware of the medical manpower shortages of staffing such a clinic. Physician assignees from a National Health Service Corps to units such as our new clinic could make a great contribution to the desperate health needs of poor agricultural workers. Our people are working hard to help themselves. Some day we will have Spanish speaking doctors from our own people but solving all the problems to bring that about will take a long time. Until then we are one of the large groups of people who need the help of a National Health Service Corps. Very truly, TOMAS VILLANUEVA. STATEMENT OF THE STUDENT AMERICAN PHARMACEUTICAL ASSOCIATION The Student American Pharmaceutical Association is the national professional society of pharmacy students, with approximately 13,000 members in 74 schools of pharmacy in this country. We are pleased to submit these comments about the proposed National Health Service Corps. (S.4106). We are currently facing a health care crisis in this country: our practitioners are too few in number; our delivery system is archaic and our resources are poorly distributed. Our health science schools can significantly increase the number of practitioners, if they are given more adequate support by the Congress. But even with dramatic increases in the number of graduates, the health needs of the people of this country will not be met unless we can effect a complete reordering of our health delivery system, accompanied by a redistribution of our resources. We believe that the National Health Service Corps will be a step in the right direction because it will place dedicated young health practitioners in the areas where the need for their services is greatest. It will allow them an opportunity to learn about the problems of delivering health care in rural and urban (inner city) areas. It will encourage young practitioners to remain in the communities after they have finished their periods of service, to continue the work that they have begun. We believe that the Corps will serve as a mechanism for increasing the efficiency of our health delivery system. For too long, our health educators and planners have paid lip service to the concept of the health team, without actually implementing its principles. The Corps could easily detail teams of health professionals into its defined target areas to demonstrate the effectiveness of increased cooperation among practitioners, and the desirability of increased utilization of allied health professionals as a part of the team. In many of our schools, pharmacy students are receiving clinical training that will enable them to greatly expand their capabilities to serve as members of health care teams. These clinically trained pharmacists are quite capable of contributing to patient care in all aspects related to drug therapy, from the initial drug history and diagnosis to the planning of one therapeutic regimen and the monitoring of the patient's response. These health practitioners would welcome the opportunity to participate in the National Health Service Corps. Finally, we wish to state our support for the mechanism of providing consumer input through the National Health Corps Advisory Council. In too many cases, the recipients of health care services have little say in the determination of priorities or the method of delivering the services. We welcome this recognition of the need for consumer input at the highest administrative levels. WASHINGTON, D.C., September 2, 1970. Hon. RALPH YARBOROUGH, Chairman, Subcommittee on Health, Senate Committee on Labor and Health. DEAR SENATOR YARBOROUGH: Recently, I learned of the existence of the proposed bill entitled The National Health Service Corps Act of 1970 (S4106) which is to be considered by Congress. It is my understanding that this bill provides for improved medical services for people living in the rural areas of the United States. It is also my understanding that a major portion of these services will be provided by young physicians in the Commissioned Corps of the United States Public Health Service who may be serving for two years while discharging their military obligation. Speaking as an individual private citizen and as a public health physician deeply interested in the health problems of the poor, particularly those living in rural areas, I would like to indicate my enthusiastic support for this legislation. It is very evident to me that one of the most urgent needs of our rural citizens is that of high quality and continuing comprehensive health care. The serious lack of this very fundamental service results in a scandalous amount of needless suffering and shortened lives among the poor in these areas. This deficit is also one of the most important reasons why people are abandoning the rural districts for the cities at a time when intensive and rapid urbanization is aggravating other social and environmental problems. Most of the people leaving rural areas do so not because they want to but because there is a lack of 1) jobs, 2) educational opportunities, and 3) adequate health care. It appears to me that S4106 would play a significant role in providing that health care and in helping meet these basic needs. The benefit of such a program would not be only for the patients, but for the doctors, also. It would be a superb experience for a young physician fresh from internship to spend two years practicing community and family medicine in a rural setting. We will always need the traditional specialties such as pediatrics, surgery, and internal medicine, but we have a truly desperate need for physicians with skills, interest, and experience in community medicine and family practice. A small town or rural setting is the best possible place for this kind of experience and it offers certain kinds of personal satisfaction for both the patient and the physician which we need to re-discover. Traditional medical education and modern technology have taught us to be sophisticated technicians, but there is a great need to also understand the relatedness of things and the social context of health and illness. This is the principal benefit to the individual physician and to the American medical tradition, but it would also provide an enormously important avenue of creative activity for young physicians who feel they want to serve their countrymen for two years but prefer not to do it in a military setting. It was my privilege and honor to serve as a staff physician for the Peace Corps in Brazil for two years at the time when this assignment was still available to Commissioned Officers of the Public Health Service. This is how I discharged my military obligation and I thought it was an extraordinarily rich and creative experience. It is truly unfortunate that that alternative is no longer available to young physicians. A great many of my colleagues long to perform similar idealistic and humanitarian services but find that they are unable to do so because of financial reasons or the military draft. It is amazing that in a country as rich as ours there are young physicians who wish to perform these services and people who need them but the needs are going unmet. Private practitioners and organized medicine have traditionally opposed such programs, but this opposition cannot be allowed to prevent the provision of better health care for the rural poor. Sincerely, WARREN M. HERN, M.D. Hon. RALPH YARBOROUGH, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MEDICAL CENTER, DEAR SENATOR YarborougH: I was delighted to learn of your decision to hold hearings on S. 4106, "The National Health Service Corps Act of 1970," on August 28, 1970. I regret that University commitments did not permit me to testify before the Senate Health Subcommittee. I have long had an interest in the shortage and maldistribution of health services and I think the proposed legislation would be an important step in helping to correct these problems. The most important deficiency in the bill, in my judgment, is the proposed authorization for appropriations. I believe that a first year authorization of $10 million would be appropriate and subsequent authorizations should be fixed in the annual appropriations process rather than through a fixed authorization as called for in the bill. It is important that members of the National Health Services Corps be assigned in areas where their services can be linked to back-up support and services of highly skilled individuals and institutions. We clearly need a system that links physicians serving in low income areas with the needed back-up services in both urban and rural areas. In existing legislation there is authority to achieve this and grant funds are available to improve the delivery of health care. In the administration of the program and the assignment of physicians, these linkages should be assured and perhaps funds to provide transportation and other needed services could be coordinated. In my judgment, this would not require new legislative authority but it may be something you would wish to point out in the Record. Let me again express my deep appreciation for your long and great service to this country. Chairman, Health Subcommittee, Committee on Labor and Public Welfare, U. S. Senate, Washington, D.C. DEAR SENATOR YARBOROUGH: I want to emphasize again my appreciation for your efforts in giving early attention to the proposed National Health Service Corps Act of 1970. In connection with section 3991 (c) (3) (B), I would like to clarify my remarks concerning the possible consideration of private agencies to cooperate in carrying out the purposes of the Act. It has been my experience that faced with limitations in resources and policy restrictions, governmental agencies are not always able themselves to respond to such an effort, although in the same area a private agency could. To offer maximum flexibility in achieving the Act's purposes therefore, I believe adding the words "or private" after "governmental" in that section would be helpful. Section 3991 (c) (3) (B) would then read: "(B) the willingness of the community or area and the appropriate governmental or private agencies therein to assist and cooperate with the Corps in providing effective health services to residents of the community or area; Thank you very much for your efforts to provide seriously needed rural and urban health services through S. 4106. Sincerely yours, ROBERT L. NOLAN, M.D., J.D., Professor and Chairman, Division of Public Health and Preventive Medicine. |