NEW YORK, N.Y., August 29, 1970. DEAR SENATOR YARBOROUGH: I have been asked to express my views on S. 4106 by Senator Magnuson. I am a resident physician, acquiring my training and rendering my services at Columbia-Presbyterian Hospital in New York City. I received my M.D. degree in June, 1969. I have always been around the center of the American political spectrum and, due to other commitment and my personality, I have never been politically active. I am in no way knowledgeable about the facts and figures relating to distribution of health services and how these bear on the validity of the National Health Service Corps Act as proposed. However, I feel that my point of view is important in that I would be the type of person participating in the program. Very briefly, after a year of being a doctor, a career in a large medical center, nor the city that goes with it, are not as attractive to me as they were a year ago. The fact that I am still subjugating my professional life for a future career at the age of 29 has begun to pall. Lately, I have had the longing both to get out of the city and into a genuinely rural setting, and to get myself into a situation where I would be serving people who truly needed my services. These longings are too personal and emotional to rationalize further. Suffice it to say that there are many, many young doctors with similar aspirations, who would make a dedicated cadre indeed. It was with this attitude that I have gotten interested, mostly through the news media in the needs of the migrant farm laborers. I am frankly shocked about two things since I have become interested in this problem: the first is that, in view of the obvious disproportion of medical care in relation to need in this country, the government does almost nothing about it in terms of employing doctors in these areas. The fact that I am having difficulty finding a single job in this area either in or out of the federal government is shocking, especially in light of the fact that it is difficult to practice medicine as a young doctor around the larger cities because of a glut of doctors in these areas. Secondly, not only do I find it shocking that there is strong opposition to this bill, but I find it embarrassing and at the same time enraging that other members of the medical profession comprise the major opposition. I cannot even imagine how a medical doctor could rationalize opposing this bill. I close with one plea: if it is the medical community which is blocking this bill-examine their motives very carefully. Sincerely, Hon. RALPH YARBOROUGH, JOHN V. WYLIE, M.D. AFL-CIO MARITIME COMMITTEE, Washington, D.C., September 3, 1970. Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: I am writing on behalf of the AFL-CIO Maritime Committee to express our support for S. 4106 that would establish a National Health Service Corps as a part of the Public Health Service. We hope that this legislation will be enacted promptly so that the health professional personnel system will be strengthened and improved. We realize that this strengthening would improve the level of medical care services for merchant seamen and other beneficiaries. We also realize that the legislation would give the PHS the opportunity to take a more aggressive role and provide leadership in the organization and delivery of health services. We believe the potential contribution to health that is authorized by S. 4106 far exceeds the $5 million in funds that are authorized for its implementation. May I respectfully request that this letter be made a part of the printed record of hearings. Sincerely yours, HOYT S. HADDOCK, PREPARED STATEMENT OF HERMAN EUGENE EVANS, EXECUTIVE SECRETARY, STUDENT NATIONAL MEDICAL ASSOCIATION, WASHINGTON, D.C. I CONCERN; II LOVE; III ACTION There is a problem in this country about which we in the Student National Medical Association are seriously concerned. That problem is the effective delivery of health care to black and other poor people. No health care, or extremely inadequate health care has been a womb to tomb reality for black folks. We are concerned about the reality of heart disease, hypertension, arthritis, mental disease, visual impairment and orthopedic disability all being more common among the poor. The fact that death rates from tuberculosis, syphilis, influenza, pneumonia and vascular lesions of the central nervous sytsem are twice as high among non whites as among whites; the fact that for the poor the risk of dying under age 25 is 4 times the national average and that life expectancy for non whites is still 7-10 years shorter than that for whites are all things about which we are very concerned. But the conditions don't stop there, they go on: the maternal mortality of blacks is much higher than that of whites, non white mothers die in childbirth + times as frequently as white mothers; the infant mortality, which according to the U.S. children's Bureau rises as family income decreases, is much greater amongst non whites-it's twice that of whites; and in recent years there's been a smaller reduction in infant mortality among non whites than whites, resulting in widening disparity in infant death rates by race. 50% of poor children are incompletely immunized against smallpox or measles; 60% of poor children have never seen a dentist; more statistics: Illness is twice as frequent among families with annual incomes of $2,000 or less; 4 times as much chronic illness among our families; in the preventive services area, only 8.6% of white children have no immunizations compared with 22.5% of non white children; visits to doctors and dentists despite the obvious greater need are less frequent among the urban and rural poor; why? Because many inner city neighborhoods are far from where hospital clinics were set up a generation or more ago; doctors have moved to the more affluent suburbs; public transportation from many of the inner city neighborhoods is lacking, insufficient or expensive. If the kids are poor and if they are black Jonathan Kozol's book "Death at an early Age" literally applies. All of these things are of primary concern to the Student National Medical Association which has for its membership all of the black students as well as other minority students in this country's medical schools. We are concerned too about the production of physicians who will be both willing and eager to serve our people I'm talking about the production of black and other minority physicians. Dr. Paul Ehrlich, in his book "The Population Bomb" has documented how the death rate today in Costa Rica is low in part due to a large number of physicians in proportion to their population. In this country at present there is one white physician per 700 white people and one black physician per 4,000 black people. Black physicians make up barely 2% of this country's total physician population, and to carry this theme further, black medical students-hopefully the future black physicians-make up barely 2.7% of the total medical school student body. In 1938-39, over 30 years ago, the black student medical school population was 1.6% of the total, thus an increase of a one percentage point in 30 years. Over this same time period the number of total positions in medical schools have nearly doubled. These figures put in context with the leaps and bounds with which the black and other minority populations have grown make for a situation which merits grave concern. But the tune goes on, it doesn't stop there: over 50% of this country's 102 medical schools income comes from government sources, both federal and local. These are monies collected from the taxes on the hard earned wages of poor people who get little in the way of service in return. Thus for health care, as well as other things, black and other poor people remain dependent on a system that has refused to educate our young people but has demanded retention of the power to plan which services have, and will trickle into our communities. We are concerned that this situation is allowed to exist! The Student National Medical Association at its conference in April 1970 accepted a number of commitments, all of which dealt with the improvement of the health condition of black and other minority people in this country. One of the most significant of these resolutions was: We as future black and other minority health personnel, recognizing that our first priority is to deal with the health needs of our people, and that our skills can best be utilized to this end, intend that the selective service obligation will be spent in our communities. We are here today to express that the National Health Corps can be that viable alternative to the military service obligation which we feel, due to our domestic priorities, is absolutely necessary. The National Health Corps will provide a number of things: (1) it will provide for needy areas, well trained personnel who are, hopefully, culturally and socially of the same vintage of the people who badly need their services (and I say hopefully because when the bill is passed we intend that the assignment of the corpsmen would be to their own, or similar community and of course, this means that these areas must be tapped for health science recruitment. (2) It will provide another avenue for the procurement of education and jobs for our people in our communities, and (3) amongst poor people in which category most blacks fall, it will provide a spark in the direction of starting the flame of faith in the administration's and congress' ability to reevaluate their priorities. We in the SNMA are not so much concerned about who gets the political credit for the passage of this bill, but we are very concerned that the bill is passed without castrating compromises; we are concerned that this bill receive swift approval and immediate implementation. The time is now. There have been enough studies, enough research papers, enough blue ribbon committees, enough high level commissions and yes, there have been enough even White House Conferences on the issue of health and its delivery to the people of this country for something to be done about it now. And clearly 50 million people in this country need action now. What is action? Action according to Webster, is the bringing about of an alteration by force, or through a natural agency. Force, according to one of the definitions given by Webster, is violence exerted upon or against a person or thing. Now I'm sure that everyone in this room and, that the rest of Congress, all deplore the use of violence as a means to any end, and we concur. However, in the past and today, violence has often been escalated to a tool of necessity for reaching the insensitive and indifferent elected officials and public agencies of power, which should be but are not serving the needs of black and other minority people. I am talking about the health care delivery system of this country which is in a real crisis, and this crisis situation is greatly magnified in regard to black people. When we consider the health statistics of this country we are constantly reminded of black genocide in ways that are not as blatant as a shot in the back or a lynching but just as deadly as both. We in the SNMA out of a sincere Love for our fellow man are concerned that black and other minority people are still living in these unchanged sickening conditions. We are committed to seeing these conditions changed. Several of our members are working now, have worked in the past and will be working throughout this coming year in comprehensive health units in areas where there is a tremendous need-both rural and urban. We have seen the need, many of us have lived that need, and now all of us want to address ourselves to that need. We feel confident that there are many members of congress who out of a deeply felt concern and love for humanity will see to it that this bill is passed and implemented. We are confident that you will not be dissuaded by cries of future budgetary excess by the administration and that you will remember that your main business is not to see what lies dimly at a distance but to do what lies clearly at hand. The health of 50 million people is clearly at hand. We feel confident that Congress will dispense with legal procrastinations and legislative tieups, the face of what we feel should be a top priority of this country, and pass a bill that will make one of the objectives of the Health Services and Mental Health Administration (Public Health Service) more of a tangible reality for many poor people and that objective is: To insure that quality health care and services are available for all. The SNMA supports the passage of and the immediate implementation of this bill establishing a National Health Corps. NATIONAL MEDICAL ASSOCIATION FOUNDATION, INC., Hon. RALPH W. YARBOROUGH, DEAR SENATOR YARBOROUGH: I have read with interest and enthusiasm a Comtee Print of S4296, your proposed amendment to Title VII of the Public th Service Act. This amendment represents a major step toward increas ing effective recruitment of minority, financially oppressed, and disadvantaged persons to the health professions. It additionally enhances the impact of $3586 which was passed by the Senate earlier this year. The basic tenets of the proposed legislation addresses directly and concretely major problems which have heretofore effectively discouraged minority and/or disadvantaged persons from pursuing health careers. Specifically, Section 2, Part H of the bill would establish new programs to identify, encourage, and assist financially or educationally disadvantaged individuals to prepare for, enter, and complete training in the health professions. This type of comprehensive approach to "recruitment" and "retention" is necessary to encourage and insure greater representation within the health professions of those previously excluded because of economic, educational, or racial constraints. Many of the financially oppressed fear the large loans necessary to support current academic study and shy away from consideration of a health profession because of their inability to mentally cope with this economic burden. For others, the existing ceiling on student loans makes it difficult to consider borrowing money which will only support in part their educational process. The enticement of a liberalized loan program under Section 3 of the bill is made even more attractive by the expanded program for loan cancellation, and succinctly presents added incentive for the recent graduate to return to, and practice in, health deprived communities. The proposed increase in student loan authorization under the same section is also sorely needed. It is universally recognized that the most pressing need in the long process of producing a health professional-especially a physicianis financial assistance. Section 4 of the bill further extends financial assistance through a change in the scholarship grant formula to schools. This change should encourage acceptance of disadvantaged students by the health schools which nationally are facing fiscal crises and hence may lean to more conservative standards and approaches to student selection. The National Medical Association Foundation is actively engaged in the development and implementation of health care programs which explore new methods of health care delivery. We are thus keenly aware of and deeply interested in the problem of health manpower. The Health Careers Program of the NMAF is our approach to meeting the need in this area. It addresses the problems of recruitment, counselling, "retention" and financial support for blacks interested in the total spectrum of health services. I enclose a brochure of the Health Careers Program and a copy of the Foundation's annual report for your perusal. The National Medical Association Foundation heartily endworses the S4296 "The Health Professions Assistance Amendments of 1970". Sincerely, 49-726 0-708 JEAN L. HARRIS, M.D., Executive Director. |