In closing, I wish to make an appeal for the objective and open-minded consideration of this legislation both within Congress and beyond. At first reading, some individuals or groups may perceive in this legislation a threat to established institutions or a barrier to future innovations. Closer inspection of the bill and its provisions will reveal that nothing of the sort is intended or contained within it.

The National Health Service Corps is frankly an experimental concept, and one that may lead to many different conclusions about the nature of health care in the future. In and of itself, however, the National Health Service Corps is compatible with current or potential national policies on the delivery of health care; it is not a threat to the manpower needs of the Department of Defense; it will not hamper, nor be hampered by, abolition of the doctor draft or the introduction of National Health Insurance. The National Health Service Corps is not an attempt to structure the health policies of the United States government, nor need it be subjected to a "public-vs.-private" debate that inevitably occurs whenever innovations in health care are suggested. Its only purpose is to serve the health needs of the poor, and to provide us with a body of knowledge from which we may find more effective ways to serve those needs on a major scale in the future.

Let us not judge the Corps in advance. Let us create it, fund it, and observe its performance. Then let us draw our independent conclusions about its value and what it tells us about the future. By creating the Corps and setting it in operation, we will at least have provided some health care to those who need it most, and we will have demonstrated to the poor that we truly are concerned about improving their condition. And if the Corps should fare better than this— as I hope and believe it will-its creation will have been a major step in meeting the crisis in health care that we face as a Nation today.

EXCERPT FROM THE HEARINGS BEFORE THE SENATE APPROPRIATIONS COMMITTEE, SUBCOMMITTEE on Departments of LABOR, HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES, 1970, ON FISCAL YEAR 1971 BUDGET

Senator MAGNUSON. Because of the lack of physicians and the problem of distribution of physicians we introduced a bill the other day, Senator Jackson and I, to see if we couldn't use commissioned officers in the Public Health Service in direct medical services to the urban poor and rural areas. Dr. Steinfeld, do you think this is a good idea?

Dr. STEINFELD. I think it is excellent.
Senator MAGNUSON. Thank you.

The CHAIRMAN. Senator, we all know serving here that very often when we have a beneficial measure in the closing days of Congress, we try to get hearings on it and set it up as a prelude to succeeding Congresses, but that it not my object in calling these hearings. I intend to get this bill out of subcommittee and the full committee and on the floor of the Senate, and I am sure the leadership of the Senate would cooperate. I would like to see it passed this year. We can't speak for the House. We hope to have the same cooperation.

It is my objective in calling these hearings, not just to set up something for next year, but to try to pass the bill this year. It would be too bad if it is deferred another year.

Senator MAGNUSON. I might say to the chairman that in the past few weeks I have been holding the hearings on the HEW education bill that has now become in overriding the veto. But the Surgeon General and Dr. Egeberg, Assistant Secretary for Health, in the hearings, particularly the Surgeon General, endorsed this bill. I will see that you get a copy of those hearings to put in your record.

The CHAIRMAN. Yes. Senator Magnuson, please, before you leave, there is an important matter pending before us for this next year. Last year, when I became chairman of the Appropriations Subcom

mittee that deals with the Bureau of the Budget, I inquired into this. They had 178 hearings examiners at the bureau, and we gave them more. They said they needed more hearing examiners. These are the top people who pass on the budgets for different departments. We found that they did not have a single health professional or educational professional among all of those hearing examiners, who are constantly cutting back on these health and education bills.

Now we had in this country at the end of World War II 23 Public Health Service hospitals, and they have cut them back to eight. I have been digging into where the cutbacks came from, whether or not it is the Bureau of the Budget urging to cut off the money. They are trying to cut off the last hospital at the Great Lakes, and these Public Health Service hospitals have more latitude for research than any other system of hospitals in the country. It is very vital they be protected so as to stop this movement to absolutely disestablish and destroy them.

This ought to be stopped, and reversed. Your bill is a reversal; it is an important bill, for its internal content and for its thrust. I hope it will blunt and turn back this effort. We have had these hospitals from 1790. One of the first laws was the Maritime Seaman's Hospital from which came the Public Health Service hospitals, and this gives us some instrumentality so the Bureau of the Budget cannot destroy the PHS. Your bill is a landmark bill in helping to bring back, revitalize, and extend the PHS system.

Senator MAGNUSON. I might say, too, I have been disturbed during all of these hearings, as have the members of this committee, in what I like to call the delivery of health care.

The research has been good; there have been good things in research, but the delivery of health care has lagged, and this bill would put a new sense of urgency there. We have also been disturbed about the morale of the Public Health Service; there is a feeling that maybe the Service is not making contributions it ought to, and this bill would allow it to do so once again.

As a matter of fact, they tell me the introduction of the bill itself built up morale in the Public Health Service.

The CHAIRMAN. I think the morale is going down because the administration is closing the Public Health Service hospitals and trying to destroy this Service. I want to assure the Senator-and I seldom make this statement publicly-but I intend to push this bill with every resource I have.

At this point we will receive for the record the statements of the senior Senator from Massachusetts, Mr. Kennedy; the junior Senator from Wisconsin, Mr. Nelson; the junior Senator from Washington, Mr. Jackson; and the senior Senator from California, Mr. Murphy. (The statements referred to follow :)

STATEMENT OF HON. EDWARD M. KENNEDY, A U.S. SENATOR FROM THE STATE OF MASSACHUSETTS

Mr. KENNEDY. Mr. President, I am pleased to cosponsor the National Health Service Corps Act of 1970, introduced today by the distinguished Senator from Washington (Mr. MAGNUSON). As chairman of the Appropriations Subcommittee on the Departments of

Labor and Health, Education, and Welfare, Senator Magnuson has been one of the foremost advocates of better and more adequately funded health programs in the Nation, especially in the area of health manpower. The legislation introduced today is a tribute to his leadership in the field of health, and I hope that it will receive early action by Congress.

A National Health Service Corps will be an important step forward toward alleviating what is perhaps the most serious aspect of our overall health crisis-the worsening shortage of health manpower. Indeed, at bottom, our crisis in health is essentially a crisis in manpower. The need is urgent for more physicians, more dentists, more nurses, and more allied health professional and technical workers. We must develop new types of health professionals and para-professionals. We must make far more efficient utilization of our existing health manpower. Only if we succeed in these efforts will we be able to free our physicians and other highly trained health experts to carry out the skills for which they have been trained. In far too many cases, highly trained physicians spend the overwhelming majority of their working day in tasks that do not require their specialized medical skills.

One of the most promising methods of easing the shortage of doctors is to train new types of health workers to perform nonspecialized tasks, thereby freeing physicians for other, more urgent needs. We must develop a broad new range of allied health professionals, such as paramedical aides, pediatric assistants, community service health officers, and family health workers.

At a number of our universities, imaginative new programs are underway to train medical corpsmen from Vietnam as physicians' assistants. In Senator Magnuson's own State of Washington, for example, hospital corpsmen are being trained for 3 months in the medical school and then sent into the field for 9 months further training in the offices of private physicians. A similar program now exists at Duke University. These programs are unique in their emphasis on combined training in the classroom and in the field. They are programs that must be greatly expanded if we are to meet the urgent demand for more and better trained health manpower.

The need is especially clear in the case of the shortage of doctors. Our low physician-population ratio means that unsatisfactory medical care is a way of life for large numbers of our people in many parts of our Nation. The family doctor-the general practitioner-is fast disappearing, and is on the verge of becoming an extinct species. At the present time, only one out of four of the Nation's physicians is engaged in the general practice of medicine. Three out of four are specialists, most of whom accept patients only on a referral basis. Simply to meet the demand that exists today, it is widely known that we need 50,000 more doctors, and 150,000 more nurses.

To make matters worse, the geographic and social distribution of our doctors is highly uneven. This is the area where the National Health Service Corps will make its greatest contribution. Two-thirds of the physicians in America serve the more affluent half of our population. In some States, to be sure, the physician-population ratio is higher than the national average of 130 doctors per 100,000 population. In Washington, D.C., for example, the ratío is 318. In New York it is 199; in Massachusetts, 181.

In 16 States, however, the physician-population ratio is far below the national average. In Alaska and Mississippi, the ratio is an abysmal 69, or about one-half the national average. In Alabama, it is 75. Even in Texas, it is only 106. Clearly, therefore, extremely large groups of our population are receiving seriously inadequate medical care because of the shortage of physicians.

The problem is especially critical with respect to the health needs of our urban and rural poor. For too many of the poor, the only doctor they know is the cold and impersonal emergency ward of the municipal or county hospital. For too many of our citizens, the family physician has disappeared, to be replaced by the endless and depressing waiting rooms of hospitals built at the turn of the century.

Nowhere are the inequalities of our society more obvious than in the sickness of our poor. We know that our affluent few can buy the world's best medical care. But all too often it is care provided in modern medical towers looking out on urban landscapes condemning thousands of citizens to a lifetime of disease, under some of the worst medical care anywhere in the world.

In the United States today-the wealthiest Nation in the history of man-millions of our citizens are sick. And they are sick because they are poor. Their sickness is the shame of America. Of all the faces of poverty, the sickness of the poor is the ugliest. Of all the effects of poverty, it is the sickness of the poor that we could attack most easily, had we the will.

In areas of urban and rural poverty in the United States, medical care is available but only if one travels far enough, waits long enough, and endures the crowds, the inconvenient hours, the understaffed facilities.

The National Health Service Corps will help to solve these serious problems. I believe it is one of the most important steps we can take if we are to meet the critical need for health manpower in depressed areas. Once young Corps physicians are exposed to the problems of health care in poverty areas, I believe that a significant number of them will be encouraged to remain and dedicate their careers to this service, to the lasting benefit of the health of America.

STATEMENT OF HON. GAYLORD NELSON, A U.S. SENATOR FROM THE STATE OF WISCONSIN

Mr. NELSON. Mr. President, I am very pleased to sponsor this legislation establishing a National Health Service Corps with my distinguished colleagues.

Under this plan, teams of medical professionals and paraprofessionals would be sent into city and rural poverty areas to upgrade the medical care now available there.

It is loosely patterned after the National Teacher Corps program, which Senator Kennedy and I originally proposed in 1965. It is my firm belief that this health care program is destined to meet with the same overall acceptance by professionals in the medical field as well as the people to be served as the Teacher Corps has enjoyed over the past 5 years of its operation.

Despite dramatic medical advances and the investment of billions of Federal dollars, we are on the brink of a national health crisis with

thousands of families in urban ghettos and residents in poverty stricken rural areas unable to obtain adequate health and medical care. The health resources of the Nation have been badly misallowed. Highly trained personnel and highly specialized medical equipment have been clustered in shiny new medical centers, isolated from the needs of many citizens in the inner city and rural towns.

The National Health Service Corps could substantially correct the present maldistribution of medical manpower by using local volunteers, paraprofessionals, and professionals in community clinics and other facilities serving the citizens of urban and rural regions.

Physicians serving in the program would become members of the U.S. Public Health Service as commissioned officers and would fulfill their military obligation. Nurses and other health care personnel would be recruited by the Public Health Service for assignment by the U.S. Surgeon General to serve in various areas of the country.

A National Health Corps Advisory Council, comprised of Government representatives, private citizens, and recipients of service by the Health Corps, would develop the policy governing the selection of personnel and their assignment to areas inhabited by medically needy.

In addition to projects in city ghettos, the Corps personnel could be used in health care programs serving Indians, migrant workers, Headstart children, people in model cities neighborhoods and expanded programs based in Public Health Service hospitals, neighborhood health clinics, and community mental health clinics.

Our young doctors, nurses, and other medical personnel should be given the opportunity to share in the satisfaction of public service through participation in a National Health Corps. Their counterparts in the educational and legal professions have already displayed their social consciousness by flocking to work in the National Teacher Corps and neighborhood legal services program.

Implicit with this manpower plan is the need for expansion of neighborhood health clinics and hospital satellite centers, the development of improved means to transfer patients to facilities with better medical resources, and a reassessment of priorities in Government health programs.

Local community residents, trained by medical personnel in local hospitals, could be mobilized as health workers to inform their neighbors about family health practices, preventive medicine, and the accessibility of health care while others could prepare for new career positions in the health field.

Without a comprehensive revision of the organization and delivery of health and medical care, millions of citizens will continue to receive no care at all or very marginal care at best.

As medicine becomes more and more specialized, there are fewer and fewer general practitioners available to serve the routine medical needs of the public. Less that 2 percent of today's medical graduates enter general practice.

When confronted with a relatively minor ailment, such as a cold or sprained ankle which could be normally treated at a doctor's office, many city residents must travel to the emergency room of a city hospital to receive medical attention.

These noncritical cases clog the emergency facilities and become a wasteful burden on the efficiency of the hospital's operation.