HEALTH PLANNING AND RESOURCES DEVELOPMENT AMENDMENTS OF 1978 THURSDAY, FEBRUARY 2, 1978 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT, The subcommittee met pursuant to notice at 10:45 a.m., in room 2123, Rayburn House Office Building, Hon. Paul G. Rogers, chairman, presiding. Mr. ROGERS. The subcommittee will come to order, please. We are continuing hearings on the Health Planning and Resource Development Amendments of 1978. We are pleased to have as our first witness the Honorable Arlan Stangeland from Minnesota who is very much interested in this matter. We welcome you and your statement will be made a part of the record, and you may proceed as you desire. STATEMENT OF HON. ARLAN STANGELAND, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MINNESOTA Mr. STANGELAND. Thank you, Mr. Chairman. I appreciate the opportunity to speak before you this morning on the revised extension and amendment of the Health Planning and Resources Development Act. We all know that Government moves slowly, but it is 1978 and we are just now beginning to implement fully the provisions of this legislation which was initially enacted in 1974. Therefore, let me preface my remarks with the fact that we obviously need to extend the law and we definitely need to amend it. My primary concern is the small rural hospital. I represent the seventh district of Minnesota which has approximately 300 small towns and covers over 60,000 square miles. In this sparsely populated area, the continued existence of small hospitals is vital. As we all know, the Department of Health, Education and Welfare last September issued proposed health planning guidelines which imposed unrealistic requirements on rural hospitals. I do appreciate the Department's response to the outpouring of comments on these proposed guidelines. As a result of more than 55,000 communications received by the Department-54,000 of which seemed to have arrived in my office-it has recently revised the guidelines to allow a good deal of discretion for local health systems agencies in determining the accessibility of hospital care [see p. 882]. (879) The point I wish to make is that a lot of time, worry and bureaucratic procedure could have been avoided if the law itself explicitly states that such local discretion would be granted. As you know, we will soon be considering the Postal Service subsidy legislation. I think that we must realize what a large part the Government itself plays in creating the need for a subsidy in placing an often unnecessary burden on this public service. Fifty-five thousand pieces of mail could possibly have been eliminated by doing some homework prior to issuing regulations and guidelines. The Federal Government must begin somewhere to eliminate red tape and return control of their lives to the citizens themselves. It is my understanding that the recent guidelines are the first in a series of such proposals. We now have the opportunity to experiment in good Government by allowing local communities to decide how their needs may best be met. Instead of solving each situation with an ad hoc solution, we should determine beforehand what the policy will be and I urge that it be local input and control. Of course, we all recognize the need to reduce health care costs. I would like to point out that Federal control does not necessarily insure reduced costs nor better service. Two small hospitals in my district, which seem to be representative, have records of which I am proud. In Aitkin County, whose population is approximately 12,000, the average cost for 1977 for a day's hospitalization was $121 and the average length of stay was 5.9 days. Another community hospital in Warren, which serves a county of 14,000 managed to provide hospital care last year for $109 per patient day and kept its patients a little over 5 days per average stay. This compares with a national average of approximately $170 per day and an average stay of more than 8 days. During your deliberations on the proposed changes to this legislation, I most earnestly request that you approve language which formalizes the concept of local control by explicitly stating that local health systems agencies and the communities which they represent will be given all possible discretion in the administration of health care planning. By imposing guidelines from above, even though they may later be revised to allow more flexibility, we automatically implant in the minds of the local Health Systems Agencies the idea that they must meet these requirements. What we actually need is initial input from the affected communities who are free to express their ideas without any fear of coercion on the part of the Federal Government. We should start from the bottom up. Rather than proposing rigid and unrealistic guidelines, a little effort spent in consulting with local communities regarding their particular needs and requirements could eliminate a mass of communications, confusion and misunderstandings. In concluding, I would like to mention that here in Washington, with our immediate access to the finest health care available, we possibly do not realize the effect which proposals, such as those initially passed, can have on a small, rather isolated community. In Minnesota we have long, hard winters and we work hard in often. physically demanding and hazardous occupations. The comfort de rived from the knowledge that health care is available and that medical emergencies can be dealt with does not have a price tag. I was particularly concerned over the many letters which I received from the elderly population in my District. In our area older people who retire from the farm tend to concentrate in these small communities which the hospitals serve. A real, everyday concern to them is the availability of health care. I cannot emphasize too greatly the need to assure that these small hospitals are preserved. From their record of cost efficiency, I do not think we are granting any favors. Indeed, we may wish to consult with them to benefit from their experience. That is the end of my testimony, Mr. Chairman. If there are any questions, I would be happy to attempt to respond. [Testimony resumes on p. 906.] [The following letters were received for the record:] |