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The medical need, of course, is the criteria which should be used, and it is often very difficult to know what that medical need is in advance.

That, of course, has been very interestingly shown to us in connection with the EMIC program. The type of care that many of the maternity patients, and the infants who have had care, have been given, many serious emergencies have arisen, and the very fact that consultation was available without question, that all of the special laboratory and X-ray and other types of examination were available without question, that hospitalization was available for as long as was necessary, that special nurses were available immediately if necessary, has been, as far as we are concerned, one of the most satisfying aspects of that program, because many people could receive the care they needed.

I would venture to say that the satisfaction that a number of the physicians who have participated have found in that aspect of the program has been a very great satisfaction. They have told me so themselves.

Senator PEPPER. In other words, Doctor, it has been your experience that it is better, on account of the difficulty of the application of the means test, to allow maybe a few people to get the benefit of such a program as this, who might without any hardship whatever be able to obtain the services otherwise, than to impose the means test on all who shall seek these services?

Dr. OPPENHEIMER. I think so. And of course, if it is necessary to impose a means test it should be a very liberal one, so that the real interests of the child can be considered in toto.

Senator PEPPER. And the public having the vital interest of the child that society always has, is, of course, vitally concerned that the parents shall not err on the side of incapacity, perhaps so that the State shall lose a citizen, or shall become a handicap which the State eventually shall have to contribute to.

Dr. OPPENHEIMER. Yes.

Senator PEPPER. Do you have any further questions, Senator Donnell ?

Senator DONNELL. No, sir.
Senator PEPPER. Thank you very much, Doctor.

STATEMENT OF DR. C. WILLARD CAMALIER, AMERICAN DENTAL

ASSOCIATION

Senator PEPPER. Dr. C. Willard Camalier, American Dental Association.

Dr. CAMALIER. Senator Pepper, members of the committee, I am a local dentist, and past president of the American Dental Association, and submit this statement on behalf of the legislative committee of that organization.

Senator PEPPER. What is your address?
Dr. CAMALIER. 1726 Eye Street NW.

I think I can save the committee a little time by filing this state. ment for the record and then discuss the outstanding points.

Senator PEPPER. Thank you.

(The statement is as follows :)

THE AMERICAN DENTAL ASSOCIATION STATEMENT PRESENTED AT THE HEARINGS

ON THE PROPOSED MATERNAL AND CHILD WELFARE ACT OF 1945 (S. 1318), BEFORE THE SENATE COMMITTEE ON EDUCATION AND LABOR

(C. Willard Camalier, D. D. S., past president of the American Dental Association,

and chairman of its war service and postwar planning committee) I am Dr. C. Willard Camalier, past president of the American Dental Association and chairman of its war service and postwar planning committee. I am presenting this statement on behalf of the legislative committee of the American Dental Association, relative to S. 1318.

The American Dental Association, whose headquarters are in Chicago, has a membership of 56,000 dentists. This represents more than two-thirds of the 75,000 dentists registered in the United States. The association is comprised of 58 constituent societies in all of the 48 States, each territory and possession, the Army, the Navy, the United States Public Health Service, and the Veterans' Administration. Within the constituent societies there are 440 organized district dental societies located in all parts of our country. Each of the constituent societies annually selects delegates to attend the sessions of the house of delegates, which is the policy-making body of the American Dental Association.

During many of its sessions in past years the house of delegates of the association has given careful attention to the dental healih problem in this country. As a result, a number of broad policies have been adopted by the house of delegates which the dental profession believes must form the framework for any plan designed to promote dental health.

The basic idea behind these rolicies is that an attack on the dental-disease problem must be made through prevention and effective dental-care programs for children. It is for this reason that the American Dental Association has a special interest in S. 1318.

The proposed bill (S. 1318) is designed apparently to make funds available to the S'ates to provide medical, nursing, dental, and hospital services to all mothers and children who elect to participate in the benefits of the program. While the American Dental Association recognizes the need for an expansion of health services for mothers and children, the association does not believe that the provisions of the bill will permit the establishment of sound methods for promoting dental health. The American Dental Association, therefore, is opposed to the enactment of S. 1318 in its present form.

The American Dental Association has adopted four principles as a guide to the establishment of dental health programs. The fcur principles are:

1. Research: Adequate provisions should be made for research which may lead to the prevention or control of dental disease.

2. Dental health education : Dental health education should be included in all basic educational and treatment programs for children and adults.

3. Dental care: (a) Dental care should be made available to all regardless of income or geographic location. (b) Programs developed for dental care should be based on the prevention and control of dental diseases. All available resources should first be used to provide adequate dental treatment for children and to eliminate pain and infection for adults. (c) Dental health is the responsibility of the individual, the family, and the community, in that order. When this responsibility, however, is not assumed by the community, it should be assumed by the State and then by the Federal Government. The community in all cases shall determine the methods for providing service in its area.

4. In all conferences that may lead to the formation of a plan for dental research, dental health education and dental care, there should be participation by authorized representatives of the American Dental Association

For a considerable number of years the American Dental Association has taken an active part in planning for an expansion of community dental health servires that are based on the above four principles. Some progress has been made in most of the States in which dental divisions in State health departments have been established through the efforts of the component societies. However, State and community dental health programs have not been as productive as they might be owing chiefly to a lack of funds and other facilities to carry out exneriments and demonstrations in methods for preventing dental disease, in educational technics, in methods of payment for dental services, and in the employment of

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ancillary personnel. The American Dental Association does not believe that the dental provisions of S. 1318 will assure the establishment of sound and effective community dental health programs for the following reasons:

1. S. 1318 does not contain specific provisions for dental research, dental health education and dental care in accordance with the four principles outlined above. Therefore, the bill will not permit the establishment and maintenance of a comprehensive dental health plan.

2. S. 1318 does not specifically earmark funds for dental programs; nor does it even suggest the proportion of funds that may be used for dental health. Experience in the past has shown that public health agencies are reluctant to budget a fair proportion of available funds for dental health programs.

The amount of money budgeted for dental health plans at the State level in the United States for the fiscal year 1941 was only six-tenths of 1 percent of the $109,000,000 budgeted from all sources for cooperative health work. The extent of the dental-disease problem is far out of proportion to the small percentage of funds now allocated for dental purposes. Dentists and dental health officers who have worked in the public health field for many years are convinced that this problem will never be solved until funds are specifically allotted for dental health programs. S. 1318 does not give that assurance.

3. S. 1318 does not provide specifically for a national dental advisory committee to assist the Children's Bureau in the adoption of administrative policies and regulations; nor does the bill provide specifically for State dental advisory committees which would be consulted relative to the adoption of State plans.

Section 103, paragraph 10 of the bill (p. 7, lines 6 to 13) states that a State plan for maternal and child health services must "provide for a general advisory council

composed of members of the professions and for technical advisory committees

composed of medical and other professional groups concerned with the administration or operation of the State plan."

Section 105, paragraph 1 (p. 10, lines 9 to 14) states that “the Chief of the Children's Bureau shall formulate general policies for the administration of this title after consultation with (1) a conference of State health officers and (2) an advisory committee composed of professional and public members and, as necessary, technical advisory committees, which he shall appoint."

While it might be assumed that dental advisory committees could be classified as “technical advisory committees” the wording of the bill is unnecessarily vague. The appointment of dental advisory committees would be left to the discretion of the State health agency and the Chief of the Children's Bureau. Such indefinite policies are not satisfactory to the dental profession.

4. S. 1318 is vague with respect to the provision of dental services. It proposes to make dental care available to all mothers and children. However, all references to dentistry are omitted in those sections dealing with the provision of health services. For example, page 6, lines 9 to 13, provides that State plans must make provisions for "payments to individual physicians for care furnished under this title on a per capita, salary, per case, or per session basis, or in the case of consultations or emergency visits on a fee-for-service basis."

S. 1318 contains no information as to how dentists will be paid for dental services.

No mention is made of dental provisions in any of the other sections dealing with public health and medical care, although the first paragraph states that it is the purpose of the bill to provide medical, nursing, dental, hospital, and related services.

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THE PROPOSALS OF THE AMERICAN DENTAL ASSOCIATION

As has been stated, the American Dental Association is opposed to the enactment of S. 1318, in its present form. Extensive revisions would need to be made to meet the association's requirements for a satisfactory dental health program for mothers and children. The American Dental Association believes a better plan would be to secure the passage of S. 190 and S. 1099. The former has already passed the Senate. These bills provide Federal grants-in-aid to the States for intensified dental research and for experimental programs in all phases of dental health education and dental care.

In contrast to the proposals contained in all other health bills now before Congress S. 190 and S 1099 would permit a realistic and comprehensive attack on the dental-disease problem.

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The enactment of S. 190 and S. 1099 would provide the means for a systematic development of dental health programs designed :

1. To prevent dental diseases by discovering more effective preventive methods.

2. To control dental diseases by the expansion of community dental programs. These programs should be maintenance programs centered on the control of the annual increment of new dental defects in children.

3. To educate the public relative to the importance of dental health and the methods by which dental health can be achieved.

We hope that the United States Senate will give favorable consideration to S. 1099 as it has done in the case of S. 190, sponsored by the American Dental Association.

Dr. CAMALIER. As you know, the American Dental Association represents about 75 percent of the dentists of the country and is composed of about 56,000 total out of 75,000 in the United States.

We are organized very well, as you gentlemen understand. The house of delegates meets annually and passes on these matters of policy as it has in this type of legislation, and this statement today reflects just about the view of the organization.

We do feel that the objectives of the bill are good, but we differ a good deal with the technical phases of it. We feel that if some changes could be made it is possible that it might be acceptable to the association. However, we do feel that it does not comprise a comprehensive program for dental health for the American people.

For instance, the association has adopted four principles that I think have been filed with this committee, and I will not burden you with them except to state that they embody research, dental health education, dental care. And they request that in all conferences having to do with dentistry, representatives of the American Dental Association be considered. That has not always been true.

Some advisory committees have been selected for consultation, but not with the approval of the association, the result being that we feel that the profession in the United States has not been properly represented at these conferences.

The American Dental Association does not believe that the dental provisions of S. 1318 will assure the establishment of sound and effective community dental health-it does not contain specific provisions for dental research, dental health, education, and dental care in accordance with the four principles contained above. Therefore, the bill will not permit the establishment and maintenance of a comprehensive dental program.

Second, S. 1318 does not specifically provide dental funds for a dental program nor does it proportion the funds to be used for dental health. Experience has shown in the past that public health agencies are reluctant to budget a fair proportion of available funds for dental health programs

The amount of money budgeted for dental health plans at the State level in the United States for the fiscal year 1941 was only six-tenths of 1 percent of the $109,000,000 budgeted from all sources for 10operative health work.

The extent of the dental disease problem is far out of proportion to the small percentage of funds now allocated for dental purposes Dentists and dental health officers who have worked in the public health field for many years are convinced that this problem will never be solved until funds are specifically allotted for dental health pro grams. S. 1318 does not give that assurance.

S. 1318 does not provide specifically for a national dental advisory committee to assist the Children's Bureau in the adoption of administrative policies and regulations; nor does the bill provide specifically for State dental advisory committees which would be consulted relative to the adoption of State plans.

Now, on that point, gentlemen, we feel, as I said here before, that representatives from the American Dental Association should be invited to be on these advisory committees, and we also feel that the nominations might be made from the American Dental Association to these committees.

It seems to me that that is a democratic way of handling the thing. At the present time you have your chiefs of your governmental services making selections, and sometimes they are not in the best interests of the problems to be considered, but we feel that the most democratic way would be to have these men selected by large groups who are primarily interested in the problem.

I can cite, for instance, the procurement and assignment service of the War Manpower Commission during the war, of which I happened to be a member. We were selected by various organizations-medical, dental, and veterinary organizations and we served the Army and Navy and Public Health Service, I think, in quite a creditable way.

We represented a large group of professional people and we are not bound specifically, as they are apt to say of these representatives by the actions of our organization, but we often took our findings back to the organization, got there reactions, and brought them to the conferences, and we feel this procedure was of real value to the governmental agencies. That would hold true at the State level.

Section 103, paragraph 10, of the bill (p. 7, lines 6–13) states that a State plan for maternal and child health services mustprovide for a general advisory council

composed of members of the professions

and for technical advisory Committees posed of medical and other professional groups concerned with the administration or operation of the State plan.

Section 105, paragraph 1 (p. 10, lines 9–14) states that, the Chief of the Children's Bureau shall formulate general policies for the administration of this title after consulation with (1) a conference of State health officers and (2) an advisory committee composed of professional and public members and, as necessary, technical advisory committees, which he shall appoint.

While it might be assumed that dental advisory committees could be classified as "technical advisory committees” the wording of the bill is unnecessarily vague. The appointment of dental advisory committees would be left to the discretion of the State health agency and the Chief of the Children's Bureau. Such indefinite policies are not satisfactory to the dental profession.

S. 1318 is vague with respect to the provision of dental services. It proposes to make dental care available to all mothers and children. However, all references to dentistry are omitted in those sections dealing with the provisions of health services. For example, page 6, lines 9–13, provides that State plans must make provisions forpayments to individual physicians for care furnished under this title on a per capita, salary, per case, or per session basis, or in the case of consultations or emergency visits on a free-for-service basis.

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