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.

Now, as 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.

Contrasts of the proposal are contained in all other health bills now before Congress. S. 190 and S. 1099 would provide the means for a realistic and comprehensive attack on the dental disease problem.

The enactment of S. 90 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.

Mr. Chairman, that concludes my statement.

Senator DONNELL. Doctor, going back to the fundamental theory of this bill, as I understand it, namely, the use of public funds, to make them available to all persons within these classes, namely, the maternal class, and all children of the country, do you favor the theory under which public funds shall be used to pay all the expenses of medical, dental care, et cetera, as listed in this bill, for all children in the country, and for all mothers during the period of pregnancy, or what is termed here the maternity period, or do you think that that is not advisable?

The theory I am trying to put before you is the theory of public funds for the payment of all of these expenses for all the children in the United States for whom application may be made, and for all mothers during the maternity period.

Do you favor that theory?

Dr. CAMALIER. I think, Senator, that a common-sense viewpoint of that would be that those who could not afford to pay for this should have the benefits.

Senator DONNELL. I am not sure whether I understand your ultimate conclusion. You say that those who could not afford to pay should be the ones to receive the benefits?

Dr. CAMALIER. Yes, sir; I feel that way.

Senator DONNELL. Then as to the people who can afford to pay, do you think they should receive the public moneys or the services purchased with public moneys?

Dr. CAMALIER. I would say that if there were certain individuals in the country, a family, for instance, that would not be willing to give these services to their child, I think that somebody should step in, either the community or in the long run the Federal or State Government, because the child should get the service irrespective of whether somebody wants to give it to him or not. But I think it goes in that order: the individual, the community, the state, or the Federal Government should take care of the situation.

Senator DONNELL. That does not quite answer the point I had in mind, Doctor, at least I did not get it.

The point I have in mind is this: Do you think it is advisable to take out of the Public Treasury and pay for all the health, nursing, dental, hospital services, of all the children in the United States, without reference to whether those children and their parents are able to pay for those services or not?

Dr. CAMALIER. No, I do not.

Senator DONNELL. This bill, at least, makes those funds available for that purpose to every child in the United States, does it not? Dr. CAMALIER. Yes, it does.

Senator DONNELL. So that to that extent you would not favor this bill?

Dr. CAMALIER. If the funds are made available I think there should be some control somewhere. To differentiate between those that can and cannot afford to pay. It could best be controlled at the State level?

Senator DONNELL. And there is no such differentiation in this bill?

Dr. CAMALIER. No. I have not seen it.

Senator DONNELL. Of course, the point is made, and I can well see its effectiveness, by Senator Pepper, that it may be very difficult to impose a test to determine whether or not a person has the need or does not have the need. Nevertheless, as I understand your view, you do not favor the principle of using public money to pay all this type of expense for people who can afford to pay for it. Dr. CAMALIER. Yes, sir.

Senator DONNELL. Doctor, there is one matter here, this is a matter of draftsmanship and I am just asking your opinion on it. Do you think that the bill clearly covers all dental services for children?

Dr. CAMALIER. No, I do not. That is what we are complaining about. It is not included in there. Dentistry is not in there where it should be. We are filing an analytical statement to that effect, which will be helpful to you.

(The statement is as follows:)

ANALYSIS OF THE OBJECTIONS TO THE MATERNAL AND CHILD WELFARE ACT OF 1945, S. 1318 AND H. R. 3922

The American Dental Association wishes to emphatically state that it is opposed to the enactment of S. 1318, in its present form and, therefore, lists the following objections which, if met, will improve the dental health services to be available under this proposed bill. Further, even if S. 1318 is changed to meet

these objections, still the American Dental Association believes that the provisions of two other bills, S. 190 and S. 1099 are far more likely to improve the dental health of the American people. The reason for this statement is the fact that the bill does not contain specific provisions regarding dental research, nor regarding the provision of dental health education to the public, nor regarding the provision of dental care in accordance with the four principles adopted by the house of delegates of the American Dental Association. Therefore since S. 1318 will not permit the establishment and maintenance of a comprehensive dental health plan, the American Dental Association cannot support it in its present form.

1. Section 102 of S. 1318, starting on page 2, line 21, does not specifically earmark funds for dental programs. If dental programs are to be developed by the Children's Bureau, then their continuity and assurance of stability can only be achieved by having a specific sum of money earmarked each year for the maintenance of the dental programs. The amount to be used for dental programs out of the first year's appropriations should preferably be a specific sum of money, although it may be more practicable to specify that the amount to be used for dental programs the first year shall be a portion or percentage of the total amount appropriated.

S. 1318 should be amended to provide that funds for dental programs shall be earmarked in the appropriation bill each year.

2. Section 103 (a), paragraph 10, on page 7, lines 6 to 13, provides for the creation of a general advisory council on the State level to be appointed by the State health agency, to be used for consultation and advice concerning State plans; however, there is no provision or requirement in S. 1318 that the general advisory council on the State level must at least contain one dentist.

S. 1318 should be amended to provide that section 103 (a), paragraph 10, be amended to provide for a general advisory council appointed by the State health agency, at least one of whom must be a dentist.

3. Section 105 (2), on page 10, line 12, provides for an advisory committee on the national level to be appointed by the Chief of the Children's Bureau; however, it does not specifically provide for a dental advisory committee, nor does it provide that if only one advisory committee is created that there must be at least one dentist on the advisory committee.

S. 1318 should be amended to provide for the creation of a dental advisory committee.

4. Section 101, starting on page 1, line 8, and continuing through to page 2, line 2, specifically provides that one of the purposes of the bill (S. 1318) is to provide dental services; however, there are several places in the bill in which reference is made to medical care only and the proper mention of dental care has been omitted.

S. 1318 should be amended wherever needed to include the words, "dental care" in addition to the words, "medical care." This amendment has already been agreed to by Dr. Martha M. Eliot and is set forth in further detail in her testimony before the House Committee on Labor.

5. There are various provisions in the bill setting forth specific provisions regarding physicians, and which omit any reference to dentists. An example of this may be found in section 103 (a), paragraph 6, page 6, lines 9 to 13, in which there is a specific provision regarding the types of payments that may be made to individual physicians, though there is not a similar provision regarding payments to be made to individual dentists.

S. 1318 should be carefully reviewed and in every case in which specific provisions have been made regarding physicians, and a similar provision is necessary in regard to dentists, the bill should be amended to make proper provisions for dentists.

The American Dental Association wishes to again call the attention of this committee to the fact that the two bills, the dental research bill, S. 190, which has passed the Senate, and the dental grants-in-aid bill, S. 1099, together with their respective companion bills in the House, H. R. 3816 and H. R. 3414, will give to the American people a comprehensive program for dental health service far superior to the proposals of the Maternal and Child Welfare Act of 1945, S. 1318 and H. R. 3922.

Senator DONNELL. In other words, you do not think that the bill clearly shows that all children are entitled to dental services? Dr. CAMALIER. That is right.

Senator DONNELL. It uses the term "dental" at various points. For instance, line 2 on page 21 uses the word "dental," and again over on page 5, line 8, it uses the word "dental." But I share with you, Doctor, the query, at any rate, as to whether or not this bill is free from ambiguity on that, because I observed that the location of the word "dental" on page 21 is in this connection:

including medical, nursing, dental, hospital, and related services and facilities required for maternity care, preventive health work, and diagnostic services for children

et cetera.

Is it the practice, insofar as possible, to see that proper dental care is given to women who are about to become mothers?

Dr. CAMALIER. Well, yes, they try to do that.

Senator DONNELL. So that this bill, at least, is susceptible of construction that the dental care referred to in line 2, page 21, is that which is limited to the dental services required for that maternity

care.

Dr. CAMALIER. That is right, and it is extremely important, if you had that, to take into consideration that when the funds are not earmarked for dentistry we do not get our proportionate share at the State level.

Senator DONNELL. You think the bill is ambiguous as to whether or not it covers dental care for children?

Dr. CAMALIER. Yes.

Senator DONNELL. On page 5, line 8, where I mentioned the word "dental," that is simply in the connection that the methods of administration to be specified in the State plans—

shall be such as are necessary for the proper and efficient operation of the plan, including methods relating to the establishment and maintenance of standards for professional personnel, rendering medical, dental

et cetera

types of care.

Dr. CAMALIER. Yes, sir.

Senator DONNELL. So that that again does not specify with any clarity whether or not the children are to be beneficiaries of the dental care?

Dr. CAMALIER. That is right.

Senator DONNELL. And that is one of the points, Doctor, that you are making?

Dr. CAMALIER. Yes, sir.

Senator DONNELL. Í have not seen your statement but I assume you have given it in some detail in your printed statement.

Dr. CAMALIER. Yes, we have.

Senator PEPPER. Dr. Camalier, we are very much obliged to you for pointing out deficiencies in the bill in respect to the provision of dental care. Of course, I can assure you that I for one am just as much interested in fully adequate dental care being provided to the children of the country as any other of the services. We will give very particular attention to your suggestion as to how we can make it clearer in the bill that adequate dental services shall be provided for the children.

It is your opinion, is it not, that the children of the country at the present time for one reason or another are not getting all the dental care that they should have?

Dr. CAMALIER. That is true; yes.

Senator PEPPER. And you welcome a plan that will make it possible for the children to get dental care that they should have?

Dr. CAMALIER. Yes; and may I add that the American Dental Association has foreseen that contingency and we have presented these two bills to Congress.

Senator PEPPER. Your research bill we have already approved in the Senate, as also in this committee.

I am one of the introducers of your S. 1099, the dental care bill, and I am very strongly for it.

Dr. Camalier, we did not put in a means test in S. 1099, did we?
Dr. CAMALIER. No, sir.

Senator PEPPER. We all recognize that the reason we have not put the means test in, and the reason that some of us do not favor a means test, is the difficulty of defining the means test so that it will not mitigate against people who ought to have the services that are provided in legislation. That is correct, is it not?

Dr. CAMALIER. That is correct.

Senator PEPPER. It is such a difficult thing to determine, as Dr. Oppenheimer pointed out a bit ago, whether people are able to provide the medical services that they really need, is it not?

Dr. CAMALIER. Yes, sir.

Senator PEPPER. We have the financially indigent and then we have the medically indigent. Somebody might be making a fair income and yet if, as Dr. Oppenheimer pointed out, they have to provide constant care for crippled children over a period of years, they really would not be able to do it without burdening their whole family.

Now, Doctor, do you recall having seen the figures that two-thirds of the children of the country are parts of families which have weekly incomes of less than $40?

Dr. CAMALIER. No, sir; I had not seen those figures.

Senator PEPPER. I have seen those figures, and I have some reason to believe in their accuracy.

Have you also heard that the majority of the children are in rather large families, and by some coincidence it is the poorer people who have the larger families in the country?

Dr. CAMALIER. Yes; I have noticed that.

I might say, though, in that connection, that I am sure it would be of interest to your committee to know that here, in the District of Columbia, the Dental Society sponsored the dental clinics they have here, and I think there are 14 or 15 of them, and we found out that in the service rendered, the poor families were not always getting the services in the clinics. So naturally there would have to be some differentiation made.

So the health officer, with the aid of the Dental Society, worked up a very simple plan which I think is working very well in that it merely asks the parent, when they receive the dental slip, whether they can afford to have their work done by a private dentist or must they go to the clinic. Then the parent states whether they cannot afford it or can afford it. That is approved by the teacher and the principal, as I understand. Dr. Oppenheimer will bear me out on that.