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under 18. According to Dr. Eliot, the cost of providing complete medical and dental care for one child under this program would be $47.45 per year. This adds up to about 11/2 billion dollars a year.
To this there must be added about $40,000,000 for the administrative expenses of the States in providing these services. Again, I use the current figure under the EMIC program at rate of 21/2 percent.
Gentlemen, I recognize that it would take years before we reached this total expenditure, but I give you these figures only to show that we are not discussing a medical program involving $50,000,000 and $100,000,000 a year, but rather one involving 112 billion dollars annually, not counting thu 11 additional programs which Dr. Eliot listed and which involve enormous and incalculable expenses.
What-troubles me deeply about this proposal is this: Unlike the President's proposal, this program would not be financed through a health insurance system. It calls upon Congress to appropriate these huge funds from the United States Treasury, from which this program is to be largely financed.
Of the $50,000,000 for maternal and child health, authorized by this bill, 90 percent is allocated to the States without any matching provision. Under the circumstances, what is likely to happen is that Congress and probably the States will be forced to resort to a means test to keep down the staggering cost of the program. A means test is so undemocratic and so dangerous, particularly in a national medical care program, that the Congress should weigh now the unfortunate human and political repercussions that are bound to ensue when a means test becomes necessary to keep the cost of this bounds.
I do not mean to imply, by listing these costs, Senator, that I am averse to spending any amount of money for child care. But if this bill were passed, it would be the first attempt at a Nation-wide health program. If the program collapses, it would set back the Nation's social progress for a generation.
Gentlemen, should not the Children's Bureau have brought out these eventual costs when urging the approval of this bill? And what does the Budget Bureau have to say about them, I wonder?
This maternal and child welfare bill, if enacted, would potentially result in the creation under the Children's Bureau of a health division at least 15 times as big as the United States Public Health Service, which has a budget of only $100,000,000 for all its activities and it would set up a welfare division larger than that of the Social Security Agency
No wonder the Children's Bureau's own Advisory Committee told that agency in polite but firm language that it is incapable of administering so gigantic a program, but even if it were capable, the merit of the plan is questionable.
I feel sure, gentlemen, that busy as you are, you have not had the time to figure out the concealed costs of this bill, nor all of its permanent implications. Most of us are well aware that the Children's Bureau executives are responsible for most of its provisions.
Mr. Chairman, the State governments are the agencies that are in touch with the local communities and responsible to them for the strengthening of local child care.
Has it ever occurred to you to ask why the Children's Bureau has not been able to persuade, as far as I know, a single State executive of health and welfare to testify on behalf of this bill?
Have you ever heard any of our State governors say a good word for it?
No. The State executives are uniformly opposed to it and thoroughly dissatisfied with the slap-happy methods of administration used by the Children's Bureau.
Let me read what a welfare commissioner from one of our Eastern States says about those methods:
One of the difficulties we have seen in our State in our dealings with the Children's Bureau is that they seem to confuse what they regard as their over-all National responsibilities with their Federal-State relations in which, theoretically, the State agency is the important administrative unit. Thus, we find them issuing releases to the press on studies or committee reports affecting the States, without giving the States any warning that the report is coming out. This is embarrassing and is certainly not team play with the States. Again, without any word to the State welfare departments, they will write to the governors about some child welfare issue. We get a call from the governor's office to inquire what it is all about and have to confess that it is something we haven't seen at all.
The Children's Bureau operation in relation to the child welfare services program seems to me to accentuate that small part in the total welfare program, even to the extent of insulating it from other child welfare activities as well as the total public welfare program in the State. I think it is fair to say that some of this is a matter of habit rather than intent. I recall a meeting of the State supervisors of child welfare service, held in Washington about 2 years ago, to which the State Welfare Commissioners were invited. The invitation was not insistent, however. When we got there we found that we were treated like necessary adjuncts to the program. Some of the newer State commissioners were so mad that they threatened to hold a meeting by themselves on their own, but Howard Russell stepped in to arrange this under the aegis of the American Public Welfare Association to avoid any serious results.
When the Children's Bureau is discussing national policies such as proposed changes in Federal-State child welfare legislation, the American Public Welfare Association is invited to send persons to present the APWA opinion, but the Children's Bureau makes up its mind on the advice of representatives of private agencies and child welfare supervisors from the States.
I can only say that were any part of our organization to conduct itself in the same way in relation to any part of the welfare program administered by the county and city welfare commissioners, a person in my position would be removed from office by the Board of Social Welfare because of the protests that would come from the local agencies.
State and local public welfare officials through the American Public Welfare Association have therefore gone on record stating that they do not want the Children's Bureau to continue separate administrative functions, with consequent confusion, and waste of time and money for separate budgets.
Here is what they say:
That all welfare programs in which Federal Government participates financially, be administered by a single agency at the local, State, and Federal level, the Federal Government's responsibility to be centered in a single combined public welfare administrative unit.
The public welfare officials are supporting the Forand bill, H. R. 5686, now under consideration by the House Ways and Means Committee. In this bill the State welfare officials, who are actually administering public child welfare services, support a program of expansion of child welfare services with Federal grants-in-aid to be administered by the Federal Security Administrator through a single
welfare administrative unit which the President's reorganizati authorized him to create.
This proposed expansion of child welfare services is part of a unified and comprehensive approach to the welfare needs of the States.
The public welfare officials take the position that in the welfare field you cannot separate the social needs of the child from that of the family. You must consider the family as a unit.
The State health officials are just as positive in their opposition to multilateral administration of health in the Federal Government.
The Association of State and Territorial Health Officers on October 11, 1945, officially went on record as favoring:
the coordination of all civilian public health activities in a single department, thereby rendering liaison and cooperation with the several States and Territories the more efficient and effective. This, in turn, would bring about an improvement in general public health work throughout the country and enable this Department to administer any future legislation pertaining to public health with much greater efficiency.
In this same statement of policy the association pointed out that at the present time the States are required to make reports to both the Public Health Service and the Children's Bureau, present their budgets, and conform with a variety of regulations, sometimes contradictory, issued by these two agencies.
The American Public Health Association recommends similar administration procedures. In October 1944 at an annual meeting this organization stated :
A single responsible agency is a fundamental requisite to effective administration at all levels-Federal, State, and local. The public health agenciesFederal, State, and local-should carry major responsibilities in administering the health services of the future. Because of administrative experience, and accustomed responsibility for a public trust, they are uniquely fitted among public agencies to assume larger responsibilities and to discharge their duties to the public with integrity and skill.
To support these views I have just received telegrams from two of our most outstanding and most capable State officials, particularly noted for their knowledge of administration and of child welfareMiss Lulu Dunn, Commissioner of Welfare for the State of Alabama and president of the American Public Welfare Association, and Dr. Ellen Potter, director of the Division of Medicine of the New Jersey State Department of Institutions and Agencies.
Dr. Potter says:
The coordination of health and welfare at the Federal level is necessary because the functions of the two departments are interrelated and interdependent if maximum results on behalf of all the people are to be secured effectively and economically. Federal agencies are pressing the States for coordination of programs on the State level in both health and welfare. Such pressure would be more justified if the Federal agencies set a better example to the States. President Truman has pledged himself to personally safeguard the interests of children and of the Children's Bureau in the development of the reorganization plan proposed by him. It would seem inopportune to press for new and specific legislation at this time. We all hope for Cabinet status of the reorganized security agency.
Miss Dunn says:
I have wired President Truman endorsing plan of reorganization welfare services. State welfare administrators are interested in coordination of grantsin-aid program as provided in section 10 of the President's Reorganization Plan No. 2. It is my belief a single administration of Federal welfare programs would increase efficiency at Federal, State, and local level.
Mr. Chairman, the State officials realize the need for a genuinely coordinated endeavor in the health and welfare field and for a clarification in those fields of the Federal-State relationship. They are wholeheartedly behind the President's Reorganization Plan No. 2. They are keenly aware that this bill, S. 1318, is a threat to that Executive order and to the hope for progress in our administrative machinery. Since these State officials are the responsible administrators of all grants-in-aid, it seems to me their wishes should outweigh those of the
Children's Bureau. What are the provisions affecting the Children's Bureau in the Fresident's Reorganization Plan No. 2?
It states clearly that the three health and welfare programs now administered by the Children's Bureau are transferred to the Federal Security Administrator and shall be performed by him or under his direction and control by such officers and employees of the Federal Security Agency as he may designate.
Furthermore, section 10 of Reorganization Plan No. 2 reads:
SEC. 10. Coordination of grant-in-aid programs. In order to coordinate more fully the administration of grant-in-aid programs by officers and constituent units of the Federal Security Agency, the Federal Security Administrator shall establish, insofar as practicable, (a) uniform standards and procedures relating to fiscal, personnel, and the other requirements common to two or more such programs, and (b) standards and procedures under wbich a State agency participating in more than one such program may submit a single plan of operation and be subject to a single Federal fiscal and administrative review of its operation.
This section corresponds with the clearly expressed wishes of the State commissioners of health and welfare.
But this bill, S. 1318, not only expands the abolished powers of the Children's Bureau, it makes the Federal Security Administrator's task of establishing uniform standards and procedures, and a single plan of operation well-nigh impossible. It flies in the face of order, simplification, and progress. It is a bill that no responsible official wants except those in charge of the Children's Bureau. Indeed, if the Children's Bureau does not see the need for its own integration in a unified program, I am convinced that the Children's Bureau can well become a detriment to child welfare.
There is, moreover, no reason why this debatable measure, S. 1318, should burden the time and attention of the Congress, since all of its worthy objectives can be achieved by far simpler means. The grantsin-aid for maternal and child care, crippled children, and child welfare, by the President's orders, will be transferred after July 15 to the Federal Security Administrator. All that is needed to increase these grants-in-aid, is a joint resolution of the Congress, the three augmented programs to be administered for the interim period by the Federal Security Administrator under the reorganization plan as part of his approach to the new intergrated health and welfare program.
I presented this idea about 2 weeks ago to Chairman Doughton of the Ways and Means Committee, which is now completing its study of the Whole Social Security Act, including the Federal welfare program. The idea appeared to him feasible and I have here Mr. Doughton's letter assuring me that he will call this joint resolution to the attention of his committee. Nobody is against the temporary extension of these three existing programs. But a joint resolution of Congress would not establish a whole permanent new system at a moment when basic changes are contemplated, and the whole health and welfare program is in flux. (The letter referred to is as follows:)
HOUSE OF REPRESENTATIVES,
Washington, D. C., June 14, 1946. Mrs. EUGENE MEYER,
Washington, D. C. DEAR MRS. MEYER: This is with further reference to our conversation the other day about amending the social-security provisions for maternal and child welfare.
As you know, it is quite possible that we may be faced with an early recess or adjournment of Congress, and accordingly it is unlikely that we may be able to report out all of the social-security amendments which appear to be needed in time for effective action by the House and Senate.
Our committee is meeting every day, and I am very hopeful that a few of the most pressing amendments can be reported out at an early date. I am, of course, not in a position to say at this time whether the committee will include amendments liberalizing the children's programs, but I assure you that I will call the matter to their attention. Very sincerely yours,
R. L. DOUGHTON.
DRAFT OF HOUSE JOINT RESOLUTION Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That title V of the Social Security Act, as amended, is amended as follows:
PART 1. MATERNAL AND CHILD HEALTH SERVICES
1. Insert at the end of section 501 : “Provided, however, That there is hereby authorized to be appropriated for each of the three fiscal years beginning with the fiscal year ending June 30, 1947, the sum of $50,000,000.”
2. Insert at the end of section 502 (a): “Provided, however, That for each of three fiscal years beginning with the fiscal year ending June 30, 1947, out of the sums appropriated pursuant to section 501 for each year there shall be allotted to each State $20,000, and such part of $16,500,000 as he finds that the number of live births in such State bore to the total number of live births in the United States, in the latest calendar year for which the Bureau of the Census has available statistics."
3. Insert at the end of section 502 (b): "Provided, however, That for each of the three fiscal years beginning with the fiscal year ending June 30, 1917. out of the sums appropriated pursuant to section 501 for each fiscal year the Secretary of Labor shall allot to the States $33,500,000 (in addition to the allotments made under subsection (a), according to the financial need of each State for assistance in carrying out its State plan, as determined by him after taking into consideration the number of live births in such State."
PART 2. SERVICES FOR CRIPPLED CHILDREN
4.'Insert at the end of section 511: "Provided, however, That there is hereby authorized to be appropriated for each of the three fiscal years beginning with the fiscal year ending June 30, 1947, the sum of $25,000,000."
5. Insert at the end of section 512 (a): “Provided, however, That for each of the three fiscal years beginning with the fiscal year ending June 30, 1947, out of the sums appropriated pursuant to section 511 for each year there shall be allotted to each State $20,000, and $8,350,000 to the States according to the need of each State as determined by him after taking into consideration the number of crippled children in such State in need of the services referred to in section 511 and the cost of furnishing such services to them."