Senator DONNELL. Have you made any estimate as to the cost of administering title II?

Mrs. JACOBS. We do believe that the funds provided at the level of $25,000,000 to begin with, is certainly all that could be handled with the professional personnel which is now available.

At the present time there is approximately $4,000,000 offered through the Children's Bureau Services for Crippled Children, $25,000,000 would be six times that amount. It will take considerable building up of the program to estimate the needs beyond that amount. Senator DONNELL. Yes, ma'am.

Is there any State in the Union at this time, that you know of, Mrs. Jacobs, that provides such extensive care and services as are contemplated by title I?

Mrs. JACOBS. No, I do not know of any.

Senator DONNELL. I read that to mean that any mother and any child would have the right, whether they avail themselves of it or not, would have the right to, in the case of the mothers, during the maternity period, and of the children, I assume, until they arrived at majority, to have medical, nursing, dental, hospital, and related services and facilities, preventive health work and diagnostic services, school health services, care during sickness, correction of defects and conditions likely to interfere with the normal growth and development and the educational progress of children, entitled to all that under an administration conducted by the various States with the money provided for joinly by the Federal and State Governments?

Is that your general understanding?

Mrs. JACOBS. That is my interpretation; yes, sir.

Senator DONNELL. Of course, I take it that is a vast program to undertake to provide all of these extensive services out of the Public Treasury for 43,000,000 people less whatever duplication there may be in the two classes?

Mrs. JACOBS. If you look at it in terms of the end result, that is the amount of money which is now spent on correction of defects of health and institutionalization as the result of neglected health, I believe the United States is spending a considerably greater amount than that, and that an investment in health at the time that children are in the early stages of growth would be of tremendous advantage. Senator DONNELL. By the United States paying that, you do not mean the United States Government?

Mrs. JACOBS. No.

Senator DONNELL. You mean the people?

Mrs. JACOBS. The people; yes.

Senator DONNELL. Yes, ma'am.

The people of the United States plus the various governments, local State and Federal, you think are paying probably as much money as it would cost under this system? Is that your thought?

Mrs. JACOBS. I believe it would be more than that, if you added the costs of institutionalization.

I believe our crime bill is some $3,000,000,000 a year, considered in terms of total economic loss.

If only a small portion of that $3,000,000,000 could be cut down under title III, it would certainly justify the expenditure of funds under title III alone.

Senator DONNELL. Now, am looking at title I, although I appreciate you are, like Mr. Ballard

Mrs. JACOBS. I gave that example because it occurred to me first.

Senator DONNELL. I did not mean to criticize your doing it. I realize you have your specialized study, just like Mr. Ballard has his, under this bill, and I was looking at it starting with title I, taking the figure of 3,000,000 mothers and 40,000,000 children and looking at these extensive services to be provided by the Government, either State or National.

Really, it would be both, because it would be a combination of the two.

That would be through a series of regulations to be set up by a governmental organization under which, I take it, the physicians would be employed and the hospitals and clinics and health service agencies would be contracted for.

It looks to me like certainly a tremendous governmental undertaking to provide all of that, when we get into it, and we ought to look it through carefully.

Mrs. JACOBS. Yes; I agree. I think it should be considered seriously. However, this is, I believe, a health program which you see set up in complete outline, providing many services that until now have been offered piecemeal. It is easy to plan a small portion of a health program, for a small segment of the population, and consider it only in terms of a small cost, but when we keep adding one to the other, the end results a rather expensive program which grow up in piecemeal fashion, and which is inadequate to meet the problem it is designed

to correct.

Senator DONNELL. Our committee is considering this other bill, S. 1606.

Mrs. JACOBS. Yes.

Senator DONNELL. I think Senator Pepper was referring to that as I came in this afternoon; which provides among other things for compulsory health insurance, the cost of which is variously estimated at figures aggregating various numbers of billions of dollars per year. Now, I do not know just how this S. 1318 is being fitted in, but it is, as I understand it, being fitted in S. 1606.

That is correct, is it not, Senator?

But I take it the attempt would be made to avoid duplication of

expense.

That is your thought, is it not, Senator?

Mrs. Jacobs, I will not detain you further with my questioning. Perhaps Senator Pepper may have some.

Senator PEPPER. Mrs. Jacobs, the Senator has emphasized that this is a program of considerable magnitude and involves considerable expense.

Mrs. JACOBS. Yes.

Senator PEPPER. You are aware that the estimates for the first year of operation are $50,000,000 for maternal and child health, $25,000,000 for the care of crippled children.

Mrs. JACOBS. Yes, sir.

Senator PEPPER. And I guess that would leave——

Mrs. JACOBS. $25,000,000 for the child welfare services.

Senator PEPPER. $25,000,000 for the child welfare services.

A total of $100,000,000.

And that would probably be increased in the second year, but when we think that that is what is contemplated for all the children of the whole country, then we see that is a relatively small sum in comparison with other public expenditures and in relation to the magnitude of the problem?

It is, is it not?

Mrs. JACOBS. Yes; it is. It is a minimum amount.

Senator PEPPER. Because there is no asset we have in the United States that is comparable in value except the other human beings, or for the future none of the population is more important than all the children of the country.

Mrs. JACOBS. I agree with that.

Senator PEPPER. And in addition to that, it deals specifically with the mother. All the present expectant mothers in the country as well.

Mr. JACOBS. In providing medical services to expectant mothers there can be a considerable amount of work done to prevent crippling conditions, both in mothers and children.

That has shown itself to be true in some of the research which has been conducted in the past.

Senator PEPPER. We are now considering a dozen or more appropriation bills on the Senate floor, and we will find many, many items where they are 50 or 100 or 200 million dollars.

In some of the appropriation bills, billions of dollars are appropriated for various things, and while they are all important, do you think it is likely that any of them have any objective more important to the country than the care of the mothers and children of the country?

Mrs. JACOBS. No, sir; I do not.

Senator PEPPER. Any questions?
Senator DONNELL. No, sir.

Senator PEPPER. We thank you very much.

We will recess until 10 o'clock tomorrow morning in room 318, Senate Office Building.

(Thereupon, at 5:15 p. m., Friday, June 21, 1946, the committee recessed until Saturday, June 22, 1946, at 10 a. m.)

MATERNAL AND CHILD WELFARE

SATURDAY, JUNE 22, 1946

UNITED STATES SENATE,

COMMITTEE ON EDUCATION AND LABOR,

Washington, D. C.

The committee met at 10:20 p. m., pursuant to adjournment, the Honorable Senator Claude Pepper, presiding.

Present: Senators Pepper, Aiken, and Donnell.

Senator PEPPER. The committee will come to order, please.

Dr. Joseph Wall, pediatrician, representing the American Medical Association, is the first witness.

I hope none of the rest of you were inconvenienced, as I and Senator Donnell were, by going to the other room.

We thought the Senate was going to be in session today, but this is not the first time the Senate has changed its mind.

Dr. Wall, we will be happy to have you proceed.

STATEMENT OF JOSEPH S. WALL, M. D., CHAIRMAN, COMMITTEE ON LEGISLATION, THE AMERICAN ACADEMY OF PEDIATRICS, REPRESENTING THE AMERICAL MEDICAL ASSOCIATION

Dr. WALL. I might say, Senator, that I am a practicing physician within the District of Columbia for 49 years and for 40 years specializing in the diseases of children;

Also past member of the board of directors of the American Association for the Study and Prevention of Infant Mortality;

And also formerly a member of the Board of directors of the American Child Health Association.

Past president of the Medical Society of the District of Columbia. Immediate past president of the Academy of Pediatrics.

And a member of the Southern Medical Association and the American Medical Association.

Senator PEPPER. Where is your home, Doctor?

Dr. WALL. Washington, D. C., Senator.

Senator PEPPER. Very well.

Dr. WALL. Because of the rather long list of witnesses before you, Senator, I would like to submit a statement and merely read from it the conclusions which express the attitude of the Academy of Pediatrics.

Senator PEPPER. Thank you very much, Doctor.

51

(The document referred to is as follows:)

STATEMENT ON BEHALF OF THE AMERICAN MEDICAL ASSOCIATION, BY JOSEPH S. WALL, M. D., CHAIRMAN, COMMITTEE ON LEGISLATION, THE AMERICAN ACADEMY OF PEDIATRICS

On July 26, 1945, Senator Claude Pepper of Florida introduced the Maternal and Child Welfare Act of 1945, for himself and the following cosponsors: Mr. Walsh, Mr. Thomas of Utah, Mr. Hill, Mr. Chavez, Mr. Tunnell, Mr. Guffey, Mr. La Follette, Mr. Aiken, and Mr. Morse. The bill was referred to the Senate Committee on Education and Labor. Senator Pepper presented the bill with certain remarks and received permission to continue the speech in the Congressional Record "to contain a statement by me and a summary of the nature and purposes of the bill."

Among the purposes of the bill, the Senator from Florida in his speech states: "This bill, which I hope will have early consideration by the Congress, provides for gradual yet substantial expansion of existing State programs of child health and welfare instituted a decade ago under the Social Security Act. Step by step, over a period of the next 10 years, the bill makes possible the enlargement and strengthening of these public services in accordance with the requirements of each State."

It may be said that no "existing State programs of child health and welfare initiated a decade ago under the Social Security Act" embraces the revolutionary principles advocated in S. 1318 but, on the contrary, the provisions of title V of that act provide Government subsidies for three types of service, i. e., maternal and child health, crippled children and child-welfare, to beneficiaries especially in rural areas and in areas suffering from severe economic distress, with absolutely no provision that a free Government dole be granted to every pregnant mother and to every child under the age of 21 within the United States, including the District of Columbia, or any Territory or possession of the United States."

The Social Security Act in no way provides for unlimited free medical services for "all mothers and children in the State or locality who elect to participate in the program," provided that the mothers be pregnant and that the children be under the age of 21 years, an age limitation which may permit some beneficiaries to enter both categories with much consequent confusion to both patient and administrative authorities as to where they rightly belong.

The bill proposes to provide for the general welfare, thus possessing the cloak of constitutional respectability under section 8 of the Constitution, which provides that the Congress shall have power to lay and collect taxes, duties, etc., to pay the debts and provide for the common defense and general welfare of the United States.

TITLE I. MATERNAL AND CHILD HEALTH SERVICES

Section 101: Page 1, line 9 and page 2, line 1 et seq. The bill states: "For the purpose of enabling each State to provide and maintain services and facilities to promote the physical and mental health of mothers during the maternity period, and of children, including medical, nursing, dental, hospital, and related services and facilities required for maternity care, preventive health work and diagnostic services for children, school health services, care of sick children, etc." Yet Senator Pepper (speech of presentation, p. 4, par. 6) says: "The bill does not contemplate a construction_program, such as is provided for in S. 191 or in similar provisions of other bills. But pending the passage of a broad program for construction of health facilities, State health departments will be able to use some of the funds provided in this bill for necessary remodeling of facilities."

Page 2, lines 9 and 10: Here is stated: "including demonstrations and training of personnel for State and local maternal and child health services." Does this mean the establishment of a kind of medical West Points as proposed in Congressman Dickstein's H. R. 713 or of State medical normal schools? Probably not; the training will be Federal and be provided to its wards by the Children's Bureau as directed on page 6, lines 1 and 2, wherein the Bureau is authorized to provide “opportunities for postgraduate training of professional and technical personnel." Where and how such training will be effected under the tutelage of the Children's Bureau is not further explained in the bill.