Education contacts school children during the compulsory age attendance period. That has nothing to do with the middle period of life. Security contacts the old. Welfare contacts a thousand dependent children in a State; the Children's Bureau is interested in crippled children. I am not minimizing their activities at all, but we want to do more. We want to do more in preventive medicine, more in the things that United States Public Health is not equipped to do, that must be carried on in the States.

The CHAIRMAN. Should aid to dependent children, aid to the blind, aid to the aged be put under the Medical Department of Government? Dr. SENSENICH. So far as the age part is concerned, we have no choice in that matter. That must be handled out of the funds of the Department; that is all right. But the health of the aged, children, and the blind will still be a medical problem, no matter where you put it, under what name.

The CHAIRMAN. Do you think the United States Department of Public Health is well administered at the present time?

Dr. SENSENICH. Well, I think so. I have no reason to question that. The CHAIRMAN. It is under civilian jurisdiction, though, is it not? Dr. SENSENICH. You mean as a division; yes. But mind you, the Public Health is not taking care of the sick. That is largely preventive. It is quarantine, it is water examination, it is immunization. It is in that general picture but is not the entire program that we are proposing to carry on to the whole population.

Senator FERGUSON. I will have to admit I have not studied the other bill, S. 545. That is why I am asking as to what you would expect to have included in the Department of Health. Would you have anything to do with crippled children?

Dr. SENSENICH. Well, your expenditure for child welfare or service at the present time is really a matter of providing funds. We have no objection to that at all. But when your dependent child is sick he is taken care of by a local physician, not by the United States Public Health Service, not by Public Welfare or Education or any other division. What we want to do is to bring the medical division, including Public Health, into a health set-up. The fact is, as I said a moment ago, that the point of service has no contact with these other departments. They carry on nothing in the State. They are separate. The Public Health Service at the present time is closer to the individual outside of the Bureau than it is in.

The CHAIRMAN. The Public Health Service does not care for sick and dependent children?

Dr. SENSENICH. That is right.

The CHAIRMAN. That is in the State Welfare Department?

Dr. SENSENICH. Yes; it pays the bill. It does not have anything to do with the medical provisions. The State Health Department provides funds for some.

The CHAIRMAN. The doctor performs the services?

Dr. SENSENICH That is right. We cooperate with both Welfare and Social Security, and may I say, because someone may ask about the means test, I was one of those who requested the Federal Security Agency before the recent legislation to increase the payment to the blind and the other dependents from Federal funds, because they were not getting enough. They were not getting enough to be able to care

for themselves. There is also the medical care needed. But we would not want the medical agency to assume responsibility for the collection of funds and handling of payments for subsistence. And on the contrary, I don't think Federal welfare is competent to assure proper medical care at the local individual level.

The CHAIRMAN. Do you think that medical inspection in schools should be under the Education Department or the Health Depart ment?

Dr. SENSENICH. Well, it is both places. In some places it is educa tion, in some places health. In most areas it is under education, with which we are perfectly agreeable. In many places the nurse who carries on the work then becomes classified as an educator, and participates in the State pension fund.

The CHAIRMAN. Do you think you can separate health and education in the schools?

Dr. SENSENICH. I don't think that there would be any difficulty in separating them. After all, the health side of it has nothing to do with the educational side of it.

The CHAIRMAN. You mean medical inspection could go on and education could go on without any coordination?

Dr. SENSENICH. Senator Aiken, we must recognize that it is perfectly possible for people to get along and coordinate their work without being under the same head. As a matter of fact, the people who are doing the school-health work at the present time are not members of the Public Health Service, in no way connected with any of these services. In some States the physicians are on salary

from the Board of Education. That is not a matter of conflict.

Senator O'CONOR. I was interested in your statement as to the medical profession stimulating the medical-care program in the States. In our State of Maryland we have made some little advance in that regard; in fact, I think we have done some outstanding work. I am wondering whether you think those programs would be helped or retarded if such a department as this were established?

Dr. SENSENICH. Well, Senator O'Conor, I could not pass on any motives or say what a department would wish to do to encourage or would have to do in acceptance of State plans. I can only say that the American Medical Association has adopted a program, and I fear it would not progress as it should if it were restricted to this position of secondary importance. We have a program for:

1. Proper standards of nutrition, housing, clothing, and recreation, and so on. Of course, we cannot control that, nor can this department, except to educate and stimulate the public to the point where there is effort to see that needs are met.

2. Preventive medical services should be available to all and should be rendered through professionally competent health departments. Medical care to those unable to provide for themselves should be administered by local and private agencies with the aid of public funds when needed, preferably by a physician of the patients choice. 3. Adequate prenatal and maternity care should be made available to all mothers. Public funds when needed should be administered by local and private agencies.

4. Every child should have proper attention, including scientific nutrition, immunization, and other services included in infant wel-.

fare.

Such services are best supplied by personal contact between .the mother and the individual physician but may be provided through child-health centers administered locally with support by tax funds whenever the need can be shown.

5. Health and diagnostic centers and hospitals necessary to community needs are preferably supplied by local agencies. When such facilities are unavailable, aid may be provided by Federal funds under a plan similar to the provisions of the Hill-Burton Act. The idea being to provide hospital facilities where there are none.

6. Voluntary health insurance for hospitalization and medical care is approved, the principles of such insurance plans to be acceptable to the Council on Medical Service and to authoritative bodies of State medical associations. That is now progressing. It might be interesting to you to know that the Blue Cross has, I think, some 27,000,000. members. It may soon have as many people enrolled as has welfareI mean social security.

7. Medical care, including hospitalization, to all veterans should be provided preferably by a physician of the veteran's choice, with payment through a plan agreed on between the State medical association and the Veterans' Administration. To be provided, wherever possible locally by their physicians and near their families, not to remove a man to a far distant place, to an institution where the medical service is no better and he is removed from his family. He has met that necessity long enough while in service.

8. Research for the advancement of medical science, including a national scientific foundation, is endorsed.

9. Services rendered by volunteer philanthropic health agencies should be encouraged. We must not forget that the American Cancer Society, the Society for Crippled Children, the Tuberculosis Association-these and other activities are doing outstanding research as well as organizing facilities that no Government could have done.

10. Widespread education in the field of health, and the widest possible dissemination of information regarding the prevention of disease and its treatment, are necessary functions of all departments of public health, medical associations, and school authorities. That is utilizing public voluntary agencies.

Now, to lay that program down before a department of welfare and education and assume that they are going to follow that out would just be doing wishful thinking.

The CHAIRMAN. You would prefer that it come under the Department of Health? You would exclude housing? I don't think you could claim that. What about nutrition control? What should that come under?

Dr. SENENICH. Nutrition is not a matter of the Department of Education. Remember, the factory worker is apt to be as undernourished as is his child.

The CHAIRMAN. You would not put that under the Department of Education?

Dr. SENSENICH. No. Nutrition in the schools is a medical matter, just as it is now. You are giving surplus food to the schools in some areas, and in some areas they are not, habits of eating and information on nutrition become a matter of education.

What happened about tuberculosis? The Government didn't do anything about that. That was voluntary. Nutrition is an element

there. Voluntary agencies have actually financed the matter of surveys in the schools. That is something coming right down home. If we are going to provide for health we must have the local individual interested in it, which we can do. Welfare cannot do it—and I am not criticizing welfare for that. I commend them for the things they do, but I am trying to make it clear that, after all, there is no reason in the world why health would benefit and a great many reasons why it would suffer as a result of welfare direction rather than medical. Senator MCCARTHY. What part of S. 140, the bill that is being proposed, would you change? What would you preserve if you were making a change in S. 140?

Dr. SENSENICH. Well, Senator, I would have to submit that to you. S. 140 includes health, and I would take it out. As for the rest of it, I would have very little to say.

Senator MCCARTHY. You mean you would take health out of S. 140? Dr. SENSENICH. I would prefer setting up a separate agency for health. It is the attitude of the medical profession that health is of sufficient importance to merit Cabinet status on its own, but if it could not have Cabinet status I would rather have it a separate agency.

Senator MCCARTHY. Have you studied the two bills, S. 712 and S. 140, and arrived at any conclusion as to which one of the two you either objected to most or least?

Dr. SENSENICH. Senator, I would have to submit you an analysis of that. I sat for two sessions reviewing these bills with people who are familiar with the welfare and education angles, and there are several angles to them. I am concerned, with the health angle. I felt that I could advise at least with reference to health.

Senator MCCARTHY. In other words, what is in these two proposed bills you do not object to, except that you feel there should be a separation of that which pertains to health and that which pertains to welfare or education? Could you see the possibility of that under one Cabinet officer, with a distinct director of this function and that function? I know in some of the States you may have a division director that assumes the responsibility of all of the units, mental and other types. Then you also have that unit that becomes medical in that here is a hospital that is a mental hospital superintended by a doctor, yet the director over the entire division may be just an ordinary layman from the standpoint of the profession.

Dr. SENSENICH. May I say this, Senator, that I had not intended to speak on these bills except in the matter of health, but you can see in the papers, you don't need to ask me, what happens to Governmentrun institutions, medical institutions--not all of them. I admit many of them are all right, but you can see what the complaint has been at the present time with reference to insane hospitals. During my time of activity with the American Medical Association I know of three different times that we have made a public effort to stimulate and to bring to the attention of the public the fact that many insane hospitals are not what they should be, but when it comes to the appropriation of funds to carry on those activities, then there are other things that take priority, and in the end the insane do not get it, and the superintendent has no authority, and probably no particular following, and as a consequence, without any evil intent on the part of anybody, it passes on and on and on, constantly deteriorating. Now, it would apply to the situation here.

I make no complaint about any head, and I cannot say that if this Department were established immediately something bad would happen, but I do know that a health program occupies a secondary position when it comes to handling a billion dollars of security money a

year.

Senator HOEY. Is it your view that unless health is given a separate status, it would be better for it to remain as it is now than to be combined with social security and education?

Dr. SENSENICH. I don't think that the status of health, if it is to remain in the Department, would be essentially different now or with Cabinet rank for the head.

Senator HOEY. This is a proposition to put health, education, and social security under one head in the Cabinet. Now, do you think it would be better to let it remain operating as it is now in a separate agency, rather than to be combined, the three of them, with one head in the Cabinet?

Dr. SENSENICH. Senator Hoey, it is not running separately now, you see. It is a part of the Federal Security Agency. It has a separate Surgeon General, but it has not the kind of set-up which we think health should have.

Someone asked awhile ago as to the amount of expenditures. Well, I do not know. Of course, expenditures have been stepped up.

Senator HOEY. You think it ought to have a separate status, the health side?

Dr. SENSENICH. Yes; I think it ought to have a separate status. And with reference to the reorganization bills, when I appeared before this committee, and before the committee in the House, requesting the transfer of the Children's Bureau from the Labor Department, it was because it should come in with health. It was to be transferred over here pending such time as the whole medical structure could be created on a separate basis where we feel it could make progress.

The CHAIRMAN. Doctor, you have not finished your very interesting testimony. Are you going to be in town tomorrow?

Dr. SENSENICH. I had not intended to. After all, I am a practicing physician, you know.

The CHAIRMAN. That is going to be our difficulty this morning. We have two other witnesses who expected to be heard that they might get home tonight, one from Boston and one from New York. All the doctors are busy, anyway.

Senator FERGUSON. I think under the circumstances, as these medical men want to get back to their homes, we should try to hear them as soon as possible.

The CHAIRMAN. We will hear Dr. Atwater at this time. Will you identify yourself and proceed with your testimony, Doctor?

STATEMENT OF REGINALD M. ATWATER, M. D., D. P. H., EXECUTIVE SECRETARY, AMERICAN PUBLIC HEALTH ASSOCIATION, NEW YORK CITY

Dr. ATWATER. I am Dr. Reginald M. Atwater, executive secretary of the American Public Health Association. I have a statement of the association which I will submit for the record, which comes as the considered judgment of the association.

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