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S 1114, and testimony will be received also on S. 93 and S. 1153 robare before the committee.

As I have indicated, the committee is primarily concerned this Dointing with the hospital survey and construction program.

On behalf of the committee, I am most happy to welcome here this coming our first witness in this series of hearings, the Secretary of Health. Education, and Welfare, Mrs. Oveta Culp Hobby. I am going 0 2.3 Mrs. Hobby to proceed in her own way in giving her testimony z the hospital survey and construction program. Prior to that, howther. I am sure this committee will be pleased to have any general infatory remarks Mrs. Hobby may care to make on this whole subject.

In view of its importance as background for these hearings, I also skuit for the incorporation in the record at this point the Presijere: health message. The message referred to is as follows:)

[H. Doc. 298, 83d Cong., 2d sess.)




to the Congress of the United States:

I submit herewith for the consideration of the Congress recommendations to Sin the health of the American people.

Apo2 the concerns of our Government for the human problems of our citibees the subject of health ranks high. For only as our citizens enjoy good physial and mental health can they win for themselves the satisfaction of a fully daruire, useful life.


The progress of our people toward better health has been rapid. Fifty years 23 their average life span was 49 years; today it is 68 years. In 1900 there **** 7 deaths from infectious diseases for every 100,000 of our people; now

are 16. Between 1916 and 1950, maternal deaths per 100,000 live births arred from 022 to 83. In 1916, 10 percent of the babies born in this country Le before their first birthday; today, less than 3 percent die in their first year.

Tos rapid progress toward better health has been the result of many particuar sports, and of one general effort. The general effort is the partnership and

pourk of private physicians and dentists and of those engaged in public be th, with research scientists, sanitary engineers, the nursing profession, and Elit auxiliary professions related to health protection and care in illness. To 1. heu dedicated people America owes most of the recent progress toward etting health.

Tet, much remains to be done. Approximately 224,000 of our people died of HP last year. This means that cancer will claim the lives of 25 million

or 160 million people unless the present cancer mortality rate is lowered. 1443 of the beart and blood vessels alone now take over 817,000 lives annually. me 7 million Americans are estimated to suffer from arthritis and rheumatic

Twenty-two thousand lose their sight each year. Diabetes annually * 100,000 to its roll of sufferers. Two million of our fellow citizens now na od ramped by physical disabilities could be, but are not, rehabilitated to lead Pou and productive lives. Ten million among our people will at some time in tort tres be hospitalized with mental illness. Ikate exist in our Nation the knowledge and skill to reduce these figures, to era us all still greater health protection and still longer life. But this knowl* ge and skill are not always available to all our people where and when thes ar breded. Two of the key problems in the field of health today are the distribution of medical facilities and the costs of medical care. Not all Americans can enjoy the best in medical care-because not always are

Pennisite facilities and professional personnel so distributed as to be available to them, particularly in our poorer communities and rural sections. There

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are, for example, 159 practicing physicians for every 100,000 of the civilian ho population in the Northeast United States. This is to be contracted with 128 physicians in the West, 116 in the North Central area, and 92 in the South. There are, for another example, only 4 or 5 hosp.tal beds for each 1,000 people in sale States, as compared with 10 or 11 in others.

Even where the best in medical care is available, its costs are often a serious burden, Major, long-term illness can become a financial catastrophe for a pormal Amner.can family. Ten pereunt of American families are spending today more than $700 a year for medical care. Of our people reporting incomes under $3,000), about 6 percent «pend almost a fifth of their gross income for medral and dental care. The total private medical bill of the Nation now exceeds $9 billion a year-an average of nearly $200 a family—and it is rising. This illus trates the seriousness of the problem of medical costs.

We must, therefore, take further action on the problems of distribution of medical facilities and the costs of medical care, but we must b cartíul and farsigited in the action that we take. Freedom, consent, and individual resporte sibility are fundamnental to our system. In the field of medical care, th's mans that the traditional relationship of the physician and his patient, and the right of the individual to elect freely the manner of his care in illness, must be preseried.

In adhering to this principle, and rejecting the socialization of medicine, we can still contidently commit ourselves to certain national health goals.

One sur's goal is that the means for achieving good health should be accesible to all. A person's location, occupation, age, race, creed, or financial status should not bar hin from enjoying this access,

Second, the results of our vast scient fic research, which is constantly ad. vaneing our knowledge of bitter health protection and better care in illness, should be broadly applied for the benefit of every citiz'n. There must be the fullest cooperation among the individual citizen, his personal physician, the resarch scientists, the schools of professional education, and our private and public institutions and services-local, State, and Federal,

The specific recommendations which follow are designed to bring us closer mon to these goals. Continuation of present Federal programs

In my budget message, appropriations will be requested to carry on during the coming tlmea! year the health and related programs of the newly established Department of Ilerlth, Elucation, and Welfare.

Throme pragram should be continued because of their past success and their present and future llwefulness. The Public Health Service, for example, bas hant a completed stare in the prevention of disease through its efforts to control health hazırds on the farm, in industry, and in the home. Thirty years ago the publie Health Service tirst recommeniled a standard milk sanitation ordinance: hy inwt year this orilinance had been voluntarily adopted by 1.6.28 Imunicipalities with a total population of 70 million people. Almost 20 years ago the Public Health Serviu first recommended restaurant sanitation ordi. munes: today 65 municipalities and 317 counties, with a total population of 10 million peonte, have such ordinances. The puritication of drinking water and the pasteurization of milk have prevented countless epidemies and saved thousands of liver. These and similar field projects of the Public Health Serk. jce, such as technical assistance to the States, and industrial hygiene work, have grint public value and shonld be maintained.

In addition, the Public Ilalth Service should be strengthened in its research activities. Throurh its National Institutes of Health, it maintains a steaily attack against cancer, mental illness, heart diseases, dental problems, arthritis and metalatie dedimpes bilindness, and problems in microbiology and neurology The new unitari en ineerins laboratory at Cincinnati, to be dertiented in April, will mahe possible a v grous arunek on health problems asociated with the rapid technological advances in industry and agriculture. In such direct resarch programs and in Pluie Health Service research grants to State and liwal grosernments and to private research institutions lies the hope of solving many of tourist's popiering balth problems,

The artivities of the Children's Bureau and its assistance to the States for maternal and child health services are also of vital importance. The proxrams for children with subterij politic diseases as epilepsy, cerebral palsy. congenital beurt diname, and rheumatic fever should recrire continued support.

Exeting the cost of medical care 1) best way for most of our people to provide themselves the resources to A9 gwd mediral care is to participate in voluntary health-insurance plans. emiss the past decade, private and nonprofit health insurance organizations 1- made strikily progress in offering such plans. The most widely pursubmand type of health insurance, which is hospitalization insurance, already 23pproximately 40 percent of all private expenditures for hospital care. progress indicates that these voluntary organizations can reach many

Dople and provide better and broader benefits. They should be encourand helped to do so. frter benith insurance protection for more people can be provided. de Government beed not and should not go into the insurance business to fraid the protection which private and nonprofit organizations do not now paine. But the Government can and should work with them to study and ze better insurance protection to meet the public need.

neutrend the establishment of a limited Federal reinsurance service to Cerige private and ponprofit health insurance organizations to offer broader e'th protection to more families. This service would reinsure the special ** qual risks involved in such broader protection. It can be launched with a wp1 tund of $25 million provided by the Government, to be retired from Sane fees. ira frent-in-zid approach

1mecage on the state of the Union and my special message of January 14 dout that Federal grants-in-aid have hitherto observed no uniform pattern. La više has been made first to one and then to another broad national need. Arach of the grant-in-aid programs, including those dealing with health, child milure and rehabilitation of the disabled, a wide variety of complicated matchlortulas have been used. Categorical grants have restricted funds to speciAs purposes so that States often have too much money for some programs and 2 tough for otbers,

ides atchwork of complex formulas and categorical grants should be simplibei aud improved. I propose a simplified formula for all of these basic grant-inLimograms which applies a new concept of Federal particiation in State proTo This formula permits the States to use greater initiative and take more mauxilihity in the administration of the programs. It makes Federal assisLux wore responsive to the needs of the States and their citizens. Under it, veral suppurt of these grant-in-aid programs is based on three general criteria:

fint, the States are aided in inverse proportion to their financial capacity. Bj relating Federal financial support to the degree of need, we are applying Our and sound formula adopted by the Congress in the Hospital Survey uc Coistruction Act. dond, the States are also helped, in proportion to their population, to extend De mprove the bealth and welfare services provided by the grant-in-aid proPlus

Floral, a portion of the Federal assistance is set aside for the support of unique "btts of regional or pational significance which give promise of new and better suf serving the human needs of our citizens. Two of these grant-in-aid programs warrant the following further recom

Besvilitation of the disabled

Working with only a small portion of the disabled among our people, Federal 12 rate Governments and voluntary organizations and institutions have proved De dramage to our Nation of restoring handicapped persons to full and proMicky our State-Federal program of vocational rehabilitation began in 1920, services rendered were limited largely to vocational counseling, training, and lacement. Since then advancing techniques in the medical and social aspects Kmetilitation have been incorporated into that program.

turite lives.

ilest are now 2 million disabled persons who could be rehabilitated and thus red to productive work. Under the present rehabilitation program only if olvi these disabled individuals are returned each year to full and productive si Meanwhile, 250,000 of our people are annually disabled. Therefore, we if I sing ground at a distressing rate. The number of disabled who enter proPetite toployment each year can be increased if the facilities, personnel, and kairiai support for their rehabilitation are made adequate to the need.

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be released for the care of the acutely ill. This would also help to relieve some of the serious problems created by the present short supply of trained nurses.

Porsical rehabilitation services for our disabled people can best be given in Dospitals or other facilities especially equipped for the purpose. Many thousands of emple remain disabled today because of the lack of such facilities and vertices

Many illnesses, to be sure, can be cared for outside of any institution. For such iloesols a far less costly approach to good medical care than hospitalization Rould be to provide diagnostic and treatment facilities for the ambulatory perient. The provision of such facilities, particularly in rural areas and small fulated communities, will attract physicians to the sparsely settled sections mbere they are urgently needed.

I recommend, therefore, that the Hospital Survey and Construction Act be Lended as necessary to authorize the several types of urgently needed medical care facilities which I have described. They will be less costly to build than zen-ral hospitals and will lessen hte burden on them. I present four proposals to expand or extend the present program:

(1) Added assistance in the construction of nonprofit hospitals for the care of the chronically ill. These would be of a type more economical to build and operate than general hospitals.

(2) Assistance in the construction of nonprofit medically supervised nursIng and convalescent homes.

(3) Assistance in the construction of nonprofit rehabilitation facilities for the disabled.

(4) Assistance in the construction of nonprofit diagnostic or treatment centers for ambulatory patients. Finally, I recommend that, in order to provide a sound basis for Federal assistaloe in such an expanded program, special funds be made available to the States a balp par for surveys of their needs. This is the procedure that the Congress rigely required in connection with Federal assistance in the construction of bospitals under the original act. We should also continue to observe the prindrie of State and local determination of their needs without Federal interBerzence.

These recommendations are needed forward steps in the development of a sound program for improving the health of our people. No nation and no administratim can ever afford to be complacent about the health of its citizens. While antinuing to reject Government regimentation of medicine, we shall with vigor and imagination continuously search out by appropriate means, recommend, and prt into effect new methods of achieving better health for all of our people. We shall not relax in the struggle against disease. The health of our people is the Teri essence of our vitality, our strength, and our progress as a nation.

I urge that the Congress give early and favorable consideration to the recommodations I have herein submitted.

Dwight D. EISENHOWER. Tu WHITE HOUSE, January 18, 1954. Senator PURTELL. Mrs. Hobby, we will be pleased to have you proceed. Mrs. Hobby. Thank you, sir. Mr. Chairman, before proceeding with my prepared statement, I should like to introduce and identify for the record several officials of the Department who are here with me this morning. First may I present Mr. Nelson Rockefeller, Under Secretary of the Department, and Mr. Roswell B. Perkins, Assistant Secretary of the Department. Dr. Scheele, Surgeon General of the Public Health Service and Mr. Arthur Kimball, Acting Deputy Director of the Office of Vocational Rehabilitation, will participate in the presentation of our prepared statement. Also present to assist in answerng technical questions on the provisions of the bill are Dr. John W. Cronin, Chief, Division of Hospital Facilities of the Public Health Service, and Miss Mary Switzer, Director of the Office of Vocational

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