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S3114, and testimony will be received also on S. 93 and S. 1153 ich are before the committee.

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

On behalf of the committee, I am most happy to welcome here this toming our first witness in this series of hearings, the Secretary of Health Education, and Welfare, Mrs. Oveta Culp Hobby. I am going 10a-k Mrs. Hobby to proceed in her own way in giving her testimony the hospital survey and construction program. Prior to that, howver. I am sure this committee will be pleased to have any general refatory remarks Mrs. Hobby may care to make on this whole subject. In view of its importance as background for these hearings, I also submit for the incorporation in the record at this point the President's health message.

The message referred to is as follows:)

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

HEALTH OF THE AMERICAN PEOPLE

MESSAGE FROM THE PRESIDENT OF THE UNITED STATES TRANSMITTING RECOMMENDATIONS TO IMPROVE THE HEALTH OF THE AMERICAN PEOPLE

To the Congress of the United States:

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

Among the concerns of our Government for the human problems of our citibens, the subject of health ranks high. For only as our citizens enjoy good physiand mental health can they win for themselves the satisfaction of a fully productive, useful life.

THE HEALTH PROBLEM

The progress of our people toward better health has been rapid. Fifty years 120 their average life span was 49 years; today it is 68 years. In 1900 there

76 deaths from infectious diseases for every 100,000 of our people; now Sere are 66. Between 1916 and 1950, maternal deaths per 100,000 live births red from 622 to 83. In 1916, 10 percent of the babies born in this country Gefore their first birthday; today, less than 3 percent die in their first year. TD's rapid progress toward better health has been the result of many particu at efforts, and of one general effort. The general effort is the partnership and Tork of private physicians and dentists and of those engaged in public th, with research scientists, sanitary engineers, the nursing profession, and Ar auxiliary professions related to health protection and care in illness. To these dedicated people America owes most of the recent progress toward Setter health.

fet, much remains to be done. Approximately 224,000 of our people died of 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. Deases of the heart and blood vessels alone now take over 817,000 lives annually. 7 million Americans are estimated to suffer from arthritis and rheumatic Cases Twenty-two thousand lose their sight each year. Diabetes annually * 100,000 to its roll of sufferers. Two million of our fellow citizens now and capped by physical disabilities could be, but are not, rehabilitated to lead and productive lives. Ten million among our people will at some time in their lives be hospitalized with mental illness.

There exist in our Nation the knowledge and skill to reduce these figures, to Er us all still greater health protection and still longer life. But this knowlge and skill are not always available to all our people where and when they are needed. 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 the requisite facilities and professional personnel so distributed as to be available to them, particularly in our poorer communities and rural sections. There

are, for example, 159 practicing physicians for every 100,000 of the civilia population in the Northeast United States. This is to be contrasted with 12 physicians in the West, 116 in the North Central area, and 92 in the South. Ther are, for another example, only 4 or 5 hospital beds for each 1,000 people in som States, as compared with 10 or 11 in others.

Even where the best in medical care is available, its costs are often a seriou burden. Major, long-term illness can become a financial catastrophe for a norma American family. Ten percent of American families are spending today more than $500 a year for medical care. Of our people reporting incomes under $3,000, about 6 percent spend almost a fifth of their gross income for med en and dental care. The total private medical bill of the Nation now exceeds 8 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 be careful and farsighted in the action that we take. Freedom, consent, and individual respon sibility are fundamental to our system. In the field of medical care, this means 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 preserved.

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

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

Second, the results of our vast scientific research, which is constantly advancing our knowledge of better health protection and better care in illness. should be broad'y applied for the benefit of every citiz 'n. There must be the fullest cooperation among the individual citizen, his personal physician, the research 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 to these goals.

Continuation of present Federal programs

In my budget message, appropriations will be requested to carry on during the coming fiscal year the health and related programs of the newly established Department of Health, Education, and Welfare.

These programs should be continued because of their past success and their present and future usefulness. The Public Health Service, for example, has had a conspicuous share in the prevention of disease through its efforts to control health hazards on the farm, in industry, and in the home. Thirty years ago the Public Health Service first recommended a standard milk sanitation ordinance; by last year this ordinance had been voluntarily adopted by 1.558 municipalities with a total population of 70 million people. Almost 20 years ago the Public Health Service first recommended restaurant sanitation ordinances: today 685 municipalities and 347 counties, with a total population of 90 million people, have such ordinances. The purification of drinking water and the pasteurization of milk have prevented countless epidemics and saved thousan is of lives. These and similar field projects of the Public Health Serv ice, such as technical assistance to the States, and industrial hygiene work, have great public valve and should be maintained.

In addition, the Public Health Service should be strengthened in its research activities. Through its National Institutes of Health, it maintains a steady attack against cancer, mental illness, heart diseases, dental problems, arthritis and metabolic diseases blindness, and problems in microbiology and neurology. | The new sanitary en ineering laboratory at Cincinnati, to be dedicated in April, will make possible a vigorous attack on health problems associated with | the rapid technological advances in industry and agriculture. In such direct research programs and in Public Health Service research grants to State and local governments and to private research institutions lies the hope of solving many of today's perplexing health problems.

The activities of the Children's Bureau and its assistance to the States for maternal and chi'd health services are also of vital importance. The programs for children with such crippling diseases as epilepsy, cerebral palsy, congenital heart disease, and rheumatic fever should receive continued support.

Meeting the cost of medical care

1 best way for most of our people to provide themselves the resources to a good medical care is to participate in voluntary health-insurance plans. ing the past decade, private and nonprofit health insurance organizations made striking progress in offering such plans. The most widely purtype of health insurance, which is hospitalization insurance, already approximately 40 percent of all private expenditures for hospital care. Das progress indicates that these voluntary organizations can reach many pople and provide better and broader benefits. They should be encourand helped to do so.

better health insurance protection for more people can be provided.

The Government need not and should not go into the insurance business to fish the protection which private and nonprofit organizations do not now de. But the Government can and should work with them to study and 2e better insurance protection to meet the public need.

recommend the establishment of a limited Federal reinsurance service to erage private and nonprofit health insurance organizations to offer broader th protection to more families. This service would reinsure the special tional risks involved in such broader protection. It can be launched with a pital fund of $25 million provided by the Government, to be retired from rance fees.

grant-in-aid approach

My message on the state of the Union and my special message of January 14 red out that Federal grants-in-aid have hitherto observed no uniform pattern. Esse has been made first to one and then to another broad national need. ach of the grant-in-aid programs, including those dealing with health, child fare, and rehabilitation of the disabled, a wide variety of complicated matchfortaulas have been used. Categorical grants have restricted funds to specipurposes so that States often have too much money for some programs and enough for others.

This patchwork of complex formulas and categorical grants should be simpliand improved. I propose a simplified formula for all of these basic grant-inprograms which applies a new concept of Federal particiation in State proThis formula permits the States to use greater initiative and take more posibility in the administration of the programs. It makes Federal assismore responsive to the needs of the States and their citizens. Under it, Feral support of these grant-in-aid programs is based on three general criteria: First, the States are aided in inverse proportion to their financial capacity. By relating Federal financial support to the degree of need, we are applying ren and sound formula adopted by the Congress in the Hospital Survey C Construction Act.

Sed, the States are also helped, in proportion to their population, to extend mprove the health and welfare services provided by the grant-in-aid pro

Therd, a portion of the Federal assistance is set aside for the support of unique 7jects of regional or national significance which give promise of new and better 28 of serving the human needs of our citizens.

Two of these grant-in-aid programs warrant the following further recomsedations.

Builitation of the disabled

Working with only a small portion of the disabled among our people, Federal State Governments and voluntary organizations and institutions have proved e advantage to our Nation of restoring handicapped persons to full and proGive lives.

When our State-Federal program of vocational rehabilitation began in 1920, de services rendered were limited largely to vocational counseling, training, and lacement. Since then advancing techniques in the medical and social aspects habilitation have been incorporated into that program.

There are now 2 million disabled persons who could be rehabilitated and thus red to productive work. Under the present rehabilitation program only of these disabled individuals are returned each year to full and productive Meanwhile, 250,000 of our people are annually disabled. Therefore, we ing ground at a distressing rate. The number of disabled who enter prove employment each year can be increased if the facilities, personnel, and Social 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. Physical rehabilitation services for our disabled people can best be given in bospitals or other facilities especially equipped for the purpose. Many thousands of people remain disabled today because of the lack of such facilities and !services.

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

I recommend, therefore, that the Hospital Survey and Construction Act be tended 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 general 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 assistance in such an expanded program, special funds be made available to the States to help pay for surveys of their needs. This is the procedure that the Congress wisely required in connection with Federal assistance in the construction of hospitals under the original act. We should also continue to observe the printiple of State and local determination of their needs without Federal interference.

These recommendations are needed forward steps in the development of a sound program for improving the health of our people. No nation and no administration 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 pit 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 very essence of our vitality, our strength, and our progress as a nation.

I urge that the Congress give early and favorable consideration to the recommendations I have herein submitted. DWIGHT D. EISENHOWER.

THE WHITE HOUSE, January 18, 1954.

Senator PORTELL. 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 answering 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 Rehabilitation.

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