Mrs. H68r. That is true, Senator, but these would be built and rhorized on the basis of State plans and review of State needs. Serator HILL. I am speaking now not only of the four categories which you have largely addressed yourself but you stated earlier I certainly agreed with you that the first emphasis should come eneral hospitals where there are no general hospitals or where there is a shortage of general hospital beds.

Mrs HOBBY. That is perfectly true if you take a town or a city that has no general hospital and it will support one. Of course you ow there are various standards for hospitals-a great many cities are fairly adequate hospital services as against communities that are less and less adequate. So there are all degrees of priority. Am I correct. Dr. Cronin, in the need for general hospital beds now? Senator HILL And that need, you see, is growing more acute all the time unless we do something about it because our population has creased.

Mrs. HOBBY. That is true.

Senator HILL. I believe, Dr. Cronin, you testified that we need about $50 million a year just to keep apace, did you not? Is that not in your testimony?

Dr. CRONIN. I think you have reference, Senator Hill, to our testi-
Dony that it would take about $80 million in Hill-Burton funds.
Senator HILL. That is right.

Dr. CRONIN. To keep up with the population increase and the attrition rate from wind, rain, fire, and obsolescence if the role of the Hull-Burton was to continue in the total Federal expenditure, of the national economy as one-third of all the hospital construction buit, it would take $80 million.

Senator HILL. We have no reason to think that there would not be the need for the one-third, do we?

Dr. CRONIN. The need, Senator, exists. There is no question about the need. It is a question basically of what can and should be done in this field in relationship to the total Federal administration program for the expenditure of money for any fiscal year.

Senator HILL. I am talking to you as members of the Public Health Service. You are not representing the Bureau of the Budget, are

Of course there is another thing with it. I do not know how long it will take to get these surveys and make these plans but you cannot start that for some months, can you?

Dr. CRONIN. That would depend, Senator, on when and if the money becomes available, with authorization and appropriation aid

Senator HILL. You would have to get this bill passed and signed and that all takes time as we know. Then we have got to come back to the Appropriation Committee and get your money actually carried in the appropriation bill and get that signed. These appropriation bills do not usually become law until the very last days of the session of Congress.

Dr. CRONIN. That is right. Then the money would have to be allotted to the States and the States would get their surveys underway and in proportion to their staff capacities.

Senator HILL. Not only that, but they would have to put up their part, too. They would so provide some means to put up 50 percent, you may find that some of these States will have to wait for the actions of their legislatures, is that not true?

Dr. CRONIN. I think that is true. I think most all the States would have the authority to match these funds because they got the authority under Hill-Burton.

Senator HILL. It is a question of whether they got the money. When I said they would have to wait for the legislature to meet to get the money, so necessarily it is going to be some time even if this thing goes along in good fashion. It is going to be some time before you can get this money, is that not right?

Dr. CRONIN. I think about 6 months would be the earliest the States would get their surveys completed.

Senator HILL. That would mean if they had the money now and were ready to go to work, it would take 6 months to get the survey? Dr. CRONIN. That is right.

Senator HILL. But before they could start the survey they would have to put up their half of the money, would they not?

Dr. CRONIN. That is right. In the chronic-disease areas they probably could move a little faster than that because they now have their chronic surveys.

Senator HILL. I am wondering if Mrs. Hobby would not get us a little more money.

Mrs. HOBBY. Could I take you over to the Appropriations Committee, Senator Hill? I think you would be very effective.

Senator HILL. My dear lady, I am a member of that committee and if you will send me a budget estimate as a member of that committee, I will just tell you and I will get that money, you and I together, will get that money.

Dr. Cronin says they move forward in this chronic-disease area, so there is no question but what you can go right ahead under the existing act. Can't you get us a little more money, Mrs. Hobby?

Mrs. HOBBY. I will take it under advisement.

Senator HILL. This $50 million is the smallest amount of money that has ever been carried in the budget estimate.

Mrs. HOBBY. I cannot quite agree with that because we had this bill in mind to introduce, to meet the need as we saw it at this time-that chart, I think, does it very neatly. In thinking just of the hospital survey or the health needs of the Nation, as you know better than I, they change from year to year. After an examination of what it cost a person to stay in a general hospital, in a chronic hospital, and in a nursing home, and after looking at the chart showing how many more days a person past 65 stays in the hospital, we thought it incumbent on us to find some way of reducing the cost to the person past 65 who has to stay in such a long time,

Senator HILL. I join wholeheartedly with you in reducing the cost per person, but if we are going to get these beds that we need for general hospitals, mental hospitals, and for chronic hospitals, because we can go to building chronic hospitals even now. But we need some more money. $50 million, you see, the act as originally passed authorized $75 million, then we raised it up to $150 million and had that for 1950 and then, of course, the Korean war came on and it was necessary

to cut out the appropriations which we did to $8212 million, then $75. Then last year the budget estimate was only for $60 million when as To know we had a big battle. The Senate put it at $75. It finally e out of conference with the House to $65 but now to go down to Sis awfully low.

Mr. HOBBY. If you were to add $20 annually for the chronic, you ould have $70 million in now.

Senator HILL. Will you get us that $20, Mrs. Secretary?

Mrs. HOBBY. You come with me to your own committee and I would t be surprised if you could do it by yourself.

Senator HILL. You could assure it, I think. Couldn't you get us 1 budget estimate?

Mrs. HOBBY. Sir, you know the budget estimates are already up. Senator HILL. I know, my dear Mrs. Secretary, your tremendous hence with the President of the United States and it is the PresiBat's budget, too. When he deals with the Director of the Budget, I want a supplemental estimate up there for $20 million or whatever t may be, whatever it comes to. He is the Commander in Chief on the budget just as he is in other things.

Senator PURTELL. Mr. Rockefeller had something to say.

Mr. ROCKEFELLER. Senator Hill, it seems to me that the record here fight bet a little misleading if we speak of this as the lowest budget history for this program. You mentioned $50 million and that is cly for part of the program. It is the second highest budget estiLate and the request from the President on the record for his

Senator HILL. Mr. Secretary, I would have to say this to you, that as of now, although the Budget talks about the fact that it will submit Fee additional budget estimates, they are not in the budget as of

now.

Mr. ROCKEFELLER. They are in the President's budget.

Senator HILL. The facts show that it is going to be some time, bound to be some time before you get any of this money.

Mr. ROCKEFELLER. The $112 million is in the President's budget as sent to the Congress. That is the figure that I think you should be considering here, not the $50 million.

Senator HILL. I happen to be on the Appropriations Committee and I have checked this pretty carefully. He speaks about the fact that it is the intent-I will use that word-about sending these estimates ap but they are not in the budget as of now.

MIS, HOBBY. There is a difference. You are talking about one thing, Serator Hill is talking about another. I know what Senator Hill talking about. The actual budget which came up is $50 million. However, in the elective part of the budget where the President refers to this legislation, and I have forgotten what page it is on, page 706 of the proposed for later transmission, is the figure we outlined here. Senator HILL. For later transmission.

Mrs. HOBBY. But there is no other way to do it, is there?

Senator HILL. Yes, there is a way to do it and that is to send your budget estimate up now under your existing law. You see, you have got up to $150 million authorized now. He could send the budget estimate up and could ask for $150 million right now.

Mrs. HOBBY. I know that is true, but we wish to do it on the basis of need as we now see it. Senator.

Senator PURTELL. I wonder, Senator Hill, if the Bureau of the Budget might have read that, the Journal of the American Hospital Association's issue of January 1954 in which they say:

In an opinion poll of the American Hospital Association house of delegates, members forecast A Road Ahead

the article is A Road Ahead and I am quoting from it. They said in part:

For the most part, members of the house of delegates were of the opinion that a shortage of beds in rural areas no longer exists. Many of them felt however, that in rural areas where small hospitals are built it might have been more wise to have established a rural health center and to channel hospital patients to urban areas where more adequate diagnostic and treatment services were available and the respondents also frequently cited too low occupancy rate in smaller hospitals in rural areas.

The delegates of one Southwest Central State summarized the opinions of those who believe that there is no shortage of beds in rural areas by stating-and I quote:

Occupancy in hospitals in this State is reported to be extremely low, except In the larger cities. This would indicate that new beds provided by Hill-Burton funds should be added in the cities rather than in the outlying districts. There is no doubt that medical service has been improved in the outlying areas because of the Hill-Burton funds, and the activities brought about in the rural districts to obtain better facilities for the doctors in those areas. But it seems that this is perhaps the time when the saturation point should be considered and determined as nearly as possible.

There is another matter in the article but I thought those might be pertinent.

Senator HILL. I think that is pertinent, but I think that the various charts and figures that Mrs. Secretary has shown here today show the need for these other things. According to her figures you have a need now for 200,000 general hospital beds, 350,000 mental hospital beds, 40,000 TB beds, and 210,000 chronic disease beds.

On tomorrow, I understand, we will have the representative of the American Hospital Association here.

Senator PURTELL. Yes, Senator.

Senator HILL. I think you will find that if we ask him the question, he will very strongly advocate an increase in the $50 million. What I was seeking to do was to get this thing started now. Why wait! We can start now. We have the authority.

Mrs, HORRY. I do not know exactly how you could get started when experience has been that the people have not made application for the chronically ill. And watching it develop, we thought the only way to get them to do it was to earmark the funds for it. It is perfectly true that under the law now, they could be built. But we believe they would not be built unless we earmark the funds.

Senator HILL. I think in view of the history that has happened here, this present bill and all this testimony and everything, that if you had additional funds, that you of the Public Health Service would be well justified in seeking more chronic hospital beds in your States Then another thing about it, even with that, I want to say this, and I want to emphasize this, I put that emphasis that you did, my dear Mrs. Secretary, on the general hospital beds. In your own figures, your own figures

Mrs. Honny. We could not deny, Senator, that there is need for

Senator HILL. The chronic need today and when you talk about $50 million, knowing that so many of these communities have put burdens upon themselves, taken all kinds of steps to build these hospitals and then we get this little small sum of $50 million for that purpose. You see, your hospital beds, including your chronic disease beds, you have got approximately some 600,000 beds according to your own figures. So, I was hoping maybe you would go to President Eisenhower and ask him to tell Mr. Dodge to send up a budget estimate for a little more

money.

MS HOBBY. Thank you very much for your counsel.

Senator HILL. Would you think it over?

Mrs. HOBBY. Yes, sir, I will think it over.

I want to express my deep appreciation to the chairman for his great patience here and also to the other members of the committee. Senator HILL. Also I want to thank Mrs. Secretary and members of the Public Health Service who have been patient. I might say this, after getting this thing further, I may have some more questions, Mrs. Secretary.

Let me ask you one other question while you are here. I introduced abili way last year and it was sent down to your Department for comment and in fact there were three of those bills, I believe. The bill I introduced was Senate 93, a bill dealing with health and health insurance, sent down on January 26, 1953, on which there has been no comment. Then I think, tomorrow, Mr. Chairman, I believe Senator Humphrey is coming on his bill, S. 1052. That bill went out on February 21, 1953, which is over a year ago. We have had no comment from your Department, I understand. Then the Flanders-Ives-Nixon bill-the Vice President was in the House and he introduced it in the House-in 1953. I think we have had no comment on those bills. I wonder if we might not have some comment from your Department on those bills.

Mrs. HOBBY. Senator, I feel very badly that your committee has not. As a matter of fact, to be perfectly frank with you, I would just have to say that we have had so much work we could not get to all of it. And I apologize for my part of the staff because they work the clock around and, as you well know, there are limitations to the number of hours in the day and to physical endurance. We do hope to have shortly, I think it is in the process, a report on Senator Humphrey's bill, S. 1052, and the Ives-Flanders bill, which, as you know, is quite an extensive one requiring the greatest kind of care. We do get so many demands from the various committees in the Senate for immeliate and almost deadline reports on bills they are hearing. This is just my apology to the committee, and a very sincere one, for not being able to keep up with all the bills on which we have been asked to report.

Senator HILL. Have you had your personnel reduced much, your

staff!

Mrs. HOBBY. Legal counsel?

Senator HILL. I mean your whole staff.

Mrs. HOBBY. No, sir, we have not.

Senator HILL. I thought you might have had reductions in your budget, too.

Mrs. HOBBY. We were very fortunate, as you know. We were made 1 Department this time. I have forgotten-I would hate to put it in