Section 213. Grants-in-aid for medical education, research, and prevention of disease and disability Insofar as this section, while part of title II, has somewhat different program content, it seems worthwhile to prevent a brief separate analysis of the agencies' views on this aspect of the proposed health legislation. The Federal Security Agency commends this provision for grants-in-aid for medical education and research as being in accord with the President's recommendation that legislation dealing with medical research should provide for coordination between the research program that is to be a part of a national health program and research that is to be a part of a general research program to be administered by a central Federal research agency. The Bureau of the Budget, however, questions the desirability of this additional authorization for medical research in view of the authorization for the same purpose presently contained in Public Law 410, Seventy-eighth Congress, which now includes grants to research agencies as well as direct research by the Public Health Service. The Bureau's report states that "it would appear desirable to contain development of the medical research program of the Public Health Service within a single authorization." Moreover, “assuming the enactment of a pay-roll tax to provide for a substantial part of the prepaid medicalcare program" this would not preclude charging a portion of the medical-research program against the special funds derived from these pay-roll taxes. In addition, the Budget Bureau questions the provision for 2 percent of the amount expended for benefits to be available for medical research and education for medical and related professions “in view of the lack of demonstrable relationship between the cost of benefits provided for under the program and the needs for stimulating medical research and education." Instead it is suggested that "either an augmented specific limitation after 1947 or complete removal of the specific limitation would appear preferable." * * * * * Under this section preference and priority is to be given "to grants-in-aid with respect to projects to aid servicemen seeking postgraduate education as medical or dental practitioners or training for administration of personal health services, disability benefits, rehabilitation services, and related services" during the 5-year period beginning January 1, 1946. The term "serviceman" is defined to mean “a man or woman who has performed active military or naval service * after September 7, 1939." Veterans' Administrator, General Bradley, calls attention to the fact that for the purposes of hospitalization, domiciliary care, and burial benefits under laws administered by the Veterans' Administration, a World War II veteran is defined as "any person who served in the active military or naval service of the United States on or after December 7, 1941 He suggests that insofar as possible uniformity in preference provisions and in definitions of such terms as "veteran" and "serviceman" is desirable. * * The Veterans' Administration suggests that the bill be also amended so that a discharged or release under conditions other than dishonorable is made a prerequisite to the proposed preference and priority. ESTIMATED FEDERAL EXPENDITURES FOR HEALTH, FISCAL YEAR 1947, CORRESPONDING TO PROVISIONS OF S. 1606 EXECUTIVE OFFICE OF THE PRESIDENT, BUREAU OF THE BUDGET, Washington 25, D. C., April 3, 1946. DEAR SENATOR MURRAY: In response to your request of March 21, 1946, I am sending herewith a tabulation entitled "Estimated Federal Expenditures for Health, Fiscal Year 1947, Corresponding to Provisions of S. 1606." I hope this material may prove of value in connection with the hearings which are being undertaken by your committee. Sincerely, HAROLD D. SMITH, Director. Estimated Federal expenditures for health, fiscal year 1947, corresponding to provisions of S. 16061 TITLE I. GRANTS TO STATES FOR HEALTH SERVICES Part A. Grants to States for public health services: Federal Security Agency, Public Health Service: Control of venereal diseases (national defense) Travel expenses, Federal Security Agency, transfer to Printing and binding, Federal Security Agency, transfer Tuberculosis: Total, venereal diseases__ Federal Security Agency, Public Health Service: Pay, etc., commissioned officers (control of tubercu- Travel expenses, Federal Security Agency, transfer to Printing and binding, Federal Security Agency, transfer Total, tuberculosis__. Public health services: Federal Security Agency, Public Health Service: Health and sanitation activites, war and defense areas Printing and binding, Federal Security Agency, transfer to Total, public-health sevices____. Total, part A...--- Part B. Grants to States for maternal and child health services : Maternal and child health services and services for crippled children: Department of Labor, Children's Bureau: Grants to States for maternal and child health services_ 1 Certain minor items, as, for instance, penalty-mail costs, have been excluded. "Estimated obligations used. 410, 000 Total estimated expenditures for services for crippled children amount to $3,800,000, but it is estimated that over 60 percent of these funds is used for direct medical and hospital care. Consequently $2,500,000 has been included under title II. Estimated Federal expenditures for health, fiscal year 1947, corresponding to provisions of S. 1606 1 TITLE I. GRANTS TO STATES FOR HEALTH SERVICES-Continued Part B. Grants to States for maternal and child health services- Maternal and child health services and services for crippled Department of Labor, Children's Bureau-Continued Travel expenses, Department of Labor (approximate Printing and binding, Department of Labor (approxi- Total, part B_____ Part C. Grants to States for medical care of needy persons_. Total, title I____ TITLE II. PREPAID PERSONAL HEALTH SERVICE BENEFITS Prepaid Personal Health Service benefits: 5 Military functions, Medical Hospital Department-. Navy Department: Bureau of Medicine and Surgery. U. S. Naval Home__. Veterans' Administration: Hospital and domiciliary care and medical activities___. Federal Security Agency: Public Health Service, hospital and medical care_ St. Elizabeths Hospital__ Freedmen's Hospital_ Department of Labor, Children's Bureau : $30,000 100, 000 7,640, 000 None 51, 722, 220 € 84, 000, 000 1, 522, 000 1, 215, 600 $32, 000, 000 286, 000 233, 541, 228 18, 000, 000 2,500,000 875,000 Emergency maternity and infant care_ Services for crippled children__ Travel expenses, Department of Labor (approximate Department of the Interior: Bureau of Indian Affairs, conservation of health among Hospitals for Alaskan Native Service____ Department of Justice: Federal Prison System, Medical and Hospital Service, War Shipping Administration: Maritime training fund (amount used for hospital and 17, 595, 000 $2,500, 000 30, 000 4, 738, 400 684, 000 1, 350, 000 156, 000 Total, prepared personal health service benefits------ $400, 993, 228 3 Total estimated expenditures for services for crippled children amount to $3,800,000, but it is estimated that over 60 percent of these funds is used for direct medical and hospital care. Consequently $2,500,000 has been included under title II. 4 Grants to States for old-age assistance, aid to dependent children, and aid to the blind under Bureau of Public Assistance, Social Security Board, Federal Security Agency, are used by the individuals to whom they are allotted for medical care to some extent. There is, however, no limitation as to the proportion of these cash grants to be used for medical care and no data on how much is actually so spent. 5 Present provisions for Federal expenditures for direct hospital and medical care of individuals were considered to be the only items relevant to this part of title II, and these are what have been included, although they do not constitute prepaid personal health service benefits. This estimate excludes the cost of hospital construction, the cost of food, transportation costs, and pay of Army (Navy) personnel. It includes the cost of equipment and supplies used both in this country and overseas, the salaries of civilian employees, and the cost of care of dependents of Army (Navy) personnel. Estimated Federal expenditures for health, fiscal year 1947, corresponding to provisions of S. 16061 TITLE II. PREPAID PERSONAL HEALTH SERVICE BENEFITS-continued Grants-in-aid for medical education and research: 7 Federal Security Agency, Public Health Service: Operating expenses, National Cancer Institute (grants-in- Department of State, international obligations, cooperation with Training grants in public health and maternal and child Total, grants-in-aid for medical education and re- Total, title II. 2 $1,834, 000 2 578, 000 16, 000, 000 126, 600 8 18,538, 600 419, 531, 828 Total, titles I and II_____. 2 Estimated obligations used. 471, 254, 048 This part of title II has been interpreted to mean grants, subsidies, and contributions (payments to individuals) rather than merely grants-in-aid which are defined more narrowly as including only Federal payments to State and local governments or political subdivisions thereof. 8 This does not include expenditures for medical education for veterans under the GI bill of rights, for which no figures were available. SUMMARIES OF COMMITTEE HEARINGS ON S. 1606, PREPARED BY LEGISLATIVE REFERENCE SERVICE, LIBRARY OF CONGRESS SENATE EDUCATION AND LABOR COMMITTEE HEARING OF APRIL 2 APRIL 3, 1946. The committee met at 10 a. m. in room 224, Senate Office Building, Mr. Murray presiding, to initiate hearings on S. 1606, the National Health Act of 1945. The witnesses were the four sponsors of S. 1606: Senator James E. Murray, Senator Robert F. Wagner, Representative John D. Dingell, and Senator Claude Pepper. The first witness, Senator Murray, chairman of the committee, opened his remarks in support of the bill with the history of legislation for a national health program beginning with the original bill introduced by Senator Wagner in 1939. With the coming of war, national health legislation had to be laid aside until the war's end, although various health measures dealing with special problems came before the committee. The work of the Special Subcommittee on Wartime Health and Education headed by Senator Pepper, was commended by Senator Murray. He then cited President Truman's recommendation to Congress on November 19, 1945, for a five-point health program. On the same day, Senator Murray stated, he and Senator Wagner introduced S. 1606 in the Senate and Representative Dingell introduced it in the House of Representatives. S. 1606 covers three of the President's five points: Expansion of public health, maternal and child health services; more adequate funds for education and research; and a system of prepaid medical costs. The other two points are already provided for in the Hospital Survey and Construction Act and in the general social security bill now pending. Hearings on the national health bill are to continue through April. According to Senator Murray these hearings will give an opportunity to examine thoroughly all the issues in the controversy over whether we should have compulsory health insurance. Senator Wagner declared the national health bill is one of the most important bills ever considered by the committee and an essential part of a broad program to improve our domestic security. S. 1606 contains three titles: Title I, which provides for grants to the States for health services; title II, which provides for a national health insurance program; and title III, which contains general provisions. Senator Wagner said that health insurance is not socialized medicine or State medicine, that it merely provides ready access to medical care to all who need it, and that no regimentation of doctors, hospitals, or patients will be part of the plan. He cited the opposition to the workmen's accident compensation law in New York 35 years ago-a measure which now is universally approved by employer organizations, insurance companies, and doctors. The individual's freedom of choice in selecting his own doctor is safeguarded in S. 1606, according to Senator Wagner, and every effort has been made to protect the professional position of dentists, nurses, and nursing organizations. Moreover, he pointed out, through the Surgeon General cooperative working arrangements to utilize local administration and personnel are assured. Voluntary health plans, said the Senator, will be able to continue and will be aided. Senator Wagner stated that the cost of financing health insurance would be 3 percent of pay rolls (up to $3,600 per year), 11⁄2 percent to be contributed by employers and 12 percent by employees. Representative Dingell confined his remarks to title II of the bill (health insurance), which has been a particular target of the American Medical Association. Mr. Dingell charged the AMA with conducting a campaign of false propaganda against the bill. He cited numerous public opinion polls taken during the last 8 years which show the American people to be in favor of health insurance. According to Representative Dingell, voluntary health insurance fails, even though belatedly endorsed by the AMA last year, in that administrative costs average 45 percent of the premiums. Also, he contended, the individual rarely gets complete medical care. Compulsory health insurance, on the other hand, is compulsory only as far as contributions are concerned, and "does not compel anyone to receive any medical care" or "any doctor to treat any patient," as quoted from Governor Warren, of California. The Representative expressed opposition to the AMA having any control of the health insurance funds and cited the AMA's protest that the Advisory Council is merely advisory to the Surgeon General. Senator Pepper presented the findings of the Health Subcommittee, which is about to issue a report entitled "Health Insurance" representing some of the subcommittee's most important research and which summarizes the variety of voluntary health plans. The Senator then gave a brief summary of the report. According to the subcommittee's report, sickness is the greatest single factor in people going into debt. The way out of this tragic situation is health insurance. While voluntary plans have made progress, they are not adequate. Only 20,000,000 people are covered by the Blue Cross. Commercial insurance plans are group and individual. They pay cash toward medical expenses or wage loss but do not provide 'medical service. The alternative would seem to be a national plan of health insurance. Senator Pepper cited the preponderance of opinion in favor of national health insurance in the public opinion polls. Prepaid medical care is the subcommittee's recommendation. Senator Pepper then devoted considerable testimony to the maternal, child health and crippled children's services provided for by S. 1318. Child welfare services contained in S. 1318 are not being considered in the national health program. Adequate maternal and child health care are very important, said the Senator, especially for migrant and rural families. The subcommittee report also included proposed amendments to S. 1606. KATHRYN G. PAWSON, Reporter. SENATE EDUCATION AND LABOR COMMITTEE HEARING OF APRIL 3 APRIL 4, 1946. The committee met at 10 a. m. in room 224, Senate Office Building, Mr. Murray presiding, to continue hearings on S. 1606, the national health bill. Mr. Watson B. Miller, Federal Security Administrator, testified on behalf of the bill. He said the bill is long overdue. Because the measure is so comprehensive it appears complex, but the basic issue is simple, the witness contended, because the health of the people is the strength of the Nation. The points which Mr. Miller indicated he wished to stress particularly are aid to medical research and education. The first proposal in S. 1606, Mr. Miller pointed out, deals with the environmental aspects of health. Thus, it is to the interest of the entire country, he said to remove statutory limitations upon grants-in-aid to the States, especially if adequate provision is to be made for maternal and child health care. |