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DEPARTMENTS OF LABOR, HEALTH

HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1992

TUESDAY, MARCH 12, 1991

U.S. SENATE,
SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS,

Washington, DC. The subcommittee met at 10:07 a.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding.

Present: Senators Harkin, Bumpers, Adams, Specter, and Stevens.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH

STATEMENT OF DR. JAMES O. MASON, ASSISTANT SECRETARY
ACCOMPANIED BY:
J. MICHAEL MCGINNIS, M.D., DEPUTY ASSISTANT SECRETARY FOR

HEALTH (DISEASE PREVENTION AND HEALTH PROMOTION) WILLIAM R. ARCHER, M.D., DEPUTY ASSISTANT SECRETARY FOR

POPULATION AFFAIRS WILLIAM A. ROBINSON, M.D., M.P.H., DIRECTOR, OFFICE OF MINOR

ITY HEALTH KENNETH J. BART, M.D., M.P.H., DEPUTY DIRECTOR, NATIONAL

VACCINE PROGRAM ANTHONY L. ITTEILAG, DEPUTY ASSISTANT SECRETARY FOR

HEALTH MANAGEMENT OPERATIONS W. HARELL LITTLE, DIRECTOR, DIVISION OF PUBLIC HEALTH

SERVICE BUDGET DENNIS P. WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, DEPARTMENT OF HEALTH AND HUMAN SERVICES

OPENING REMARKS OF SENATOR HARKIN Senator HARKIN. Good morning. The Appropriations Subcommittee on Labor, Health and Human Services, and Education will come to order. I apologize to all of you for being a little late this morning.

This morning we will hear testimony first from Dr. James Mason, Assistant Secretary for Health concerning the 1992 budget request for the Public Health Service. He will be followed by Dr. J. Jarrett Clinton from the Agency for Health Care Policy and Research. Then we will conclude this morning with testimony from Dr. William Roper, Director of the Centers for Disease Control.

The fiscal year 1992 request for the Public Health Service is $15.6 billion, which is 3.3 percent more than last year. Excluded from this total but within the Public Health Service are budget requests for the Food and Drug Administration and the Indian Health Service. These agencies fall under the jurisdiction of the Ag. riculture and Interior Appropriations Subcommittees.

Dr. Mason, first I want to commend you for the level of effort that you have devoted to actively pursuing the Nation's 1990 and 2000 health care objectives. Certainly the three overall national health goals that you have outlined-increasing the healthy lifespan of the population, reducing health disparities, and achieving access to preventive services for all Americans—are critical ones if we hope to begin the next century as a productive and vigorous Nation.

am concerned, however, that we have met only one-half of the 1990 health objectives and that diseases that we once thought were nearly eradicated such as tuberculosis are on the increase again.

Recently, I along with several other Senators, introduced legislation which we hope will get us on the right track to meet the goals that we have set for the year 2000. This is a package of seven bills to expand the number of prevention programs available for young people and adults. That legislation includes Medicare-reimbursed breast cancer screening for women age 50 and over; a wider range of health promotion programs targeted to older Americans; and a comprehensive 50-State program to educate children and adults on the dangers of lead poisoning.

I believe this legislation will ensure that we use our health dollars to promote wellness today instead of devoting resources to costly treatments tomorrow. I keep saying, Dr. Mason, that we are very good in this country at patching and filling and mending and remedying things. We spend $700 billion per year on health care, and less than 1 percent of that goes to prevention. I think that it is time to start reversing that.

We have to put more emphasis, I believe, on prevention and on wellness. That starts in medical schools. This is beyond your jurisdiction, of course, but I am just sort of sketching out the picture, drawing the picture where I think we ought to be going and where I intend to hopefully get this subcommittee directed. That is one of the goals that you have outlined, too, and I appreciate that. We need to get more attuned to prevention. Quite frankly, the Public Health Service can play a very active and leading role in that.

So, I am pleased to see that your budget request reflects a commitment to these preventive services. I understand that about $5.4 billion of your total request this year falls under the category of prevention spending. I appreciate that. That is about a 7.4-percent increase over last year. I look forward to anything you have to say about these programs this morning.

There is one other issue that I wanted to highlight for you and discuss this morning; that is, the issue of family planning. I am concerned with reports I have heard that the Department intends to centralize the award of family planning funds in Washington,

and I want to discuss that with you perhaps in our question and answer session.

Dr. Mason, we are pleased to have you with us this morning. I will leave the record open at this point for any statements which Senator Specter, our ranking member, may wish to make, and at this time would recognize the distinguished Senator from Alaska for any opening statement he has.

Senator STEVENS. No; I have no opening statement. I am sort of wandering between subcommittee meetings today, so I will be back later after we have another one. Thank you very much.

PREPARED STATEMENT

Senator HARKIN. Dr. Mason, welcome, and please proceed as you so desire. Your complete statement will be included in the record.

[The information follows:)

STATEMENT OF JAMES O. MASON

Mr. Chairman and Members of the Subcommittee:

I am pleased to appear before you again to discuss the Fiscal Year (FY) 1992 budget request for the Public Health Service (PHS).

The discretionary budget request for PHS agencies under the jurisdiction of this Subcommittee totals $15.3 billion, an increase of $542 million, or 3.7 percent over FY 1991 appropriations.

This represent a deep commitment on the part of the President and the Secretary of Health and Human Services to the major health problems that we as a Nation face.

I am committed to the idea that in these difficult budgetary times, government must make the most possible sense out of every dollar available to help us meet the needs of the people we serve.

This budget proposal is an effort to do just that. Thus, we have grouped our spending priorities around three principal themes:

The prevention of disease with special emphasis on health promotion and prevention of infant mortality and childhood diseases;

The stabilization and enhancement of biomedical research. The enhancement of Anti-Drug Abuse activities.

Let me outline for you some of the major elements of this proposal as they relate to these priorities.

Many of the prevention activities envisioned under this proposal center around, or stem from, Healthy People 2000, which Secretary Sullivan unveiled last fall.

This is a truly national plan of 300 measurable targets to enhance the healthy lives of our people by reducing preventable death, disease and disability.

It was formulated under the leadership of the PHS in close consultation with nearly 300 Federal, State, local and voluntary health agencies and organizations.

The subtitle of this document is "National Health Promotion and Disease Prevention Objectives." Its implementation will require the direct involvement of every sector of our society. Most important to its implementation will be the attitudes and behavior of the American people themselves.

We recognize that the kind of prevention envisioned in Healthy People 2000 calls for difficult changes. Perhaps the most difficult of all are changes in personal behaviors.

So much of the needless suffering and death that afflict our citizens could have been avoided if different choices had been made about how they have lived their lives: smoking cigarettes, poor dietary habits, abusing alcohol and drugs, recklessness in the use of automobiles, promiscuous sexual

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