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It is apparent that the amended version of the bill weakens the provision on behalf of local and voluntary interests in these fields. The bill does not require Federal development or encouragement of local interests. If adopted in its present form, the effect of the bill (depending partly on Federal administrative policy) may well make for discouragement of voluntary and local action.
Before action is taken on the Cabinet proposal, it would appear that an essential first step would be discussion of the proper relationship between Federal and State-local responsibility. This relationship should be clarified, and it is desirable that such clarification should come at a period such as the present when there is no economic crisis bringing pressure on Congress for immediate Federal expansion.
Chart 4.-Federal grants to States for health, education, and security purposes by fiscal years ending June 30:
(1) Maternal and child health and welfare services, public health services, venereal disease and tuber. culosis control, vocational rehabilitation, State and Territorial homes for disabled soldiers and sailors, emergency maternity and infant care, and school-lunch program. 1947 data not yet available.
(2) Education of the blind, agriculture and mechanical arts colleges, marine schools, vocational education, training of war workers, and services for farm labor, 1947 data not yet available.
(3) Old-age assistance, aid to dependent children, and aid to blind.
(4) Unemployment compensation administration; employment services through 1941.
Since 1943, there has been a decline in grants to States for education, due to the curtailment of defense training programs. Grants for employment security purposes have shown some fluctuation, but grants for public assistance and health and welfare services have steadily increased. In the last 2 years public assistance grants have risen more than 50 percent, from 421.2 million dollars in 1946 to 644.1 million dollars in 1947. Source: Social Security Yearbook, 1945, and Social Security Bulletin, September 1947.
In conclusion, it is doubtful whether granting Cabinet status to the Federal Security Agency has any real value other than a frankly political one. On the other hand, this proposal, of little apparent significance in the immediate future, may contain implications for the potential growth of the Department of Health, Education, and Security of such magnitude as to merit careful consideration. Further study of all possibilities is necessary before Congress acts on S. 140.
The CHAIRMAN. I just wish to ask one or two other questions.
The CHAIRMAN. I would like to ask some questions to clairfy the position of the American Medical Association which, in the course of the contest over these issues, is frequently under attack.
Does the American Medical Association have any objection to the creation of a Department of Welfare or Social Security as such? Dr. BAUER. No, sir; we do not consider that is our affair at all. The CHAIRMAN. In other words, if they want to elevate someone to a Cabinet position or elevate a service here to a department position of Cabinet rank, if they will confine it to social security, you have no objection whatsoever?
Dr. BAUER. No.
The CHAIRMAN. And your association has no objection? Dr. BAUER. That is correct. I do not think we have ever gone on record one way or the other on that matter because we do not feel that is part of our program. We are very definitely concerned that we do not want health to become a part of welfare, sort of a tail to the dog, so to speak. If they want a Department of Welfare, that is their business, not ours.
The CHAIRMAN. Is your profession and association today satisfied with the present conditions and with the present arrangements of the Public Health Service in the social security set-up?
Dr. BAUER. No, sir; we are not satisfied with that. I am speaking for the American Medical Association now, and not the Public Health Service. We feel the Public Health Service should not be a part of the Federal Security Agency.
The CHAIRMAN. I am trying to establish here for the record the clear position of the American Medical Association. What is their position with reference to this? You say you are not satisfied with the present conditions and the present arrangement, and you oppose the elevating of the present arrangements-that is what this does-to the department status. What is the position with reference to the American Medical Association? How should this service be handled, and where should it be placed in the administration and organization of Government?
Dr. BAUER. We feel that ideally the proper solution is a separate Department of Health of executive status. If that is not feasible at the present time, we are in favor of an independent health agency with the health functions correlated in that one department, and not scattered in various organizations as they are at present. But that independent agency would have the status of certain other independent agencies which now exist, but they should not be tied into other activities which have no close relationship to it.
The CHAIRMAN. In other words, your preference is a department, a single department of health?
Dr. BAUER. That is correct.
The CHAIRMAN. That is your first choice?
Dr. BAUER. That is our first choice.
The CHAIRMAN. Until such time as that is feasible and can be attained, then you want the Public Health Service to remain an independent agency?
Dr. BAUER. That is correct; yes, sir.
I think there are things besides public health which could be brought into it, such as the Food and Drug Administration, for example. The CHAIRMAN. You mean into the department?
Dr. BAUER. Or into an agency,
The CHAIRMAN. I want an expression from your association with reference to this. In support of this plan, the contention is made by the advocates of it that public health and education and social security should have a voice in the decisions made by the Cabinet. In other words, these agencies should have representation in the high level decisions of the Cabinet in the affairs of government.
Now, under this plan, do you feel that the Public Health Service could be assured of a voice at that high level of decision?
Dr. BAUER. No; I do not feel that they would. The voice would be a very small voice.
The CHAIRMAN. Under the plan as it is argued and contended by those who favor the plan, all of the statutory functions of the Surgeon General are reserved in him even in this transfer, and that therefore it still remains, the agency still remains autonomous and independent. The point I am making is, when the secretary of the new department is particpating in Cabinet deliberations where matters of health may be involved, under this plan do you feel that there is any assurance that the secretary of the department would speak the mind of the head of the Public Health Service?
Dr. BAUER. No, sir; I have no such assurance that he would.
The CHAIRMAN. So whether you would have a voice or not would depend upon the secretary.
Dr. BAUER. Yes, sir; I believe that.
The CHAIRMAN. How do you think that voice would speak with reference to the proposed compulsory health insurance program when that came up?
Dr. BAUER. Well, I think under the present circumstances he would speak very much in favor of it.
The CHAIRMAN. Would that be the voice of the American Medical Association?
Dr. BAUER. It most certainly would not.
The CHAIRMAN. Senator Schoeppel, do you have any questions? Senator SCHOEPPEL. For the purpose of the record, about how many members do you have in the American Medical Association at the present time?
Dr. BAUER. Nearly 146,000.
Senator SCHOEPPEL. And they were all represented in your San Francisco meeting which you were discussing a while ago in giving up their viewpoint?
Dr. BAUER. Yes, sir.
Senator SCHOEPPEL. The chairman has cleared up some matters that were very much in my mind as to what your actual position was, and I do not think I have any further questions.
The CHAIRMAN. Thank you very much, Dr. Bauer.
Dr. BAUER. Thank you, Mr. Chairman.
The CHAIRMAN. The committee will next hear from Dr. E. Harold Gale of the American Dental Association, and I understand he is accompanied by Mr. Francis Garvey.
Doctor, you may proceed.
STATEMENT OF DR. E. HAROLD GALE, CHAIRMAN OF THE COUNCIL ON LEGISLATION, AMERICAN DENTAL ASSOCIATION, NEW YORK, N. Y., ACCOMPANIED BY FRANCIS GARVEY, SECRETARY OF THE COUNCIL ON LEGISLATION, AMERICAN DENTAL ASSOCIATION, CHICAGO, ILL.
Dr. GALE. Mr. Chairman and members of the committee, my name is Dr. E. Harold Gale, of Albany, N. Y. I am a practicing dentist in that city, past president of the Dental Society of the State of New York, and am presently chairman of the council on legislation of the American Dental Association. I appear here this morning to present the views of the association with regard to Senate Resolution 302, and Reorganization Plan No. 27 of 1950.
The only function of Senate Resolution 302 is to initiate the mechanics for causing the disapproval of Reorganization Plan No. 27 of 1950. It is, therefore, the reorganization plan with which we are primarily concerned. That plan proposes to establish a new Federal department to be known as the Department of Health, Education, and Security. To this Department would be transferred all existing agencies of the Federal Security Agency, together with their functions, duties, personnel, funds, and the like. The Department would be headed by a Secretary appointed in the usual manner who would be assisted by an Under Secretary and an Assistant Secretary.
Section 2 (b) of the bill states:
All functions of the Federal Security Administrator are hereby transferred to the Secretary.
The plan further specifically transfers or establishes in the new Department three offices, to wit: those of Surgeon General of the Public Health Service, Commissioner of Education, and Commissioner of Social Security. It is provided by the plan that the Surgeon General shall be the head of the Public Health Service and shall perform such other duties concerning health as may be required by law or as the Secretary may prescribe to law. There would be transferred to him all the functions of the heretofore existing Surgeon General of the Public Health Service. He would report directly to the Secretary and would be required to have professional qualifications, experience, and training appropriate to the duties of his office. He would be appointed by the President with the advice and consent of the Senate for a term of 4 years. If a member of the regular corps of the Public Health Service, he would continue to receive compensation at the rate provided for his rank. If he were appointed from without such corps, he would be paid $14,000 per year. Section 6 of the plan authorizes the Secretary to make certain administrative consolidations in the interest of economy, but contains a proviso denying his authority to transfer or remove from the control of the Surgeon General any professional or substantive functions vested in him "under the provisions of the reorganization plan or of law hereafter enacted."
Section 7 abolishes certain existing offices, and section 8 authorizes the President to make ad interim appointments to the new posts provided for a period of 60 days.
In analyzing this plan, I have taken pains to outline only those portions which apply to the office of the Surgeon General or to the
health functions of the proposed new Department. The American Dental Association has long believed that there should be a Federal Department of Health. It further believes that the Department should not be under the control of a layman, but should be under the control of a person trained in one of the health services. Reorganization Plan No. 27 does not meet with that program of the American Dental Association.
The American Dental Association is the official spokesman of more than 85 percent of the 83,000 registered dentists in this country. Dentists and their association as members of the health services are concerned with the health problems of the public. They feel it is their duty and their responsibility to enunciate wherever it may be necessary the position of the profession with regard to proposals which may directly or indirectly affect the health of the public. Pursuant to this objective, it has sent representatives to appear before committees of Congress since prior to 1900.
Let me make it clear at this point that the American Dental Association has no opposition to the elevation of the Federal Security Agency to Cabinet status, but it believes that the elevation of that Agency with the health organizations of the Government as a component part of the new Department is inconsistent with the health needs of this country. In his transmittal message, the President states that the present plan is designed to meet the major oppositions which were raised in opposition to the 1949 plan. He states that the objection advanced that the plan threatened to subordinate professional judgment to nonprofessional domination has been overcome. The American Denatal Association has some doubt as to whether this assertion is technically correct. It is true that Reorganization Plan No. 1 of 1949 proposes to "consolidate" all functions of the then proposed Department of Welfare in the Secretary. This plan apparently undertakes to overcome that opposition by establishing the office of the Surgeon General of the Public Health Service as a separate bureau and by restricting the Secretary from transferring or removing from the control of the Surgeon General any professional functions vested in him. This concept does not square either with the practical facts of good administration nor with principles of good administration, nor yet with the real position which the new Secretary would occupy with relation to the Surgeon General. As was quoted above, section 2 (b) of the plan states, "All functions of the Federal Security Administrator are hereby transferred to the Secretary." This means that wherever in existing statutes relating to the duties of the Surgeon General, the words "Federal Security Administrator" appear, we may substitute in the existing law the words "Secretary of the Department of Health, Education, and Security." Let us examine briefly how some of the statutes of the office of the Surgeon General operate and see what the true relationship of control would be.
Subchapter 1 of title 42 of the United States Code relates to the administration of the Public Health Service. Section 201 (c) of that subchapter states that the term "Administrator" means the Federal Security Administrator. Subsection (d) states that the term "regulations, "when not otherwise specified, means rules and regulations made by the Surgeon General with the approval of the Administrator.