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Section 202 states:
The Public Health Service in the Federal Security Agency shall be administered by the Surgeon General under the supervision and direction of the Administrator.
Reorganization Plan No. 27 states (sec. 5):
There are hereby transferred to the Surgeon General * * * provided for in this section, all of the functions of the heretofore existing Surgeon General of the Public Health Service * * *
Under section 203 of title 42, the Public Health Service consists of (1) the Office of the Surgeon General, (2) the National Institute of Health, (3) the Bureau of Medical Services, and (4) the Bureau of State Services. Under this section, the Surgeon General is authorized to abolish, transfer, establish, or consolidate various divisions, but only with the approval of the Administrator. Under section 215 of title 42
The Administrator is authorized, upon the request of the head of an executive department, to deliver officers or employees of the Service to such Department for duty as agreed upon by the Administrator and the head of such Department in order to cooperate in, or conduct work related to, the functions of such Department or of the Service.
Under section 216 (b)
the Surgeon General, with the approval of the Administrator, unless specifically otherwise provided, shall promulgate all other regulations necessary to the administration of the Service * * *
(The President prescribes regulations with respect to appointment, promotion, etc.)
Under section 218, a National Advisory Health Council is established. The Surgeon General, with the approval of the Administrator, is to appoint 10 members. Under subsection (c) of the same section, the Surgeon General is to appoint the members of the National Advisory Cancer Council with the approval of the Administrator. Under subsection (d) the same is true with regard to the National Advisory Mental Health Council. Under subsections (f) and (g) the same is true with respect to the National Advisory Heart Council and the National Advisory Dental Research Council.
Under section 219 the Administrator is authorized to accept, on behalf of the United States, gifts made unconditionally by will or otherwise, for the benefit of the Public Health Service or for the carrying out of any of its functions.
Under section 222 insane patients entitled to treatment by the Public Health Service are to be admitted upon the order of the Administrator into St. Elizabeths Hospital. Under section 246, which relates generally to grants-in-aid for venereal disease control, tuberculosis control, the maintenance of adequate public health services. at the local level, and heart disease control, the Surgeon General is directed with the approval of the Administrator to determine the total sum of certain appropriations which shall be available for allotment among the various States and under 246 (e) he is further to determine the amounts to be paid to each State from the allotments with the approval of the Administrator.
Under section 252 the Surgeon General is to provide for the surgical and mental examinations of aliens under the immigration laws subject to administrative regulations prescribed by the Attorney
General and medical regulations prescribed by the Surgeon General with the approval of the Administrator.
Section 262 (d) authorizes the Surgeon Generals of the Public Health Service, Army, and Navy to prescribe regulations for licensing of establishments to manufacture or propagate biologicals, such as serums, toxins, virus, and so forth, subject to the approval of the Administrator.
Under section 264, the Surgeon General is authorized to make regulations to prevent the introduction, transmission, and spread of communicable diseases with the approval of the Administrator. Under the Hill-Burton Act (42 U. S. C. 291 et seq.), general regulations to be prescribed by the Surgeon General are made subject to the approval of the Federal Hospital Council and the Administrator.
Under section 291 (k) the Federal Hospital Council is to consist of the Surgeon General and eight members appointed by the Adminis
The foregoing citations have been made for the purpose of showing that the Surgeon General, who will occupy the status of a bureau commissioner in the executive department will, in fact, be subject to the control of a lay administrator under this plan, just as he is now subject to such control in the Federal Security Agency set-up. This is confirmed by the words of the President himself where, on page 2 of his transmittal message, he states:
The Surgeon General and the Commissioner of Education will have the same relationship to the Secretary of the new Department that they now have to the Federal Security Administrator.
The association is sincerely interested in economy and efficiency in government. It has followed with interest the Hoover Commission reports and the actions of the President under the Reorganization Act of 1949. It subscribes wholeheartedly to the mechanism provided in that act for realining various governmental functions. However, it believes that when a number of agencies are combined into a single large agency there must be a logical connection between the functions of the various agencies so associated. We do not think that it is logical to combine the health activities of the Government with education and social-security problems. We believe that the health functions of the Government today are sufficiently great in number and importance to warrant all health activities being placed in a separate Federal department. We realize that this committee has no power to recommend amendments to the reorganization plan. We do think, however, that it has a duty to consider whether any reorganization plan should be allowed to become law, if that plan will tend to stabilize an undesirable situation. We are firmly convinced that if the Federal Security Agency becomes an executive department with the Public Health Service as one of its component agencies, it will be many years before the establishment of an independent Department of Health can be obtained.
In conclusion, let me refer to the relationship of this reorganization plan to the compulsory health insurance proposals. There is no doubt in the minds of personnel engaged in the health services but that the Office of Surgeon General is included in this plan in order to maintain the existing social-security establishment intact for the administration of the compulsory health insurance scheme if it is ever
enacted. I do not desire at this time to argue the merits or demerits of that scheme. The views of the American Dental Association on that subject have frequently been presented to the Congress; however, since the association does not approve of the health service being controlled by the only existing machinery now constituted so as to be able to operate compulsory health insurance, it disapproves strongly any attempt to give added prestige to that agency.
The association has appreciated the courtesy of your committee in allowing us this time to present our views. If there are any questions, either myself or Mr. Francis J. Garvey, secretary of the council on legislation, who is here with me this morning, will be glad to attempt to answer them.
The CHAIRMAN. Doctor, I wish you would elaborate a little on the last sentence in the next to the last paragraph of your statement where you referred to the added prestige this plan would give to those advocating the compulsory health insurance program. It is contended by those who sponsor the plan and support it that that is just a myth; that there would be no added prestige. You say it would give them added prestige. I wish you would elaborate upon that.
Dr. GALE. I think without any question there is an added prestige in departmental status. It does not seem to me that that is hardly debatable. In fact, if that were not part of the picture, I wonder why it is so earnestly sought. And here we come into the opinions that are held by the person who is without any question to be appointed if this Cabinet post is created.
We object on two bases: First, we feel that the head of a health agency should have professional training. Secondly, when you have an individual stepping into that position who is perhaps the leading exponent of a health plan, with which both the American Dental Association and the American Medical Association are thoroughly in disagreement, we feel that it is to that individual an opportunity to use his Department for the dissemination of information and misinformation supporting the compulsory health plan.
The CHAIRMAN. You possibly heard my questions of Dr. Bauer with reference to the requirements in the plan as to qualifications for the Surgeon General, which I repeat, and I quote from the plan: That the Surgeon General and others shall have professional qualifications, experience, and training appropriate to the duties of his office.
Does that insure in your opinion that a medical doctor or a dentist would have to be appointed? In other words, would it be necessary that he have such professional attainments in order to qualify under that provision?
Dr. GALE. It would not seem so to me. The term "professional requirements" is quite a broad one. There are a number of professions besides dentistry and medicine in the health field, and it would be purely a question of interpretation by whoever was to make the appointments, in this case the President. It might be a sanitation engineer or a man of that type.
The CHAIRMAN. Do you interpret it as being so broad that it would permit anyone who may have held a responsible position in the Public Health Service for a number of years to be appointed to that position whether he was a doctor or not?
Dr. GALE. If they had a background that they claimed to be sufficient:
The CHAIRMAN. If they just had that background of experience? Dr. GALE. Which they could claim, or it would be claimed for them that it was professional training for the post. I think it would be entirely a question of interpretation as to whether they could be appointed. It might make an interesting question to see who would question the qualifications and on what basis.
The CHAIRMAN. May I ask the same question I asked Dr. Bauer now with reference to your organization? Do you oppose this plan and the setting up of the department with these components, including the Public Health Service, or is your association opposed to the creation of a Department of Welfare or Social Security if it excludes the Public Health Service?
Dr. GALE. Not at all. We feel that we have limited our testimony and our attitude to the field in which we feel competent to make our statements, and that is the question of health. We feel that the health agencies of the Federal Government are of sufficient importance so that they should have Cabinet status and a separate department with a professional head. As far as education and social welfare are concerned, I think that is a separate matter for perhaps Congress to decide, whether or not these departments warrant Cabinet status.
The CHAIRMAN. Is the position of your association the same as that of the American Medical Association with reference to this: You prefer first departmental status for health alone?
Dr. GALE. That is correct.
The CHAIRMAN. And secondly, if that is not practical or feasible at this time, then you prefer an independent agency of health?
Dr. GALE. We feel that we would like to bring together the health services into one group, whether it be a department or an agency.
The CHAIRMAN. All right. Are you satisfied with the present setup? This plan just transfers the present existing organization and set-up from an agency into a departmental status. Are you satisfied with the present situation?
Dr. GALE. No, sir; we are not. I do not believe it would be logical for us to oppose this plan if we were entirely in agreement with the present plan because there is very little change in some aspects. We are not satisfied with the present situation, we believe that health should be under the administration of professionally trained individuals, and that is not true today.
The CHAIRMAN. Senator Smith, do you have any questions?
The CHAIRMAN. Senator Schoeppel?
Senator SCHOEPPEL. Dr. Gale, I probably should have asked this question of Dr. Bauer, but I wonder if you have had some experience with the attitude of the veterans or the fear expressed on the part of the veterans that an ambitious secretary at the head of this department if this plan goes through could certainly take charge of the veterans' medical department. Do you have any views on that?
Dr. GALE. Of course I am not here this morning, Senator, to reflect my own views, but those of the association. As far as I know, and I would like to ask Mr. Garvey if I am not correct in my statement, the Dental Association has taken no stand on that aspect.
Mr. GARVEY. If you are referring to the united medical administration bill, we have it under study. We have made no public announcement of our position, and will be unable to do so until October when
we expect in our annual session to pass upon that question. As to the general fear of the membership with regard to it, I do not think we are in a position to say because we do not know. But certainly it is, as I think somebody pointed out in the committee yesterday, such that to put this plan into effect certainly tends to preclude consideration of a united medical administration plan at least for an indefinite period because by the very operation of setting up this plan, the Congress has indicated definitely that they are not accepting that Hoover report. Whether our association will accept that will depend upon the administration of the house of delegates.
The CHAIRMAN. Do you wish to make any further comment, Mr. Garvey, on any point?
Mr. GARVEY. No, sir. I would just like to answer one question which you put to Dr. Bauer that you did not ask Dr. Gale, and that is as to whether or not we feel the health services would be represented in Cabinet circles by the Secretary.
I would like to reply to that by paraphrasing from the great book of all books that "the hand would be the hand of Jacob, but the voice would be the voice of Oscar."
The CHAIRMAN. Thank you very much, gentlemen.
Dr. GALE. Thank you, Mr. Chairman.
The CHAIRMAN. Our next witness is Dr. Robert E. S. Young of the Association of American Physicians and Surgeons. Will you come forward, please, Dr. Young?
STATEMENT of dr. ROBERT E. S. YOUNG, CHAIRMAN OF THE LEGISLATIVE COMMITTEE OF THE ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS, INC., COLUMBUS, OHIO
Dr. YOUNG. Thank you, Mr. Chairman.
The CHAIRMAN. Doctor, do you have two prepared statements? Dr. YOUNG. Mr. Chairman, I have a lengthy statement which, in view of the fact that all of the gentlemen wishing to testify today will be asked to limit their testimony to today only, I will submit for the record, and I brought along a supplementary summary.
The CHAIRMAN. Doctor, then your full statement may be printed in the record in full, and then if you will summarize your views and. the points which you wish to make with reference to this plan, the committee will appreciate it.
You may proceed.
(The statement referred to follows:)
STATEMENT BY ROBERT E. S. YOUNG, M. D., CHAIRMAN, LEGISLATIVE COM-MITTEE OF THE ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS
The Association of American Physicians and Surgeons, which I represent as chairman of the legislative committee, appreciates this opportunity of presenting its views on Reorganization Plan No. 27.
For the record, I should like to state that I was born at Columbus, Ohio. I received my college training at the Ohio State University, and was graduated in medicine from Harvard Medical School in 1934. Since 1938 I have been engaged in the private practice of surgery in Columbus, Ohio; and also I carry on, in an administrative capacity, a practice of industrial medicine. I am an assistant professor in surgery and an assistant professor in preventive medicine at the Ohio State University.
The Association of American Physicians and Surgeons is national in scope and has members in every State and in the Territories. The purposes of the associa