and when it seems to be the proper thing to do. But except for that, I do not know of any propagandizing that has been going on. I know other people feel differently about that, but I give you that as my opinion. Senator SCHOEPPEL. I appreciate that. Because I have received hundreds of communications and telegrams that express that fear if this type of a department is established with the attendant powers and responsibilities resting in whoever the individual might be. I want to be candid with you, and I wanted to raise that question for the record, here. Do you see any reason why, if this department is organized and established, proper credit and consideration should not be given to the related State agencies, whether it is in the educational field or in the medical field, in the respective States? Mr. EWING. Proper credit? I am not just sure what that means. Senator SCHOEPPEL. I mean whether the functioning would all be just channeled strictly through the Washington division, or whether you think that some arrangement or organizational set-up could be established that would give proper credit and working relationship to the various and sundry State groups and State set-ups. Mr. EWING. I want to say as emphatically as I can that working through the States is the pattern that we follow. And it is the only intelligent pattern that any head of the agency or department could possibly follow. Because we work very largely through grants-in-aid. That means that the States are administering our programs, and we have to have their cooperation. And one of our main endeavors is to make that cooperation just as satisfactory to the States as possible. I happened to get this morning a copy of a telegram that has been sent to your committee from Dr. Getting, who was the former head of the State Health Officers Association; and I think it was sent with the approval of the present president, in which he says that the cooperation of the Public Health Service today with the chief health officers of the States has been as perfect cooperation as he can imagine. I forget his exact words, but you will have the telegram before you. That is absolutely right, Senator. That is just basic in the way we have got to operate. Senator SCHOEPPEL. The reason I mentioned that phase of the thing is that generally speaking, in my State, the relationship between my State organizations in those particulars and the Federal groups here charged with that responsibility has been pretty satisfactory. Mr. EWING. Yes, sir. Senator SCHOEPPEL. And you would see no reason to alter or change that, no reason that it should be changed into something more autocratic, should cabinet status be granted in this case, as proposed? Mr. EWING. No, indeed. Senator LONG. Let me say that I would never be a party to penalizing you for expressing your own opinion in any matter, whether it is public health or any other matter. I believe that, if nothing else, we will have started people thinking about public health, in this connection; and even if you do not succeed in this, you may get public health legislation, I have seen examples where there was unnecessary red tape. I believe a lot of it was as much the fault of Congress as it was of the administration, but I do hope we will be able to work out some plan to eliminate a lot of this. I have seen examples of it in the administration of the grants-in-aid program in my own State; and I hope, so far as efficiencies can be made, you will make recommendations to us. I know in the administration of our old-age assistance program, just as an example, there is a large amount of investigation required in going back and investigating cases where the facts are so obviously clear that a mere glance at the situation would show a person what the facts were and that the facts had not changed. I hope we can work out a way to give the Government the benefit of some savings by eliminating some of these unnecessary activities. Mr. EWING. I hope we can. After 2 years in this job, the things that are undone simply appal me. There just simply aren't hours enough in the day to get them done. Senator LONG. I hope you will have the authority under this new reorganization plan to save the Government some money. Mr. EWING. I am sure we can. The CHAIRMAN. Mr. Ewing, just one other question. The Hoover Commission recommended, I believe, the transfer of the Public Health Service to a proposed United Medical Administration which would embrace all Federal hospital facilities. In response to a letter from me as chairman of the committee, you advised the committee, I believe, on July 14, that that part of the Hoover recommendations you opposed. Is that correct? Mr. EWING. Yes, sir. The CHAIRMAN. So you feel that if this department is established the Public Health Service should not be transferred out of it? Mr. EWING. I would urge that, at the proper time. The CHAIRMAN. Since this plan transfers it all together, if it remained in there, it would conflict with the Hoover Commission's recommendation; that is, with the recommendation of a majority of the Commission-it was not a unanimous recommendation. Mr. EWING. I think you did not wholly agree yourself, Senator. The CHAIRMAN. I did not wholly agree that every military medical service should be placed under one head. I did not agree with that. Mr. EWING. Senator McClellan, to me that issue of whether or not there should be a united medical administration definitely is not involved here. I agree with Mr. Hoover's testimony before your committee to the effect that that takes legislation, that it could not be set up by Presidential order. Bills that have been drafted by the people associated with the Hoover Commission have been introduced in the Senate and the House to establish a united medical administration, and if hearings are held on that I would express a view in opposition. But I do not think that is involved in this issue, in plan No. 1. The CHAIRMAN. It is not immediately involved, but I just brought out that point; that once this department is created, with this service and function in it, you would at least oppose its being transferred? Mr. EWING. But I want to say that in choosing the word "welfare" rather than making it a "department of health, education, and welfare," which was suggested in S. 140, which was reported out by this committee in the Eightieth Congress, the very reason that we did finally settle on the name of the Department of Welfare was so as not to even remotely imply any prejudgment on what should be done with the health activities. Senator LONG. I am of the opinion that a separate department of health could be completely established under a reorganization plan, as long as it did not create any new activities, and as long as it was just a matter of taking the activities and functions that presently exist in the Government and throwing them all into one department. Do you have any legal opinion as a basis for your statement that that could not be done without separate legislation? Mr. EWING. Senator Long, I do not think there is any question but that by a reorganization plan the President could lift the Public Health Service right out of this Department and put it anywhere he wants to. But what would bother me would be how he would split up the medical services in the Military Establishment and in the Veterans' Administration without legislation. That is what bothers our lawyers about it. I do not think they are absolutely positive in their opinion, but they feel that there would be a difficulty and that legislation would be the much better course to follow. Senator LONG. In conferring with Mr. Rice, I found him in agreement with me on this subject, that any plan of reorganization could take any functions that presently exist in the Government, insofar as the reorganization act itself does not preclude that being done, and place any of those functions into any department that they want it in. Now, if you want to pass a law that would change the law of the land with regard to functions of the Federal Government and add new functions to the Federal Government, that would of course require legislation. But as far as any function that the Government is now performing is concerned, it is my opinion that unless the act expressly forbids it, as it does in certain minor connections, you could take any function in the Federal Government and reorganize it, or combine it with other functions. Mr. EWING. I would be the last to say that that opinion is wrong. I would say that I think there is some doubt about it. Senator LONG. That is what I thought I voted for when I voted for the act. I can say that. The CHAIRMAN. Senator Smith? Senator SMITH. I am sorry I had to leave during the interesting part of your discussion with Mr. Ewing, Mr. Chairman, but I had a Maine delegation meeting that I had to attend. I simply want to make an observation for the record, if I may. I am sure we are all satisfied that we are trying for the same objective. We are seeking efficiency. We are seeking economy and better government. And I have felt strongly, Mr. Ewing, for a long, long time about the need for a Department of Welfare, with the executive head having cabinet status. But as I studied these changes, I have not yet been convinced that we can accomplish what we are after if we go by the way of spreading functions rather than consolidating them. And it is that, I think, together with the much talked of so-called socialized medicine proposal, which bring in so much mail to my desk, anyway. The CHAIRMAN. Thank you very much, Mr. Ewing. Mr. EWING. Thank you. The CHAIRMAN. Is Colonel Ijams present. Will you come around, please? You wish to testify with respect to plan No. 1? STATEMENT OF GEORGE E. IJAMS, DIRECTOR, NATIONAL REHABILITATION SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES, WASHINGTON, D. C. Mr. IJAMS. Mr. Chairman, my testimony will have no direct bearing on plan No. 1, but it will have an indirect bearing on one phase of it that has been discussed here this morning, and that is the Hoover Task Force Report. The CHAIRMAN. What I am trying to get at is: on which plan you wish to testify before the committee? Mr. IJAMS. Plan No. 1, sir. The CHAIRMAN. We wanted to get the record straight as to that. Do you have a prepared statement? Mr. IJAMS. NO; I have not, Senator. My remarks will be very brief. The CHAIRMAN. All right, you may proceed. Mr. IJAMS. Thank you, sir. The CHAIRMAN. Whom do you represent? Mr. IJAMS. My name is George E. Ijams. I am the Director of the National Rehabilitation Service of the Veterans of Foreign Wars of the United States. The CHAIRMAN. All right, sir. You may proceed. Mr. IJAMS. The first news we had of any suggestion for setting up a separate department to administer all Federal hospitals or practically all of them was a news release which appeared in the Washington press on December 26, 1948. The following day I wrote to former President Hoover. I will put this letter in the record, if I may, sir, to save time. The CHAIRMAN. All right, sir. The letter may go in the record. (The letter referred to is as follows :) VETERANS OF FOREIGN WARS OF THE UNITED STATES, Hon. HERBERT HOOVER, NATIONAL REHABILITATION SERVICE, Washington 6, D. C., December 27, 1948. Commission of Organization of Executive Branch of the Government, MY DEAR MR. PRESIDENT: To identify myself, may I remind you that I was appointed Assistant Director of the Bureau of War Risk Insurance immediately after my return from France. After the United States Veterans' Bureau was created by law, I served as its Assistant Director. In 1930 when the Veterans' Administration was authorized, you appointed me Director of the United States Veterans' Bureau for the last year of its existence. In 1931 I became Assistant Administrator of Veterans' Affairs, and served in that capacity until March 1, 1946, when I resigned to assume the directorship of the national rehabilitation service of the Veterans of Foreign Wars. Yesterday, I read an article in the Washington Star entitled "Waste Charged in Health Set-up; Merger Urged." In that article, a proposed reorganization plan was outlined which contemplates the establishment of a new department to have jurisdiction over all medical and hospital activities of the Federal Govérnment, and to include veterans' hospital and medical personnel of the regional and branch offices, charged with the responsibility of medical treatment and examinations for rating purposes. I was very glad to read that this was merely a proposed plan and which had not yet received your approval. In an effort to be heelpful to you inreaching a decision as to whether the proposed plan should be approved, I should like to give you a brief outline of the situation which existed in the old Bureau of War Risk Insurance at the time I came here in 1919. Both the Bureau of War Risk Insurance and the United States Public Health Service were then under the jurisdiction of the Treasury Department. The Honorable Jouett Shouse, then Assistant Secretary of the Treasury, had administrative jurisdiction over both of these organizations and I believe of several others which were not related to this problem. Mr. Shouse was supposed to coordinate the activities of the War Risk Insurance Bureau and the Public Health Service insofar as veterans' activities were concerned. When a veteran applied for compensation or insurance benefits, it was necessary to have a thorough and complete physical examination made. Therefore, the War Risk Insurance Bureau had to refer veterans to the nearest Public Health Service hospital for this examination. The veteran activity of the Public Health Service was only one of many. Consequently, this organization did not give preference to veteran examinations, but handled them in a routine manner. In many instances, months elapsed between the examination of the veteran and the time when his physical report was sent to the Bureau of War Risk Insurance for adjudication purposes, and during this period the Bureau of War Risk Insurance was severely condemned because of the delay in the adjudication of these claims. Similar delays occurred in securing beds for the treatment of veterans in Public Health Service hospitals, and while this was not the responsibility of the Bureau of War Risk Insurance, nevertheless, that organization was severely condemned because of any delays which occurred in securing hospitalization. It was because of the lack of control of the hospital and medical organizations by the Bureau of War Risk Insurance that the United States Veterans' Bureau was brought into existence through congressional enactment, so as to place definite responsibility for all phases of the veteran problem under one man. It must be remembered, Mr. President, that in those days we were dealing with less than 5,000,000 veterans. Today, we are dealing with more than three times that number. Consequently, if criticism and chaos existed in 1919 because of the lack of definite responsibility for all problems arising out of veteran care, it can be readily seen that the proposed plan of again separating medical care and treatment from other responsibilities of the veteran problem will lead to certain criticism in the handling of this difficult activity of government. There are many other reasons why the proposed plan would not operate smoothly. In the first place, the vast majority of Federal beneficiaries for hospitalization are the veterans of our country who have served in time of war. Then, too, as time goes on, the veterans become victims of diseases of age and chronic conditions which are quite different from the hospital cases in Army and Navy institutions where all of your patients are young men, and where they are suffering from acute, rather than chronic conditions. As a matter of fact, when a man in active military service suffers from a chronic condition, he is, and should be, released from active military duty. In reading the list of those making up the committee which recommended the consolidation of all Federal hospitals in one separate department, I did not find the name of one person who has had any background and experience in this work over a long period of years. I believe you will agree, Mr. President, that before the stamp of approval is placed on this proposed plan, you should be armed with facts predicated upon actual experience. I would welcome an opportunity to discuss this matter with you personally because so many of the matters which I have briefly mentioned above occurred during your administration as President of the United States. I should be glad to make myself available to you at any time of the day or night that you may designate. Very respectfully, GORGE E. IJAMS, Director. Mr. IJAMS. In the letter I first identified myself, and then I stated that I had read this article in the Washington press, and in that article a proposed reorganization plan was outlined which contemplates the establishment of a new department, to have jurisdiction over all medical and hospital activities of the Federal Government, and to include veterans' hospitals and medical personnel of the regional and branch offices, charged with the responsibility of medical treatment and examinations for rating purposes. I then stated I was delighted to learn that this was merely a proposal and that it had not yet received Mr. Hoover's approval. 94651-49-3 |