REORGANIZATION PLAN NO. 1 OF 1949-PROVIDING FOR A DEPARTMENT OF WELFARE FRIDAY, JULY 22, 1949 UNITED STATES SENATE, COMMITTEE ON EXPENDITURES IN 'The committee met at 10: 15 a. m., pursuant to adjournment, in room 357, Senate Office Building, Senator John L. McClellan (chairman) presiding. Present: Senators McClellan, Taylor, Long, Ives, Smith, and Schoeppel. Present also: Walter L. Reynolds, chief clerk. The CHAIRMAN. The committee will come to order. We resume hearings this morning on Reorganization Plan No. 1. A number of witnesses have been scheduled. We regret we are a little late getting started, but that is understandable to anyone who knows the problems which exist in connection with the burden of work which is now in the Congress. It will be necessary for us to conclude by 12 o'clock, when the Senate convenes, because some important matters are coming up on the floor that will require the presence of the members of the committee; so we will ask the witnesses to be as brief as possible. We do not want to hinder them in any way from giving us a full discussion of their views, but if we are to conclude and give everyone an opportunity, we may have to ask you to be comparatively brief. The first witness this morning is Dr. J. R. Miller. Doctor, I believe you have a prepared statement. STATEMENT OF DR. JAMES R. MILLER, CHAIRMAN, EXECUTIVE COMMITTEE, BOARD OF TRUSTEES OF THE AMERICAN MEDICAL ASSOCIATION Dr. MILLER. Yes, sir. The CHAIRMAN. Do you wish to read it or just comment on it? Dr. MILLER. No; I do not wish to read it. I can condense it, very briefly. The CHAIRMAN. Then let Dr. Miller's statement be made a part of the record. 31 (The prepared statement of Dr. Miller is as follows:) STATEMENT OF DR. JAMES R. MILLER, ON BEHALF OF THE AMERICAN MEDICAL ASSOCIATION, SUBMITTED TO THE SENATE COMMITTEE ON EXPENDITURES IN THE EXECUTIVE DEPARTMENTS ON THE PRESIDENT'S REORGANIZATION PLAN No. 1 of 1949 My name is James Raglan Miller. I have been a practicing physician since 1915 in Hartford, Conn. I am speaking today as chairman of the executive committee of the board of trustees of the American Medical Association and on behalf of 140,000 physicians who are members of that association, and I am here to express opposition to the President's Reorganization Plan No. 1 of 1949 proposing the creation of a Department of Welfare. In February of 1949 the American Medical Association issued a revised 12-point program for the advancement of medicine and public health. Point 1 of this 12-point program is as follows: "1. A Federal Department of Health.-Creation of a Federal Department of Health of Cabinet status with a Secretary who is a doctor of medicine, and the coordination and integration of all Federal health activities under this Department, except for the military activities of the medical services of the armed forces." Since 1884, the American Medical Association has demanded a Federal Department of Health with a Secretary who is a physician in charge. At present the various agencies concerned with health are distributed in various Government departments. It would be in the interest of efficiency and economy to have them under one head to avoid duplication of effort and diversion of activity. Various suggestions have been made to establish a Department of Welfare; a Department of Education, Health, and Welfare; and an Independent Health Agency. The health of the people is certainly important enough to warrant an independent agency, in accordance with the recommendations of the Hoover Commission. The argument has been made that it is not the policy of our Government to have an expert in charge of a department, but that the experts should be subservient to the chief of the department. In answer to this, the American Medical Association feels that no other Government department is so closely concerned with the individual as would be a Department of Health. Other departments deal as a rule with the population as a group. Matters of health are often individual and no one could be better qualified to superintend matters of individual health than a physician. At this time we urge support of the report of the Hoover Commission on this subject, which recommends an Independent Health Agency under which will be assembled all activities concerned with health except those of the armed forces and Veterans' Administration. Current opinion in the association at the present time is to the effect that this Department should be an agency separated from other activities of the Government. There are at least two outstanding reasons why such a feeling exists. In the first place, the magnitude of the duties devolving upon a single Department of Welfare, including health, education, and social welfare or security activities, is such that it would be impracticable and too important for one man to supervise and properly take care of them. The health of the Nation, on the other hand, is of sufficient importance to rate a department of its own. It has been estimated that educators are concerned in some manner with approximately 28,000,000 members of the population. Social security has contact with about 51,000,000 people including recipients as well as taxpayers. Just for purposes of further comparison, it is interesting to note that an estimated 4.6 percent of the population is engaged in agriculture, but there is a separate Department of Agriculture; 34.6 percent of the population is engaged in commerce and labor, and there are separate Departments of Commerce and Labor. One hundred percent of the population, however, is vitally concerned with matters of health. Surely that is sufficient to warrant a separate department of health. In the second place, the variety of functions which would be squeezed into the proposed department does not lend itself to competent and thoughtful administration. Equal attention to health, education, and security could hardly be expected in times of hardship when relief measures are uppermost in the minds of both Congress and the people. For example, it is to be hoped that the Nation will not again face an economic crisis such as that of the thirties, with widespread unemployment and acute distress. Nevertheless, the possibility must be faced. During that period, the Federal administration obtained congressional approval for unprecedented welfare measures. A large group of powerful independent agencies was established for direct and work relief, including the Civil Works Administration, the Federal Emergency Relief Administration, the Public Works Administration, Civilian Conservation Corps, National Youth Administration, and Works Progress Administration. These agencies accounted for a major share of Federal expenditures in the thirties. While some of them continued in existence for several years as temporary agencies after the economic emergency had subsided, nevertheless they were eventually disbanded. With a cabinet Department of Health, Education and Security, the logical place for the expansion of relief measures would be within that department. Functions that in the thirties were assigned to temporary agencies would probably go to the department. Then, too, incorporation of emergency functions in a permanent department may tend to have the effect of perpetuating such functions long after the reason for their establishment has disappeared. These possibilities may seem remote at present, but they merit careful consideration. It is my fear that if such a situation developed, the health functions of the proposed department, being overshadowed by the emergency activities, would be slighted and the health of the Nation would suffer. An examination of the proposals to group all health activities of the Federal Government under one head may be accomplished in a number of ways. most commonly considered conceptions are: 1. A separate Department of Health whose head has Cabinet status. The 2. Combining all health activities of the Federal Government in a separate agency not of Cabinet status. 3. Combining health activities with other activities of the Federal Government in one Department. While the American Medical Association is still of the opinion that the health of the Nation warrants a separate Department of Health with a Cabinet officer at its head, it realizes that it may be impractical to develop this at the present time. Furthermore it is its opinion that if a separate Department of Health is not feasible, it is possible to group health activities in a separate independent bureau. The association is opposed to having health activities grouped with other activities in a department with Cabinet status. It will be seen from the preceding historical review that our opinion is clear that health activities of the Government rate recognition at the topmost level. We are likewise clear in our minds concerning the desirability of having a physician at the head of such a department or bureau. We cannot accept the statement which has been made, with insufficient consideration, I believe, that a physician competent to manage such a department or bureau cannot be found. On the contrary, among physicians there are many who have a broad experience in administration and broad vision of the health needs of the Nation, men whose lives have been spent working in cooperation with other agencies for the welfare of the people. 4 Essentially, it would seem that the effect of this reorganization plan would be to transform the Federal Security Agency with its various and not too closely related functions into an executive department with a relocation of the several functions of that Agency. While the house of delegates has repeatedly urged that a national department of health be established, it has recognized the dangers incident to the mingling in one department of health and other functions. At a special meeting held in 1937 at a time when the reorganization of governmental activities in the executive departments was under consideration, the board of trustees prepared a statement expressing the opinion that "health activities of the Government, except those concerned with the military establishments, should not be subservient to any other departmental interests." This action of the board of trustees was approved by the house of delegates at its meeting in Atlantic City in June 1937. Reorganization plan No. 1, if adopted, might serve to bring about such subserviency. The American Medical Association is deeply concerned that the quality of medical and hospital care be kept at the highest possible level, that nothing in the administration of Federal or other programs should be crystallized along lines which do not keep uppermost the importance of high quality standards. I fear that reorganization plan No. 1 will postpone for a long time, if not permanently, the coordinated development of health functions in the Federal Government.. The CHAIRMAN. Now you may proceed, Doctor, to discuss the high lights of it. Dr. MILLER. I am appearing as the representative of the American Medical Association, being vice chairman of its board of trustees. I have been a practicing physician in Hartford, Conn., since 1915. The testimony I have to give is essentially the same as was presented 2 years ago in hearings on Senate bill 140 and Senate bill 712. The CHAIRMAN. Those were bills creating a department of health, education, and welfare? Dr. MILLER. Yes, sir. They were on this same topic. Since that time the Hoover Commission report has come in, and to some extent the views have been modified. We are still firm in our belief that ultimately a department of health is a vital necessity for the Government. Whatever steps are taken, we should like to feel are steps which will not hinder the ultimate development of a department of health of Cabinet standing. The second choice, in our estimation, would be along the lines of the Hoover Commission report; an independent agency grouping together the principal medical services of the Government, not including a few specified in that report. Failing that, the reorganization plan which is being presented here we should like to see accepted, if it is done with the understanding that ultimately it may be much preferable to have the health services of the Government unified in a separate Cabinet. The CHAIRMAN. Doctor, do you understand, as a matter of mechanics and parliamentary procedure under the law, that the plan before us has to be accepted as is, without any amendment, without any change, and that it would be impossible to approve it with any sort of understanding that would have any moral or legal force? Dr. MILLER. I do understand that, sir. The only thing we can do, then, is to express our opposition to it as such and indicate that our opposition is based on the fact that we want to have eventually a Health Department. I think that is the essence of my testimony. The CHAIRMAN. Do you regard this plan, plan No. 1, as submitted and now pending, as being in conflict with the recommendations of the Hoover Commission? Dr. MILLER. As I understand them, yes sir. There is difficulty, of course, in working out a consolidation of all health activities. I believe that I am correct in stating that somewhere in the neighborhood of $2,000,000,000 is being expended by the Federal Government for these various activities, principally in hospitalization. Now, these matters of hospitalization involve not only hospital construction but involve very heavily personnel; and one of the difficulties that we have observed is a controversy for personnel and in the realm of hospital construction, which is wasteful of Government funds and not conducive to giving the best possible use to those funds in terms of medical services. The CHAIRMAN. The way I interpret your testimony, your principal objection to this plan is that you just feel that the Department of Health is of such importance that it should have independent status within itself. Dr. MILLER. I think the feeling of the American Medical Association is that if we cannot have a Department of Health we would like to see an attempt made along the general lines of the Hoover Commission report toward a consolidation of the health activities of the Government. The CHAIRMAN. You do object to the health activities of the Government and to the Health Department as it is now being placed in a Welfare Department, as proposed by this plan? Dr. MILLER. I have been around long enough to know that we live under many conditions, even if we do not like them. We have been getting along under the present conditions, under which, as I understand it, the Federal Security Agency is a sort of holding company or holding corporation for the various departments under it. We have good relations in working out many of the branches of health activities under this, and I suspect that if this reorganization plan goes through we still will have good relations in many of them. I hope they will not be altered essentially. The CHAIRMAN. Do you have any questions, Senator Taylor? The CHAIRMAN. Senator Smith? Senator SMITH. In your proposal for a Department of Health, would you include the military health activities with it? Dr. MILLER. I think a great deal of discussion and thought has already been devoted to that, and at the present time it would be foolish for me to express myself. I think the Federal Government has just embarked on a very extensive attempt to unify medical services of the armed forces, and with Dr. Allen and Dr. Meiling that is certainly in process of development. It might be well, before any fixation of medical services occurs in the Department, to work it out on a more tentative basis. Senator SMITH. But generally speaking you would approve of a Department of Health including all Government health activities? Is that true? Dr. MILLER. Aside from those that are merely military in their significance. Senator SMITH. Would that include the Veterans' Administration? Dr. MILLER. I see no reason why a sick veteran should not be handled in his home hospital if that is advantageous for him. Senator SMITH. It would be preferable to handling it through the military? Dr. MILLER. Oh, yes; I think so. Senator SMITH. Assuming that Congress does not favor the creation of a Department of Health, you would then favor this plan No. 1? Dr. MILLER. I would say we would go along with it and do the best we can. Senator SMITH. Thank you very much, Dr. Miller. The CHAIRMAN. Are there further questions? Thank you, Doctor. Dr. MILLER. Thank you. The CHAIRMAN. Dr. Gale? Come around, Doctor, and have a seat. STATEMENT OF E. HAROLD GALE, MEMBER, COUNCIL ON LEGISLATION OF THE AMERICAN DENTAL ASSOCIATION, ACCOMPANIED BY FRANCIS J. GARVEY, CHICAGO, ILL., LEGISLATIVE COUNSEL, AMERICAN DENTAL ASSOCIATION Dr. GALE. Mr. Chairman and gentlemen of the committee, I am Dr. E. Harold Gale of Albany, N. Y., a practicing dentist in that city for more than 35 years. At the present time I am president of the Dental |