administered through an organizational structure established by law more than two decades ago stands as a major obstacle to the fulfillment of our Nation's health goals. As presently constituted, the Public Health Service is composed of four major components: National Institutes of Health. Office of the Surgeon General. Under present law, Public Health Service functions must be assigned only to these four components. This structure was designed to provide separate administrative arrangements for health research, programs of State and local aid, health services, and executive staff resources. At a time when these functions could be neatly compartmentalized, the structure was adequate. But today the situation is different. Under recent legislation many new programs provide for an integrated attack on specific disease problems or health hazards in the environment by combining health services, State and local aid, and research. Each new program of this type necessarily is assigned to one of the three operating components of the Public Health Service. Yet none of these components is intended to administer programs involving such a variety of approaches. Our health problems are difficult enough without having them complicated by outmoded organizational arrangements. But if we merely take the step of integrating the four agencies within the Public Health Service we will not go far enough. More is required. III The Department of Health, Education, and Welfare performs major health or health-related functions which are not carried out through the Public Health Service, although they are closely related to its functions. Among these are: Health insurance for the aged, administered through the Social Security Administration; Medical assistance for the needy, administered through the Welfare Administration; Regulation of the manufacture, labeling, and distribution of drugs, carried out through the Food and Drug Administration; and Grants-in-aid to States for vocational rehabilitation of the handicapped, administered by the Vocational Rehabilitation Administration. Expenditures for health and health-related programs of the Department administered outside the Public Health Service have increased fom $44 million in 1953 to an estimated $5.4 billion in 1967. As the head of the Department, the Secretary of Health, Education, and Welfare is responsible for the administration and coordination of all the Department's health functions. He has clear authority over the programs I have just mentioned. But today he lacks this essential authority over the Public Health Service. The functions of that agency are vested in the Surgeon General and not in the Secretary. This diffusion of responsibility is unsound and unwise. 66-429 0-66- -2 To secure the highest possible level of health services for the American people the Secretary of Health, Education, and Welfare must be given the authority to establish and modify as necessary-the organizational structure for Public Health Service programs. He must also have the authority to coordinate health functions throughout the Department. The reorganization plan I propose will accomplish these purposes. It will provide the Secretary with the flexibility to create new and responsive organizational arrangements to keep pace with the changing and dynamic nature of our health programs. My views in this respect follow a basic principle of good government set by the Hoover Commission in 1949 when it recommended that "the Department head should be given authority to determine the organization within his Department." IV In summary, the reorganization plan would: Transfer to the Secretary of Health, Education, and Welfare the functions now vested in the Surgeon General of the Public Health Service and in its various subordinate units (this transfer will not affect certain statutory advisory bodies such as the National Advisory Cancer and Heart Councils); Abolish the four principal statutory components of the Public Health Service, including the offices held by their heads (the Bureau of Medical Services, the Bureau of State Services, the National Institutes of Health exclusive of its several research institutes such as the National Cancer and Heart Institutes, and the Office of the Surgeon General); and Authorize the Secretary to assign the functions transferred to him by the plan to officials and entities of the Public Health Service and to other agencies of the Department as he deems appropriate. Thus, the Secretary wou: d be Enabled to assure that all health functions of the Department are carried out a effectively and economically as possible; Given authority commensurate with his responsibility; and Made responsible in fact for matters for which he is now, in any case, held accountable by the President, the Congress, and the people. V I have found, after investigation, that each reorganization included in the accompanying reorganization plan is necessary to accomplish one or more of the purposes set forth in section 2(a) of the Reorganization Act of 1949, as amended. Should the reorganizations in the accompanying reorganization plan take effect, they will make possible more effective and efficient administration of the affected health programs. It is, however, not practicable at this time to itemize the reductions in expenditures which may result. I strongly recommend that the Congress allow the reorganization plan to become effective. LYNDON B. JOHNSON. HE WHITE HOUSE, April 25, 1966. (Prepared by the President and transmitted to the Senate and the House of Representatives in Congress assembled, April 25, 1966, pursuant to the provisions of the Reorganization Act of 1949, 63 Stat. 203, as amended) PUBLIC HEALTH SERVICE SECTION 1. TRANSFER OF FUNCTIONS.-(a) Except as otherwise provided in subsection (b) of this section, there are hereby transferred to the Secretary of Health, Education, and Welfare (hereinafter 1eferred to as the Secretary) all functions of the Public Health Service, of the Surgeon General of the Public Health Service, and of all other officers and employees of the Public Health Service, and all functions of all agencies of or in the Public Health Service. (b) This section shall not apply to the functions vested by law in any advisory council, board, or committee of or in the Public Health Service which is established by law or is required by law to be established. SEC. 2. PERFORMANCE OF TRANSFERRED FUNCTIONS.-The Secretary may from time to time make such provisions as he shall deem appropriate authorizing the performance of any of the functions transferred to him by the provisions of this reorganization plan by any officer, employee, or agency of the Public Health Service or of the Department of Health, Education, and Welfare. SEC. 3. ABOLITIONS. (a) The following agencies of the Public Health Service are hereby abolished: (1) The Bureau of Medical Services, including the office of Chief of the Bureau of Medical Services. (2) The Bureau of State Services, including the office of Chief of the Bureau of State Services. (3) The agency designated as the National Institutes of Health (42 U.S.C. 203), including the office of Director of the National Institutes of Health (42 U.S.C. 206(b)) but excluding the several research Institutes in the agency designated as the National Institutes of Health. (4) The agency designated as the Office of the Surgeon General (42 U.S.C. 203(1)), together with the office held by the Deputy Surgeon General (42 U.S.C. 206(a)). (b) The Secretary shall make such provisions as he shall deem necessary respecting the winding up of any outstanding affairs of the agencies abolished by the provisions of this section. SEC. 4. INCIDENTAL TRANSFERS.-As he may deem necessary in order to carry out the provisions of this reorganization plan, the Secretary may from time to time effect transfers within the Department of Health, Education, and Welfare of any of the records, property, personnel, and unexpended balances (available or to be made available) of appropriations, allocations, and other funds of the Department which relate to functions affected by this reorganization plan. SENATE COMMITTEE ON GOVERNMENT OPERATIONS, June 6, 1966. Staff Memorandum No. 89-2-25. Subject: Reorganization Plan No. 3 of 1966, Providing for Reorganization of Health Functions of the Department of Health, Education, and Welfare. Reorganization Plan No. 3 of 1966 was submitted by the President to the Congress on April 25, 1966. Unless disapproved by a majority vote of either House of the Congress, it will become effective on June 24, 1966. Plan No. 3 was referred to the Subcommittee on Executive Reorganization on May 9. 1966. PURPOSE OF THE PLAN The stated purpose of Plan No. 3 of 1966 is (1) to modernize and strengthen the structure and organization under which the Department of Health, Education, and Welfare administers Federal health and health-related programs and activities. (2) eliminate diffusion of responsibility, and (3) increase efficiency, by giving the Secretary of Health, Education, and Welfare the flexibility required to reorganize the Public Health Service and coordinate health programs and functions throughout the Department. The plan seeks to accomplish this objective by (1) trausferring to the Secre tary of Health, Education, and Welfare all of the functions of the Public Health Service, its Surgeon General, and all of its other officers, employees and agencies. except for certain statutory advisory bodies; (2) authorizing the Secretary of Health, Education, and Welfare to assign the performance of such functions to officers, employees or agencies of the Public Health Service or the Department of Health, Education, and Welfare; and (3) abolishing the four principal statutory components of the Public Health Services and the Offices of the heads of these agencies:-the Bureau of Medical Services, the Bureau of State Services. the Office of the Surgeon General, together with the position of Deputy Surgeon General, and the National Institutes of Health, with the exception of its research institutes. (Plan No. 3 does not abolish either the Public Health Service or the statutory position of its head, the Surgeon General of the Public Health Service.) According to the President's Message transmitting the plan, the program and activities referred to involve an estimated $7.8 billion for fiscal year 1967, of which $2.4 billion is administered by the Public Health Service and $5.4 billion. will be expended by other components of the Department of Health, Education, and Welfare for health and health-related programs and activities. THE PRESIDENT'S MESSAGE In the President's Message on Health and Education, transmitted to the Congress on March 1, 1966, he stated: "Over the last 12 years, the budget of the Public Health Service for research. training, and services has grown almost ten-fold-from $250.000.000 to $2.4 billion. Yet major elements of the basic structure of the Public Health Service remain set by a law more than 20 years old. "The Secretary of Health, Education. and Welfare and the Surgeon General of the United States have consulted leading experts-physicians, administrators. scientists, and public health specialists-in a thorough search for the best means to improve the administration of public health programs. They all agree that the need to modernize the administration of the Public Health Service is urgent.“ In his Message transmitting Plan No. 3 to the Congress, the President stated that: "Today the organization of the Public Health Service is clearly obsolete. The requirement that new and expanding programs be administered through an organizational structure established by law more than two decades ago stands as a major obstacle to the fulfillment of our Nation's health goals." The President then noted that as presently constituted, the Public Health Service is composed of four major components: National Institutes of Health. Bureau of State Services, Bureau of Medical Services and Office of the Surgeon General, and under present law, Public Health Service functions must be assigned only to these four components. Continuing, the President stated that: "This structure was designed to provide separate administrative arrangements for health research, programs of State and local aid, health services, and execu tive staff resources. At a time when these functions could be neatly compartmentalized, the structure was adequate. But today the situation is different. "Under recent legislation many new programs provide for an integrated attack on specific disease problems or health hazards in the environment by combining health services, State and local aid, and research. Each new program of this type necessarily is assigned to one of the three operating components of the Public Health Service. Yet none of these components is intended to administer programs involving such a variety of approaches. "Our health problems are difficult enough without having them complicated by outmoded organizational arrangements." After pointing out that merely integrating the four agencies within the Public Health Service would not go far enough, President Johnson stated that the Department of Health. Education, and Welfare performs major health or healthrelated functions which are not carried out through the Public Health Service, although they are closely related to its functions. Among these are health insurance for the aged, administered through the Social Security Administration; medical assistance for the needy, administered through the Welfare Administration; regulation of the manufacture, labeling, and distribution of drugs, carried out through the Food and Drug Administration; and grants-in-aid to States for Vocational rehabilitation of the handicapped, administered by the Vocational Rehabilitation Administration. Referring to the position of the Secretary of Health, Education, and Welfare, the President said: "As head of the Department, the Secretary*** is responsible for the administration and coordination of all the Department's health functions * * *. "But today he lacks this essential authority over the Public Health Service. The functions of that agency are vested in the Surgeon General and not in the Secretary. "This diffusion of responsibility is unsound and unwise. "To secure the highest possible level of health services for the American people the Secretary of Health, Education, and Welfare must be given the authority to establish and modify as necessary-the organizational structure for Public Health Service programs. "He must also have the authority to coordinate health functions throughout the Department. The reorganization plan I propose will accomplish these purposes. It will provide the Secretary with the flexibility to create new and responsive organizational arrangement to keep pace with the changing and dynamic nature of our health programs." PROVISIONS OF THE PLAN Section 1(a) transfers to the Secretary of Health, Education, and Welfare all of the functions of the Public Health Service, the Surgeon General of the Public Health Service, and all of its other officers and employees and agencies, except as otherwise provided in section 1(b). (A list of these functions is contained in Appendix A). Section 1(b) exempts from the provisions of this section the functions vested by law in advisory councils, boards or committees of the Public Health Service which are established by law or are required by law to be established. of these bodies is contained in Appendix B). (A list Section 2 authorizes the Secretary, from time to time, as he may deem appropriate, to delegate the performance of any of the functions transferred to him by the provisions of this plan to any officer, employee or agency of the Public Health Service or of the Department of Health, Education, and Welfare. (The proposed delegation orders of the Secretary, relative to the Public Health Service, are contained in Appendix C). Section 3 (a) lists the agencies of the Public Health Service which are abolished, as follows: Section 3 (a) (1) the Bureau of Medical Services, including the Office of the Chief of the Bureau of Medical Services. Section 3(a) (2) the Bureau of States Services, including the Office of the Chief of the Bureau of State Services. Section 3(a) (3) the agency designated as the National Institutes of Health and the Office of the Director of the National Institutes of Health, but excluding all of the research institutes presently existing in the National Institutes of Health. |