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SHORTAGES OF HEALTH MANPOWER

Mr. FOGARTY. Do you think that if you did build these additional beds you could get the manpower to operate these facilities?

Dr. DEARING. I believe we could. The communities would have the responsibility of operating these beds and of getting the manpower. To some extent that would mean spreading a short supply of manpower somewhat thinner.

Mr. FOGARTY. I am told that many hospital rooms are being closed for lack of nurses. They cannot get enough to operate the hospital beds that have been in use for years.

Dr. DEARING. The nursing shortage is, perhaps, the greatest shortage in health manpower. Beds are closed as a result of a nursing shortage. I do not know of any closed as a result of doctor shortages. But perhaps some hospitals have not been built on that account.

Mr. FOGARTY. Have you any idea what number of rooms have been closed as a result of lack of nurses?

Dr. DEARING. I do not believe we have any specific figures on that, Mr. Chairman.

Mr. FOGARTY. If that is the case, how can we build more beds and give the proper health care?

Dr. DEARING. It will be a question of shifting to the most urgent

areas.

Mr. FOGARTY. How are you going to shift to them?

Dr. DEARING. By whatever attractions can be provided. It will probably mean higher salaries.

Mr. FOGARTY. If that was the case then, we would have more rooms being closed.

Dr. DEARING. And also by increasing the supply by measures which we have recommended to the Congress to be authorized.

Mr. FOGARTY. You mean such as the so-called Bolton bill?

Dr. DEARING. Yes, sir. And also incorporated in S. 337. I have forgotten the number of the House bill but there was a House bill before the Interstate and Foreign Commerce Committee. They have not been acted upon.

Mr. FOGARTY. And it does not look as though they will be acted on this year.

Dr. DEARING. That requires a crystal ball.

HOSPITALS AND HEALTH CENTERS

Mr. HEDRICK. Are these hospitals going to be operated by the United States Public Health Service or by private people?

Dr. DEARING. Community hospitals to the maximum extent possible.

Mr. HEDRICK. They will be responsible for them in the community or the county or State?

Dr. DEARING. Whatever the community thinks to set up. There might be a nonprofit hospital administered by a number of trustees or it may be a town or county hospital.

Mr. HEDRICK. Would these hospitals be fully equipped by the Government?

Dr. DEARING. The equipment would be considered as under the Hill-Burton Act, a part of the construction cost of the hospital to be

borne proportionately as determined in each case by the community and the Government. That would be involved in the means test in determination of the local ability to pay, to which Mr. Miles referred. Mr. FOGARTY. Now, the patrons of these hospitals would have to contribute so much a month for that service?

Dr. DEARING. It would be a local decision. Payment of rates; in other words, so much per day, as any other hospital charges. Or if there was a health-insurance plan or a Blue Cross plan in the area, they would pay their share. The type of hospital contemplated under this is no different than the type of hospital operated normally. It is conceivable that in a completely new area, or a new community built up in an isolated area direct Federal construction would be authorized. The Federal Government might have to go in and build, but that would be the last resort.

Mr. HEDRICK. Do you know how many hospitals the Veterans' Administration have that they are unable to open through lack of doctors and nurses?

Dr. DEARING. There is one in your State, Doctor.

Mr. HEDRICK. One in my town which we cannot get doctors and nureses to operate. It is a 250-bed institution and we probably only have 50 beds used and there are dozens all over the United States in the same shape. I don't see how you can open up and operate more hospitals until we can get more doctors and nurses.

Dr. DEARING. As the population shifts into those areas we can expect a certain number of professional personnel that could shift and be attracted into the area.

SCHOOL FACILITIES IB CRITICAL AREAS

Mr. FOGARTY. What about the schools? Schools are not provided for in Public Law 139?

Mr. MILES. That is true, Mr. Chairman.

Mr. FOGARTY. As I recall, the Education and Labor Committee has just reported out a bill on that subject.

Mr. MILES. Yes. It has.

Mr. FOGARTY. Have you anything on that? It has not yet come up for debate.

Mr. MILES. That is true. The general purpose of the bill is to provide in the school area substantially what is provided in this bill with respect to other community facilities.

Mr. FOGARTY. What changes in this new legislation are there over the existing law as far as schools are concerned in so-called federally impacted areas?

Mr. MILES. The present law for schools in those areas sets up a particular formula indicating what the Federal share will be and what the local matching amount will be and so on. This new bill which I

think will probably come before the House next week does not establish any specific rigid formula but, as in the case of Public Law 139, it establishes a means test so that if a community is absolutely flat broke and it has spent all of the money it can possibly afford to spend on account of defense impact already and still additional people are moved in to do defense work, then the Federal Government could provide up to 100 percent of the money under the bill as it is now.

DURATION OF PUBLIC LAW 189

Mr. FOGARTY. The total we have here is $25,000,000 for the first item. I notice it is suggested that it remain available until expended. The law expires June 30, 1953. Why should not this language provide that the money go only until the expiration of the law or the date of the expiration of the law?

Mr. MILES. I would see no objection to make the money available for obligation until the end of fiscal 1953 which is the expiration date of the law.

Mr. FOGARTY. The suggested language does not say that, does it? Mr. MILES. No, sir. I believe the reason why it was written that way was that as a general pattern most appropriations that cover public-works construction are made available until expended because in some instances it takes longer than the 2-year period which by law is permitted between the expiration date of the obligational authority and the obligation date of expenditure authority. I myself cannot conceive of any projects that would be built under this act that would not be completed within the 2-year period.

ADMINISTRATIVE EXPENSES RELATED TO CONSTRUCTION

Mr. FOGARTY. The language suggested for the first appropriation also includes provision for administrative expenses in connection with construction. What does that mean?

Mr. MILES. That means that it covers the amounts which may be transferred to the Housing and Home Finance Agency for the purpose of supervising all construction work on projects which involve direct construction by the Federal Government. That is a direct contract let by the Federal Government, for example.

Mr. FOGARTY. And how much is estimated to be involved? Mr. MILES. It is extremely difficult to tell in advance. I think it would not be very much money. I would think that the maximum would be 3 percent of the amount of money which is set aside for Federal construction of community facilities and it is hard in advance to tell how much will be Federal construction and how much will be loans or grants.

BREAKDOWN BY TYPES OF FACILITIES AND SERVICES

Mr. FOGARTY. How much of the $25 million is for each type of facility-health facilities and service; and how much is earmarked for hospitals?

Mr. MILES. I would like to enter into the record an estimated breakdown of the $25 million and I will be glad to read it also. Mr. FOGARTY. All right. Read it.

Mr. MILES. I would like to emphasize it is a very tentative estimate because, as I am sure, you realize, it is impossible until we get the projects in and begin to study them, and their order of priority, to tell what the precise breakdown will be. But we assume, on the basis of our best judgment and taking into account the Lanham Act experience during World War II, that the figures would run something like this:

Estimated breakdown of $25,000,000 for grants and loans for community facilities and services for health, day care, and recreation

Construction:

Hospitals and health centers

Water purification__

Interceptors and sewage treatment.

Refuse collection and disposal.
Recreation_

Day care

Total, construction_.

Services:

Hospital and related services.

Sanitation services...

Day-care services_

Recreation services_

Total, services

Mr. DENTON. What did you have for housing?

$11, 380, 000 4,845, 000 3, 970, 000 450, 000 1, 000, 000 300, 000

21, 945, 000

1, 068, 000 267, 000 1, 500, 000 220, 000

3, 055, 000

Mr. MILES. The housing estimate, Mr. Denton, is being submitted separately by the Housing and Home Finance Agency.

Mr. DENTON. That is another appropriation?

Mr. MILES. Yes, sir.

PROPOSED CHILD DAY-CARE PROGRAM

Mr. FOGARTY. How much do you propose altogether for day care? I think you said $1,500,000.

Mr. MILES. $1,500,000 for day-care services.

Mr. FOGARTY. What is the need for establishing day-care centers at this time?

Mr. MILES. I would like to have Dr. Eliot, of the Children's Bureau, talk on that point but I would like to say first that it is thought that in certain types of situations you actually can save money by making the maximum use of your local labor supply if an area is already completely overburdened and there are women in the community who want to work but have no facilities for taking care of their children. The alternative is between building new houses for additional people to be brought in, with new community facilities for those houses, on the one hand; and spending some money on day care so that some of these women who want to work can fill some of these jobs. It may actually be cheaper and may save some of the very appropriation we are talking about to make provision for day care so you will not have to bring in as many additional workers-in-migrants to do the job.

Mr. FOGARTY. Well, wouldn't it also be cheaper if there was a shortage of skilled help for the military or whoever has charge of these plants to survey areas where there is a surplus of labor and have someone work on a subcontract with surplus labor where men are out of work because of the defense effort.

Mr. MILES. Yes, Mr. Chairman. That is a very desirable objective. It has been discussed many time with the Military Establishment and with the Director of Defense Mobilization.

I participate from time to time in the meetings of the Manpower Policy Committee of the Office of Defense Mobilization which has discussed this problem very extensively. The Defense Establish

ment is represented on that committee. Policies have been drawn up and approved and enunciated which do urge very strongly that the manpower factor be given very high consideration in establishing the location of defense plants. There are sometimes situations in which the manpower factor cannot be given highest or the only consideration. Once you make a decision, as in the case, for example, of the big atomic-energy plant near the Savannah River in South Carolina, and you need 30,000 to 35,000 construction workers, that is an irreversible decision and you simply have to make provision for the necessary people to do all the different kinds of jobs that are involved including the necessary service trades.

Mr. FOGARTY. I can see that point but I know of the situation in Rhode Island where our principal trades are jewelry and textiles. Textiles have been hard hit on account of the war effort and the jewelry industry is suffering from lack of materials. I have never seen any direct action taken to put defense work in that area where we have some of the best skilled mechanics in the country and they are drawing unemployment compensation. We have the facilities and the manpower to contribute to defense.

Mr. MILES. That is an extremely difficult and important problem. I agree thoroughly, Mr. Chairman, that that is one to which a large amount of attention needs to be devoted. The Labor Department is paying a good deal of attention to it and working with the Defense Production Administration and the Defense Establishment but I am not in a position to give you the details of that operation. Mr. FOGARTY. It could give me the answer?

Mr. MILES. The representatives of the Defense Production Administration and the Labor Department and Defense Establishment are the key people in that problem.

Mr. FOGARTY. Dr. Eliot, I could see in the last war where day-care centers were necessary in many areas because they were practically driving women to go to work in shipyards and factories. We were in an all-out mobilization at that time but we are not in that position now. It seems to me that in looking back on the last war, in considering the situation we are in at the present time, that we do not have that same emergency situation now.

Dr. ELIOT. I would be glad to speak to this point. Even though the situation is not as acute as it was at the peak of World War II period, I think there is at this time growing evidence that more of the women with children are being thrown into the national defense industrial effort. The largest single pool, apparently, of available labor at this time, over and above the labor force which could be made available by shifting contracts, similar to that which you have spoken of, namely, shifting into communities where new industrial effort could be hadover and above that and the normal growth of the labor force, the largest single pool is among women between the ages of 19 and 40 or 45. In other words, the group of women who have children to a very large

extent.

The larger proportion of the pool, as it exists today, are housewives. About 32 percent of the pool of available labor force, as reported by the Bureau of Labor Statistics, is married women of these age groups. A very large proportion of these have relatively young children and the problem of these women in going to work is, of course, the care of their children.

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