Mr. SCHWABE. They do that in a lot of places?

Dr. DEARING. Yes.

Mr. SCHWABE. They are doing it now, and they can do it in this instance?

Dr. DEARING. Yes.

Mr. SCHWABE. The military is going to have a hospital if it is much of a military establishment, are they not?

Dr. DEARING. Yes, sir, but there are many in which they will not. Mr. SCHWABE. If there is much of an installation, from the standpoint of personnel, they are going to have one, are they not? Dr. DEARING. You are very right.

Mr. SCHWABE. And they can take care of and will take care of a number of these others who are not strictly military personnel?

Dr. DEARING. That, I believe, they do not want to do and do not aim to do. I think it is the policy of the Secretary of Defense to get out of that business of caring for civilians.

Mr. SCHWABE. They are taking care of the families or the dependents of these men, are they not, this military personnel?

Dr. DEARING. In some areas, yes.

Mr. SCHWABE. In most of them where the facilities are otherwise inadequate?

Dr. DEARING. They are taking care of them to the limit of their own facilities.

Mr. SCHWABE. They give their own priority?

Dr. DEARING. That is right, sir.

Mr. SCHWABE. Over and above that, so far as they can take care of them; and they ought to?

Dr. DEARING. Yes; but I repeat it is the fact that the Secretary of Defense is resisting pressure from his own staff to expand facilities for the care of dependents of the military personnel, to hold that down.

Mr. SCHWABE. Maybe there should be some charges or reimbursements, but as a general rule that is not rue, is it?

Dr. DEARING. I believe, sir, that they could make a charge.
Mr. SCHWABE. It is very nominal, if at all?

Dr. DEARING. Things have changed and the policies vary so much. It is not full cost. I am pretty sure of that.

FINANCING HOSPITAL OPERATIONS AND MAINTENANCE

Mr. SCHWABE. If these hospitals charged, the charges would be made comparable to charges for other hospitals; is that the idea? Dr. DEARING. Yes.

Mr. SCHWABE. The Government would not undertake to operate these hospitals or maintain them?

Dr. DEARING. No, sir.

Mr. SCHWABE. Even if they had to close?

Dr. DEARING. Well, may I say the act does authorize funds for services, and part of this estimate would provide some funds for

service.

Mr. SCHWABE. That is just what I am getting at.

Dr. DEARING. Where the community for one reason or another was not able to maintain it or get it going.

Mr. SCHWABE. Which I am sure would result in many instances, sooner or later, because these installations we hope will not continue

always. There will be people living there, and you will have a hospital that will be a bat roost, or something of that sort, unless it is maintained by the Federal Government, in many instances.

Dr. DEARING. Sir, we visualize the real need for service help in hospital facilities at the time when they are first opened, when they are building the staff, and before they get their patients, who then will by their fees pay the load. It is that beginning before you have income. Mr. SCHWABE. As far as you can visualize it?

Dr. DEARING. Yes. That is when the hospital needs help.
Mr. HEDRICK. Will the gentleman yield?

Mr. SCHWABE. Yes.

RELATIONSHIP OF NEW PROGRAM TO HILL-BURTON PROGRAM

Mr. HEDRICK. I would like to know why they cannot be built under the Hill-Burton Act.

Mr. SCHWABE. That is a good question. I join with you in that.

Dr. DEARING. Well, sir, these are needs over and above those that are contemplated, or perhaps it is fair to say that are permitted to be met under the Hill-Burton Act, which sets its own system of rules, based on normal peacetime living for the establishment of hospital beds, and determining where they shall be built and under what priorities.

We have had our act studied thoroughly, and our legal advice is that we may not require under the Hill-Burton Act that they adjust their priorities to take account of these emergency defense impacts and the temporary situations.

Mr. HEDRICK. After the emergency is over, the hospitals will naturally drift into community hospitals?

Dr. DEARING. Yes, sir.

Mr. HEDRICK. I cannot see why the county or State would not participate in the construction to start with.

Dr. DEARING. We expect they shall. I think it was brought out this morning that we would insist that there be a relationship as to any request for a community hospital in any of these critical areas to the State plan, so that it would not be built without relation to the State plan and it would be looked at so it would be related to other hospitals and whether it was needed at all.

So the Hill-Burton machinery and the State planning machinery which has been developed and the information developed State by State regarding hospital needs and the plans they have projected are all available to see that these emergency facilities would be properly related and not wastefully built or duplicated or put in places where they could not be supported or staffed.

Mr. HEDRICK. That is all.

Mr. SCHWABE. Doctor, as a matter of fact, the recommendations are made to the Public Health Service by the State authorities? Dr. DEARING. Yes, sir.

Mr. SCHWABE. As to where they consider hospitals are needed, and with all investigation necessary by the local authorities, State authorities and the recommendation based thereon is made to you that this is to be a location where Hill-Burton funds would be properly allocated?

89877-51-11

Dr. DEARING. That is correct, sir, regarding the Hill-Burton hospitals.

Mr. SCHWABE. I understand, but you know we all understand that those surveys are changed from time to time, or at least are subject to change.

Dr. DEARING. They must be reviewed once a year.

Mr. SCHWABE. And can be reviewed oftener as conditions warrant. Down in the country where I live we have great influxes of population due to a sudden development of oil in some new sector or field. Populations move in and follow the development of that field, sometimes to the extent of several hundred, there are estimates to the extent of several thousand, up to 25,000 or 30,000 people.

We have always found a way for the people who come there to work to have a place to educate their children before too long, for them to get medical attention, and that means hospitalization, crude as it may be to start with, because these people are pioneering in this new enterprise or this new development of that community.

We have never come to the Federal Government for assistance on those things.

The State authorities in the medical field find that here is a community that gives promise of becoming a permanent community and needs Hill-Burton assistance, and it is recommended to you even though it was not included in the original usrvey, because unique circumstances have arisen, and an emergency has developed, and you will authorize that allocation.

Dr. DEARING. And revise the plan.

Mr. SCHWABE. That is right. There is no reason, is there, why it cannot be done in cases where the defense impact has produced the change?

Dr. DEARING. None whatsoever.

Mr. SCHWABE. That is what I am getting at. So they can be built under the Hill-Burton funds as Dr. Hedrick has suggested?

Mr. HEDRICK. That is the way they should be built.

Dr. DEARING. Public Law 139 states that grants under this title shall be made only after such action by the local agency to secure assistance as is determined to be reasonable under the circumstances only to the extent that the required assistance is not available under the Hill-Burton Act.

Mr. SCHWABE. That, in my judgment-and I believe it would apply to what Dr. Hedrick said-would minimize and reduce it to a very small amount, that is, the funds that would be necessary for you to have to have to build hospitals for these facilities that we are talking about; is that your idea?

Mr. HEDRICK. That is the idea.

Dr. DEARING. I may say that the request for hospital funds that Mr. Miles gave you this morning amounts to 20 percent only of the needs over and above those that would be met by the Hill-Burton Act in the surveys that we have made of these 50 areas that have come to our attention.

Mr. SCHWABE. In dollars and cents how much would that be? Dr. DEARING. About $11 million. That $55 million is the total need over and above Hill-Burton needs. This request would provide only $11 million of that.

Mr. SCHWABE. There is always an amount over the Hill-Burton need, because there is always the situation where conditions change and the possibility of a revived recommendation.

Dr. DEARING. One of the problems, as was brought out by Mr. Pond just before lunch, is the question of time. That is the thing that the Atomic Energy Commission has laid on us very heavily in connection with their build-up in these two areas which they are developing.

Mr. SCHWABE. As much money as the Atomic Energy Commission has been furnished by this Congress, almost unstintingly, I am sure they can take care of any situation which they have to meet.

Dr. DEARING. I do not think they are authorized to build hospitals. Mr. SCHWABE. They can get you to do it then under the HillBurton Act.

CHILD DAY-CARE CENTER-NEED IN CERTAIN LOCALITIES

I want to talk to Dr. Eliot just a moment. Doctor, you made some surveys, you and your colleague, Miss Arnold. I want to know how you made these surveys.

Dr. ELIOT. I will have Miss Arnold answer that.

Miss ARNOLD. We would not call them surveys. We got information from our field staffs as to what the situation was.

Mr. SCHWABE. Tell us where you got the information, which centers are involved, and so on.

Miss ARNOLD. We got the information from different sources. Some of it was from the State departments of public welfare. Some of it we got through local councils of social agencies, whatever source was best available to us.

We have some from two places in Georgia, Kansas City, Denver, Pueblo, Rochester, New York, Indianapolis, other various places. We had about six States represented. Savannah, Ga. was another one; Richmond, Va. I think those were the main ones.

Mr. SCHWABE. I did not hear of any place out in the southwest except Kansas City and Denver.

Miss ARNOLD. And Pueblo. Yes, Cleveland, Ohio, is another one. Mr. SCHWABE. I think you realize we have a lot of installations, bomber plants, airplane factories, assembly plants, and so forth, out in the great Northwest.

To take women away from their homes and families, in my opinion, should be about the last resort. I do not care if the Bureau of Labor Statistics does show, as Dr. Eliot says, that it is a great pool for labor. I think it should be a pool which is overflowing before you encourage them to do that which eventually will mean the absolute dissolution of our homes.

In many instances it will mean the tearing down of our ideal American homes and putting them on a commercial basis where we do have these day-care people that you want to have go into these homes to take care of the children and raise them like they do maybe in Russia, rather than like they have been raised in America and like we should want to continue to raise them in American ways, and where the woman's place has been in the home primarily, as we have been taught to think. I am just that old-fashioned.

If you raise children without the affectionate care of the mother, in my opinion, I do not care how good a day center you have, or night

center you have, you are not going to have the same type of American citizen ordinarily that you have had in the last generation or two.

So you are going to have to convince me that you need to do something besides go out and offer these opportunities to these people to get these women to work in these factories before I will feel that you have justified your end of the program.

If you have anything to answer to that, I will be glad to hear from

you.

CIRCUMSTANCES WHICH PRODUCE NEED FOR DAY-CARE CENTERS

Dr. ELIOT. I would like to say the Children's Bureau is deeply concerned that mothers of young children, mothers of children all the way up through adolescence, should have every opportunity to give those children the most appropriate care in their own homes that can possibly be provided. There is no question about that whatsoever.

Mr. SCHWABE. By the mother herself rather than hired people. Dr. ELIOT. Certainly. That is the primary principle upon which we would go. There can be no question about that at any time.

However, there do come situations and times when a situation confronts us in which some of these women are going to work. That does not mean that we are encouraging them to go to work. We do know that when a critical need arises in the life of the country that very often these women do go to work. I was going to say that they have to go to work.

Every effort should be made, first, to get all women into the labor force that can be gotten into the labor force, obviously, before the mothers of children are called upon.

But there are situations in some of these critical areas where the mothers of children are going to work.

When that happens, we want to do something about it. Let me say that already there are 7 million children who are affected by this because their mothers work. In other words, there are a lot of children in this country who are living in families where the mother is at work. We depreciate that. We do not like it for one moment. Mr. SCHWABE. Then do not put a premium on it.

Dr. ELIOT. We do not want to.

Mr. SCHWABE. That is what you are doing.

Dr. ELIOT. The situation we are trying to meet is a situation which exists, and under the pressure of the national defense situation we feel will increase.

In World War II the increase of the number of married women with children who went to work during that time was slow, but it was there. It persisted.

Mr. SCHWABE. And with divorces increasing almost proportionately.

Dr. ELIOT. For a variety of reasons, Mr. Congressman. There were many reasons why we would not want married women to go to work; but again, we must face the facts as they exist; when they do, we want to provide proper care of these children. We wish to see that care is provided that will do two things, that will assure those women that the care is adequate in terms of physical facilities, that there is adequate health facilities for those children, and that when