Mr. RICH. Now, when you speak of the fund being exhausted, what are you going to do on your social security or any other form of Government insurance when you collect the moneys for a particular purpose and you put it into the Federal Treasury, and then you spend it and you do not have it in reserve? What do you think of that policy?

Mr. COHEN. I believe that is the same question you asked me, Congressman, about 7 or 8 months ago.

Mr. RICH. You did not give me the answer. I would like to get it now.

Mr. COHEN. The involvement of these insurance funds in United States Government obligations does mean exactly what you imply; the United States Government, of course, utilizes that money, the excess, for current expenditures, as authorized by congressional appropriations.

It will be necessary, if those funds are exhausted-there is no danger of that at the present time-for the Government at that time either to raise additional taxes or to sell other United States bonds to raise the funds.

Mr. RICH. What do you mean by "there is no danger of that at this time"?

Mr. COHEN. We have $11,000,000,000 in the trust fund for unemployment insurance.

Mr. RICH. Yes, but supposing, with the Government going into the red at the rate of about 7 to 10 billion dollars this year, if we continue that-your trust fund is now being expended by the Federal Government.

Mr. COHEN. But there is enough current income coming in, Congressman.

Mr. RICH. Oh, no, as soon as we get it we turn it in to the general fund and the Federal Government spends it.

Mr. COHEN. Yes, but the current benefits

Mr. RICH. Well, but supposing you had a depression. Supposing you had a depression and your current income was not great enough, what would happen then?

Mr. COHEN. Well, on the basis of the requirement in Congress that we estimate for 5 years in advance, there is sufficient money coming in at the present time to pay all of the benefits for at least the next 5 years.

Mr. RICH. Did you not observe what happened to the coal miners when they thought they had enough funds to pay, and then they stopped working and what happened?

Mr. COHEN. Well, I think we are in a much more favorable position than the coal-mining fund is.

Mr. RICH. Well, you are more optimistic than I am.

Mr. COHEN. The actuarial report, Congressman, does show that the income to the fund at the present time is sufficient to pay the benefits during any immediate period, even despite a serious downswing in business conditions.

Mr. RICH. Well, I do not agree with you.

Senator SPARKMAN. Well, there are several other questions I would like to ask, but time is moving along, so I shall leave them out, but I do want to ask this question with reference to the rehabilitation pro

gram. You said we ought to rehabilitate 250,000 a year. How many are we rehabilitating?

Mr. THURSTON. About a fifth of that, 58,000.

Senator SPARKMAN. By the way, I want to pay my respects to that program. I have seen it function down in my State and they are really doing a remarkable job both in rehabilitating and placing rehabilitated persons.

You make certain recommendations in your statement regarding a national health program. I have had this complaint which seemed to me to be a perfectly good complaint: That we had a great shortage of facilities for training doctors and nurses, and that one of the strongest aids that the Government could give would be helping to establish additional training facilities. In that connection my attention was called to the fact that the Government does not participate or does not engage in any nurses' training program, but that the Veterans' Administration and the national defense take up a great portion of the nurses that are trained in private training institutions.

Mr. THURSTON. You mean the Government does not participate in the sense of providing facilities?

Senator SPARKMAN. That is right.

Mr. THURSTON. Well, I am not sure that that is entirely

Senator SPARKMAN. I was told that was true, and I questioned it, too; but I was told that they do not do any training, have no facilities for training, but that they use a great number of the nurses after they are trained.

Mr. THURSTON. It is certainly true that Federal participation in that respect is very, very limited. I think that Dr. Grigsby would indicate that there are a few vocational-education programs so far as certain aspects of nursing are concerned.

I think it is also true, Senator, that the hospitals that we have in the Public Health Service and in the Veterans' Administration may provide some training. I must confess that I do not know the extent of it except that it is very limited. If there is anyone along the line who does, let him speak up. Certainly the basic point

Senator SPARKMAN. Let me say I would be very glad if you would have someone check on that particular statement.

Mr. THURSTON. We will.

Senator SPARKMAN. And let us have for the record at this point just what the Federal Government is doing, if anything, toward making available facilities and training as such for nurses.

(The document above referred to follows:)

PRACTICAL NURSES

In recent years, increasing interest has been shown in the possibility of utilizing more subprofessional personnel of the type popularly known as practical nurses to perform the more simple and nontechnical duties of nursing. Through the vocational-education programs in 22 States, the Federal Government is assisting in the training of approximately 1,200 such persons annually. At the Federal level the program is administered by the Office of Education in the Federal Security Agency.

NURSES HOLDING THE REGISTERED-NURSE DIPLOMA OR A BACHELOR'S DIPLOMA The conventional training programs are conducted in approximately 1,200 university and hospital schools of nursing throughout the country for the preparation of nurses. The Federal Government is making almost no contribu

tion to these training programs at the present time. Exceptions to the rule are the schools in two Federal hospitals which are under the Federal Security Agency: Freedmen's and St. Elizabeths. Together the two institutions graduate from 30 to 40 nurses annually.

The veterans' educational program (Public Law 346) aids in the training of nurses indirectly. The Veterans' Administration reports that 4,000 were enrolled in 1948-49 for undergraduate courses.

During World War II, the Federal Government, through the Cadet Corps Nursing program, did provide training which resulted in the graduation of 124,000 nurses. The program terminated in 1948 and the volume of training declined to prewar levels.

SPECIALIZED TRAINING FOR GRADUATE NURSES

Throughout the country, schools offer a variety of programs for training special types of nurses, such as teachers of nursing, administrative personnel, publichealth nurses who will engage in community nursing services, and psychiatric nurses. In this area the Federal Government is offering some assistance.

Public Health Service grants-in-aid to States are used in part for the training of public-health nurses. The number of such students this year is 2,384. Their courses vary from 6 weeks to a year in length.

In the field of psychiatric nursing, traineeships are being provided this year for 86 nurses for advanced training through the National Institute of Mental Health in the Public Health Service of the Federal Security Agency. There is also a small subsidy to schools for expanding their facilities. St. Elizabeths Hospital graduates about 15 nurses each year for psychiatric duty. Under the veterans' educational program, there are 3,100 enrolled for advanced training in university schools of nursing.

When considered in relation to the need-more than 150,000 practical nurses or nurses' assistants and about 50,000 trained nurses-it is apparent that the Federal Government's participation in meeting the need is relatively minor.

Senator SPARK MAN. By the way, the statement was further made to me I think I remember this correctly-that the average service of a nurse after she was trained was only about 5 years; and that the cost for that short period of service is rather heavy. It takes, I believe, a couple or 3 years to train a nurse, and you get only about 5 years of service, and the inroads of the Federal Government just about use up

Mr. THURSTON. There is no doubt, Senator, that the replacement rate among nurses is very high. There is no doubt that it is one of the major problems in the nursing field.

I do not know whether the 5-year figure is right or wrong. I suspect that it is more nearly right than it is wrong. Inevitably there is a high replacement rate. It is one of the major problems in meeting the shortage. There is no getting around it.

I suspect we may have to make use of less well-trained nurses to do some of the jobs, perhaps.

Senator SPARKMAN. Well, now, let me ask you this last question, using that as a predicate for it. Do you not believe that one of the most essential parts of any health program that the Government participates in would be one directed toward making it possible for us to have additional doctors and additional nurses?

Mr. THURSTON. Yes; I do.

Senator SPARKMAN. For instance, they say that all of these hospitals we are building over the country under the Hill-Burton Act and this is a very fine program, and I am for it, but they come back and say— "What are you going to do with these hospitals without nurses to perform the necessary services in them and without doctors to perform the functions that will be required?"

Mr. THURSTON. That is why we are very hopeful that the House will act promptly with respect to that aid-to-medical-education bill which has in it provision for increasing the number of nurses.

Mr. RICH. You do not mean that socialized medicine bill?

Mr. THURSTON. I am referring to the aid to medical education bill. Mr. RICH. May I ask a question here in reference to the nurses? We have organizations of various kinds, and the nurses have theirs in the hospitals. For instance, I think in Pennsylvania a nurse is not supposed to work in a hospital unless she is a registered nurse. She is not supposed to take any charge. We have made the requirement so strict and so strong that it is difficult to aid in conducting a hospital because of the high standards that they have made.

As someone mentioned here, the practical nurse is almost outlawed in many, many institutions. Do you think that our restrictions have become so great in that respect that that is one reason or one cause why we have such difficulty in finding nurses?

Mr. THURSTON. I know the nursing profession is giving a great deal of thought to that, as we are. We had some experience during the war when we used nurses' aides, not with an intent to lower the professional status of the nurses at all, because in my opinion that would be highly undesirable, but to identify certain activities which nurses now perform that other persons trained, but not perhaps as highly trained, could perform. I think that is a possibility. Certainly we have had some experience along that line.

Mr. RICH. I know there is a great need for some relaxation in some of the regulations that will permit the practical nurse to do a lot of work that really she is prohibited from doing today. We had it in the old days and we got along and there is a need for that. I find that is the situation in our own State.

Senator SPARKMAN. Anything further, Senator Flanders?
Senator FLANDERS. No, thank you.

Senator SPARKMAN. Thank you very much, Mr. Thurston, and all of those who came with you.

Mr. THURSTON. Thank you, Senator Sparkman, and members of the committee.

Senator SPARKMAN. The meeting will stand adjourned until 10 o'clock tomorrow morning when Mr. Blaisdell will be here.

(Whereupon, at 12: 40 p. m., the hearing was adjourned to reconvene on Tuesday, December 13, 1949.)

LOW-INCOME FAMILIES

TUESDAY, DECEMBER 13, 1949

CONGRESS OF THE UNITED STATES,
SUBCOMMITTEE ON LOW-INCOME FAMILIES,

JOINT COMMITTEE ON THE ECONOMIC REPORT, Washington, D. C. The subcommittee met, pursuant to adjournment, at 10 a. m. in room 224, Senate Office Building, Senator John Sparkman (chairman) presiding.

Present: Senators Sparkman and Flanders and Representatives Huber and Rich.

Also present: Grover W. Ensley, associate staff director, Joint Committee on the Economic Report; Samuel L. Brown, economist, Subcommittee on Low-Income Families; and Mrs. Elizabeth G. Magill, research assistant, Subcommittee on Low-Income Families.

Senator SPARKMAN. Let the committee come to order, please. We have with us this morning Mr. Thomas C. Blaisdell, Jr., Assistant Secretary of Commerce. Mr. Blaisdell, we are very glad to have you with us. I understand you have a prepared statement and also a summary. You may proceed in your own way.

STATEMENT OF HON. THOMAS C. BLAISDELL, JR., ASSISTANT SECRETARY OF COMMERCE, ACCOMPANIED BY WILLIAM H. SHAW, DEPUTY DIRECTOR, OFFICE OF PROGRAM PLANNING; LOUIS J. PARADISO, CHIEF STATISTICIAN, OFFICE OF BUSINESS ECONOMICS; AND MATTHEW HALE, ACTING SOLICITOR

Mr. BLAISDELL. Mr. Chairman and members of the committee, I am here in response to the invitation in your letter of November 9 to discuss issues that have been raised in the study initiated by your Subcommittee on Low-Income Families. I shall try to answer such questions as you may have to the best of my ability, but I should like first to present a summary of the statement prepared for your subcommittee which was submitted by the Department of Commerce on December 9.

A sizable proportion of the Nation's families receive substandard incomes despite the achievement in recent years of the highest levels of real income and consumption in our history along with practically full employment. As indicated by materials assembled by the staff of the Joint Committee on the Economic Report, more than 912 million families received cash incomes below $2,000, about one-fourth of all families of two or more persons in the United States. In addition, almost 6,000,000 single individuals reported cash incomes below $2,000.