ever since. The question of whether there is now sufficient participation by the Department of Medicine and Surgery in the development of medical criteria in connection with the disability rating system, particularly in the identification of disability resulting from various disease entities, is a matter which requires further study by the Veterans Administration. This includes the question of whether any redistribution of responsibilities in this field to the Department of Medicine and Surgery is indicated. Hence, the Administrator is not prepared at this time to make a final determination on this matter and is directing a careful exploration by the departments concerned as a basis for reaching a definite conclusion. This agency has every desire to conduct its operations relating to the evaluation of disabilities for compensation and pension purposes on a sound and realistic basis, and when improvements to that end are indicated, after careful study, they will be placed into effect.

RECOMMENDATION NO. 14

"That all laws relating to veterans or veterans' benefits, and in particular to medical treatment and domiciliary care benefits, be consolidated and enacted into a single, all-inclusive, comprehensive code; and that all existing rules, regulations, and Executive orders relating to veterans and veterans' benefits be brought together in one volume.” Comments of Veterans' Administration

In general, this recommendation would involve legislative action to consolidate and enact a code of laws relating to benefits for veterans. That portion of the recommendation referring to existing rules, regulations, and Executive orders being brought together in one volume is not entirely clear as to its intended scope. If it refers to the considerable and changing volume of regulatory and procedural material which is promulgated and amended by administrative action, there is a serious question as to the feasibility of attempting to consolidate all such material into a single volume which would quickly become obsolete unless supplemented on a continuous basis. The basic administrative regulatory material is now contained in a looseleaf publication designated Veterans' Administration Regulations. The discussion of this recommendation in the task force report, to which reference is made by the Commission, indicates that the objective is the enactment of a complete code of basic substantive provisions. The emphasis is placed upon provisions relating to medical treatment and domiciliary care benefits.

In view of the multiplicity of laws and other basic provisions governing veterans' programs, it is a desirable long-range objective that these provisions be gathered together, clarified, and enacted into a positive code. This would be a task of large proportions. In 1948 and 1949 the Committee on the Judiciary, House of Representatives, intiated a project of this order, and the Veterans' Administration cooperated to the extent requested. While this was not carried to fruition at the time, it will be noted that the chairman of the Committee on Veterans Affairs, House of Representatives, recently stated to the House, while discussing this recommendation, that his committee, in cooperation with the Committee on the Judiciary, is working on such a project at the present time. He alluded, among other things, to a bill, H. R. 3805,

84th Congress, which is now under active consideration by the Committee on Veterans' Affairs as a step in this direction. This bill has as its basic purpose the consolidation and clarification of laws relating to compensation and the reenactment of these laws into a single, integrated statute.

There is in fact a single basic statute relating to medical treatment, hospital care, and domiciliary care; namely, section 6 of Public No. 2, 73d Congress, approved March 20, 1933, as amended and re-enacted by Public No. 312, 74th Congress, approved August 23, 1935 (38 U. S. Č. 706). There are implementing Veterans Regulations (Executive orders) and administrative regulations related to this basic authorization. In any future overall codification of veterans' provisions it would be desirable to have a more closely knit, clear-cut pattern governing these matters.

RECOMMENDATION NO. 15

"That the provision of hospital and clinical service to American merchant seamen by the Federal Government be ended."

RECOMMENDATION NO. 16

"(a) That the hospital and medical care of the Coast and Geodetic Survey, the Coast Guard, and the Public Health Service personnel be provided for by the military medical services at their nearest facilities, and that, pending the establishment of voluntary contributory healthinsurance plans for dependents, the dependents be similarly cared for on a reimbursable basis between the agencies.

"(b) That civilian Federal Government employees receive care for job-connected illness in the non-Federal hospitals at the expense of the Bureau of Employees' Compensation in the Department of Labor."

RECOMMENDATION NO. 17

"That except for mental, drug addict, tuberculosis hospitals, the Leprosarium, and also the facilities for the care of Indians, and the Freedman's Hospital, the Public Health Service should close all of its general hospitals and all of its clinics, except research activities, such as those conducted by the National Institutes of Health and those clinics necessary for (a) physical examination of Federal civilian employees, and (b) examination of foreign nationals entering the United States. These hospitals should be disposed of in accordance with our sugges tions in chapter II."

RECOMMENDATION NO. 18

"That the Secretary of the Department of Health, Education, and Welfare reconsider the whole question of the use of specific Federal grants to the States for health purposes, particularly in relation to the inflexibility of the present system.'

RECOMMENDATION NO. 19

"That the President establish a joint committee representing the Department of Health, Education, and Welfare, the Department of

Agriculture, and the Bureau of the Budget, with the advice of the Federal Advisory Council of Health, to make a detailed examination of the policies, programs, and operations of the Food and Drug Administration and the Agricultural Research Service in the Department of Agriculture, with a view of eliminating those activities no longer necessary under present conditions and eliminating conflicts and overlap between departments."

Comments of Veterans' Administration

In general, these recommendations are not applicable to the Veterans' Administration. It should be observed with respect to Recommendation No. 16 (b) that, while this appears to be sound in principle, there may be exceptional situations calling for the use of Federal hospitals for the treatment of job-connected illnesses of Government employees on a reimbursable basis, and this should be recognized.

RECOMMENDATION NO. 20

"That the executive branch develop a voluntary contributory program of medical care and hospital insurance to be conducted through a pool of private health-insurance agencies, for all the civilian employees of the Federal Government, on a prepayment basis and using payroll deductions. The Federal Government should pay a portion of the cost. This program should contain a provision for convertibility to family coverage on termination of Federal employment." Comments of Veterans' Administration

This would, of course, require the enactment of legislation. The Veterans' Administration concurs in the objective, and it is understood that it is generally consistent with Administration policy.

RECOMMENDATION NO 21

"That the Government develop for dependents (within the United States) of military personnel a voluntary contributory plan of medical care and hospital insurance to be conducted through a pool of private health-insurance agencies, for inpatient care and, as far as practicable, outpatient care; and that in this case the Federal Government pay a greater portion of the cost than might be determined by the Congress for civilian employees. Such insurance for dependents would be convertible to family coverage on completion of military service."

RECOMMENDATION NO. 22

"That the Government develop for dependents of uniformed personnel of the Public Health Service, the Coast Guard, and the Coast and Geodetic Survey, a voluntary contributory plan of medical care and hospital insurance similar to that which we have recommended for military dependents."

Comments of Veterans' Administration

These recommendations are not directly applicable to the activities of this agency. It is noted that the Commission refers (H. Doc. No. 99, 84th Cong., p. 61) to the belief of its task force that the convertibility feature of Recommendation No. 21 "should go far to meet the problem of medical care for non-service-connected disabilities of veterans."

RECOMMENDATION NO. 23

"That legislation be enacted to establish a National Library of Medicine as a division of the Smithsonian Institution, with a Board of Trustees to be selected by the Board of Regents of the Smithsonian Institution; and that the Board of Trustees be responsible for directing the policy of the National Library of Medicine. The medical collections, staff, and activities of the Armed Forces Medical Library should be transferred to these trustees. Housing and a budget adequate for the National Library of Medicine should be provided."

Comments of Veterans' Administration

The Veterans' Administration endorses this recommendation which, as stated by the Commission, would provide a National Library of Medicine, generally accessible, to "function properly as a truly national institution."

RECOMMENDATION NO. 24

"That the proposed Federal Advisory Council of Health make recommendations to improve preventive health services, including those rendered in connection with medical care of Federal beneficiaries, in the interests of both health conservation and long-range economy.' Comments of Veterans' Administration

The discussion preceding the recommendation in the Commission's report shows that it is directed primarily to programs conducted by the Department of Defense, the Public Health Service, and the Children's Bureau. The Veterans' Administration is in accord with the purpose of this recommendation, but it should be pointed out in this connection that, under the governing laws concerning the treatment and care of eligible veterans, the functions of the Veterans' Administration relate to treatment of the sick and disabled veteran, as distinguished from activities in the nature of "preventive" medicine.

RECOMMENDATION NO. 25

"(a) That the proposed Federal Advisory Council of Health be given responsibility for reviewing the health research programs of the Federal Government; and the making of appropriate recommendations to the President; and

"(b) That the present system of project grants to institutions or agencies for research pertinent to health be modified, and that it be gradually replaced by a system of grants not confined to a specific year (i. e., 'no year' grants), these grants to be made in accordance with an approved overall plan for health research submitted by each institution or agency."

Comments of Veterans' Administration

The general purposes of this recommendation appear to be sound, subject, however, to the reservations of the Veterans' Administration stated in connection with Recommendation No. 1 with respect to the composition and degree of authority of the proposed Federal Advisory Council of Health. It should be repeated for emphasis that the Council, if established, should be restricted to advisory functions as distinguished from supervision of agency operations.

RECOMMENDATION NO. 26

"That the Federal Government in making plans for assignment of responsibilities during and immediately following an attack on the continental United States should include in its consideration of the problem the question of appropriate delegations of operational authority for directing medical care."

Comments of Veterans' Administration

It is manifest that preparations for a possible attack on the continental United States should include a determination of appropriate delegations of operational authority with respect to medical care. The Veterans' Administration concurs in this recommendation.

RECOMMENDATION NO. 27

"That the proposed Federal Advisory Council of Health examine means of establishing cooperative planning among Federal agencies providing psychiatric care; that the military services and the Veterans' Administration give greater emphasis to preventive psychiatric services; and that the Federal Government, through the Public Health Service, encourage more research and more training of psychiatrists and workers in allied fields."

Comments of Veterans' Administration

The Veterans' Administration endorses this recommendation in principle. However, with respect to the specific part dealing with preventive psychiatric services, it must be noted that the Veterans' Administration is generally limited to treatment procedures, as distinguished from preventive medicine activities, and any question of broadening our field of authority to include preventive services raises an overall question of legislative policy as to which no recommendation is submitted at this time. At the present time the Veterans' Administration is contributing materially to research and training in the field of psychiatry and is in a position to do a great deal in encouraging this program throughout the country.

RECOMMENDATION NO. 28

"That the President's adviser on personnel review the personnel systems of the several Federal agencies using health personnel and consult with the proposed Federal Advisory Council of Health with a view to making them more uniform; and that he give consideration to greater use of cross-agency assignment."

Comments of Veterans' Administration

The Veterans' Administration is unable to concur in this recommendation. The missions of the various Federal agencies are generally so dissimilar that uniformity of medical personnel systems would be most difficult and would not serve a useful purpose. The Veterans' Administration has considerable latitude under Public Law 293, 79th Congress, to operate a personnel system for professional medical personnel which is geared to the agency's particular needs. A uniform system which would attempt to merge nine different systems could hardly satisfy the precise needs of all and would probably