Senator LONG. I am of the opinion that a separate department of health could be completely established under a reorganization plan, as long as it did not create any new activities, and as long as it was just a matter of taking the activities and functions that presently exist in the Government and throwing them all into one department. Do you have any legal opinion as a basis for your statement that that could not be done without separate legislation?

Mr. EWING. Senator Long, I do not think there is any question but that by a reorganization plan the President could lift the Public Health Service right out of this Department and put it anywhere he wants to. But what would bother me would be how he would split up the medical services in the Military Establishment and in the Veterans' Administration without legislation. That is what bothers our lawyers about it. I do not think they are absolutely positive in their opinion, but they feel that there would be a difficulty and that legislation would be the much better course to follow.

Senator LONG. In conferring with Mr. Rice, I found him in agreement with me on this subject, that any plan of reorganization could take any functions that presently exist in the Government, insofar as the reorganization act itself does not preclude that being done, and place any of those functions into any department that they want it in. Now, if you want to pass a law that would change the law of the land with regard to functions of the Federal Government and add new functions to the Federal Government, that would of course require legislation. But as far as any function that the Government is now performing is concerned, it is my opinion that unless the act expressly forbids it, as it does in certain minor connections, you could take any function in the Federal Government and reorganize it, or combine it with other functions.

Mr. EWING. I would be the last to say that that opinion is wrong. I would say that I think there is some doubt about it.

Senator LONG. That is what I thought I voted for when I voted for the act. I can say that.

The CHAIRMAN. Senator Smith?

Senator SMITH. I am sorry I had to leave during the interesting part of your discussion with Mr. Ewing, Mr. Chairman, but I had a Maine delegation meeting that I had to attend.

I simply want to make an observation for the record, if I may. I am sure we are all satisfied that we are trying for the same objective. We are seeking efficiency. We are seeking economy and better govern'ment. And I have felt strongly, Mr. Ewing, for a long, long time about the need for a Department of Welfare, with the executive head having cabinet status..

But as I studied these changes, I have not yet been convinced that we can accomplish what we are after if we go by the way of spreading functions rather than consolidating them. And it is that, I think, together with the much talked of so-called socialized medicine proposal, which bring in so much mail to my desk, anyway. The CHAIRMAN. Thank you very much, Mr. Ewing.

Mr. EWING. Thank you.

The CHAIRMAN. Is Colonel Ijams present.

Will you come around, please? You wish to testify with respect to plan No. 1?

STATEMENT OF GEORGE E. IJAMS, DIRECTOR, NATIONAL REHABILITATION SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES, WASHINGTON, D. C.

Mr. IJAMS. Mr. Chairman, my testimony will have no direct bearing on plan No. 1, but it will have an indirect bearing on one phase of it that has been discussed here this morning, and that is the Hoover Task Force Report.

The CHAIRMAN. What I am trying to get at is: on which plan you wish to testify before the committee?

Mr. IJAMS. Plan No. 1, sir.

The CHAIRMAN. We wanted to get the record straight as to that. Do you have a prepared statement?

Mr. IJAMS. No; I have not, Senator. My remarks will be very brief.

The CHAIRMAN. All right, you may proceed.

Mr. IJAMS. Thank you, sir.

The CHAIRMAN. Whom do you represent?

Mr. IJAMS. My name is George E. Ijams. I am the Director of the National Rehabilitation Service of the Veterans of Foreign Wars of the United States.

The CHAIRMAN. All right, sir. You may proceed.

Mr. IJAMS. The first news we had of any suggestion for setting up a separate department to administer all Federal hospitals or practically all of them was a news release which appeared in the Washington press on December 26, 1948. The following day I wrote to former President Hoover. I will put this letter in the record, if I may, sir, to save time.

The CHAIRMAN. All right, sir. The letter may go in the record. (The letter referred to is as follows:)

VETERANS OF FOREIGN WARS OF THE UNITED STATES,

Hon. HERBERT HOOVER,

NATIONAL REHABILITATION SERVICE, Washington 6, D. C., December 27, 1948.

Commission of Organization of Executive Branch of the Government,

Washington, D. C.

MY DEAR MR. PRESIDENT: To identify myself, may I remind you that I was appointed Assistant Director of the Bureau of War Risk Insurance immediately after my return from France. After the United States Veterans' Bureau was created by law, I served as its Assistant Director. In 1930 when the Veterans' Administration was authorized, you appointed me Director of the United States Veterans' Bureau for the last year of its existence. In 1931 I became Assistant Administrator of Veterans' Affairs, and served in that capacity until March 1, 1946, when I resigned to assume the directorship of the national rehabilitation service of the Veterans of Foreign Wars.

Yesterday, I read an article in the Washington Star entitled "Waste Charged in Health Set-up; Merger Urged." In that article, a proposed reorganization plan was outlined which contemplates the establishment of a new department to have jurisdiction over all medical and hospital activities of the Federal Government, and to include veterans' hospital and medical personnel of the regional and branch offices, charged with the responsibility of medical treatment and examinations for rating purposes. I was very glad to read that this was merely a proposed plan and which had not yet received your approval. In an effort to be heelpful to you inreaching a decision as to whether the proposed plan should be approved, I should like to give you a brief outline of the situation which existed in the old Bureau of War Risk Insurance at the time I came here in 1919.

Both the Bureau of War Risk Insurance and the United States Public Health Service were then under the jurisdiction of the Treasury Department. The

Honorable Jouett- Shouse, then Assistant Secretary of the Treasury, had administrative jurisdiction over both of these organizations and I believe of several others which were not related to this problem. Mr. Shouse was supposed to coordinate the activities of the War Risk Insurance Bureau and the Public Health Service insofar as veterans' activities were concerned. When a veteran applied for compensation or insurance benefits, it was necessary to have a thorough and complete physical examination made. Therefore, the War Risk Insurance Bureau had to refer veterans to the nearest Public Health Service hospital for this examination. The veteran activity of the Public Health Service was only one of many.

Consequently, this organization did not give preference to veteran examinations, but handled them in a routine manner. In many instances, months elapsed between the examination of the veteran and the time when his physical report was sent to the Bureau of War Risk Insurance for adjudication purposes, and during this period the Bureau of War Risk Insurance was severely condemned because of the delay in the adjudication of these claims.

Similar delays occurred in securing beds for the treatment of veterans in Public Health Service hospitals, and while this was not the responsibility of the Bureau of War Risk Insurance, nevertheless, that organization was severely condemned because of any delays which occurred in securing hospitalization. It was because of the lack of control of the hospital and medical organizations by the Bureau of War Risk Insurance that the United States Veterans' Bureau was brought into existence through congressional enactment, so as to place definite responsibility for all phases of the veteran problem under one man.

It must be remembered, Mr. President, that in those days we were dealing with less than 5,000,000 veterans. Today, we are dealing with more than three times that number. Consequently, if criticism and chaos existed in 1919 because of the lack of definite responsibility for all problems arising out of veteran care, it can be readily seen that the proposed plan of again separating medical care and treatment from other responsibilities of the veteran problem will lead to certain criticism in the handling of this difficult activity of government.

There are many other reasons why the proposed plan would not operate smoothly. In the first place, the vast majority of Federal beneficiaries for hospitalization are the veterans of our country who have served in time of war. Then, too, as time goes on, the veterans become victims of diseases of age and chronic conditions which are quite different from the hospital cases in Army and Navy institutions where all of your patients are young men, and where they are suffering from acute, rather than chronic conditions. As a matter of fact, when a man in active military service suffers from a chronic condition, he is, and should be, released from active military duty.

In reading the list of those making up the committee which recommended the consolidation of all Federal hospitals in one separate department, I did not find the name of one person who has had any background and experience in this work over a long period of years. I believe you will agree, Mr. President, that before the stamp of approval is placed on this proposed plan, you should be armed with facts predicated upon actual experience.

I would welcome an opportunity to discuss this matter with you personally because so many of the matters which I have briefly mentioned above occurred during your administration as President of the United States. I should be glad to make myself available to you at any time of the day or night that you may designate.

Very respectfully,

GORGE E. IJAMS, Director.

Mr. IJAMS. In the letter I first identified myself, and then I stated that I had read this article in the Washington press, and in that article a proposed reorganization plan was outlined which contemplates the establishment of a new department, to have jurisdiction over all medical and hospital activities of the Federal Government, and to include veterans' hospitals and medical personnel of the regional and branch offices, charged with the responsibility of medical treatment and examinations for rating purposes. I then stated I was delighted to learn that this was merely a proposal and that it had not yet received Mr. Hoover's approval.

94651-49- -3

In an effort to be helpful to you in reaching a decision as to whether the proposed plan should be approved, I should like to give you a brief outline of the situation which existed in the old Bureau of War Risk Insurance at the time I came here in 1919.

I might say, there, that I was appointed Assistant Director of the Bureau of War Risk Insurance in June 1919, and served in that organization, in the Veterans' Bureau, and then in the Veterans' Administration until March 1, 1946, when I resigned to take the position I now occupy.

I then pointed out to Mr. Hoover:

Both the Bureau of War Risk Insurance and the United States Public Health Service were then under the jurisdiction of the Treasury Department. The Honorable Jouett Shouse, then Assistant Secretary of the Treasury, had administrative jurisdiction over both of these organizations and, I believe, of several others which were not related to this problem. Mr. Shouse was supposed to coordinate the activities of the War Risk Insurance Bureau and the Public Health service insofar as veterans' activities were concerned. When a veteran applied for compensation or insurance benefits, it was necessary to have a thorough and complete physical examination made. Therefore, the War Risk Insurance Bureau had to refer veterans to the nearest Public Health Service hospital for this examination. The veteran activity of the Public Health Service was only one of many.

Consequently, this organization did not give preference to veteran examinations, but handled them in a routine manner. In many instances, months elapsed between the examination of the veteran and the time when his physical report was sent to the Bureau of War Risk Insurance for adjudication purposes, and during this period the Bureau of War Risk Insurance was severely condemned because of the delay in the adjudication of these claims.

I will skip over some of this, if I may.

It must be remembered, Mr. President, that in those days we were dealing with less than 5,000,000 veterans. Today, we are dealing with more than three times that number. Consequently, if criticism and chaos existed in 1919 because of the lack of definite responsibility for all problems arising out of veteran care, it can be readily seen that the proposed plan of again separating medical care and treatment from other responsibilities of the veteran problem will lead to certain criticism in the handling of this difficult activity of government.

There are many other reasons why the proposed plan would not operate smoothly. In the first place, the vast majority of Federal beneficiaries for hospitalization are the veterans of our country who have served in time of war, Then, too, as time goes on, the veterans become victims of diseases of age and chronic conditions which are quite different from the hospital cases in Army and Navy institutions where all of your patients are young men, and where they are suffering from acute rather than chronic conditions. As a matter of fact, when a man in active military service suffers from a chronic condition, he is, and should be, released from active military duty.

In reading the list of those making up the committee which recommended the consolidation of all Federal hospitals in one separate department, I did not find the name of one person who has had any background and experience in this work over a long period of years. I believe you will agree, Mr. President, that before the stamp of approval is placed on this proposed plan you should be armed with facts predicated upon actual experience.

Sometime later, after the Hoover task-force report recommending the separation of hospitals was being given considerable publicity, the national welfare and service committee of the Veterans of Foreign Wars held a meeting, on February 18, 1949, and adopted the following resolution:

Whereas efficient administration of veteran-benefit laws requires an organization of Government fully equipped to administer all veteran benefits under the administrative control of one responsible official; and

Whereas any other form of administration separating the administration of one type of veteran benefit from the others would not only divide responsibility

but would be turning the pages of history back 30 years to a type of organization which was proven to be ineffective and inefficient when the various benefits were administered under separate control; and

Whereas the present functional type of organization of the Veterans' Adminis tration was created after a thorough and exhaustive study by competent and experienced businessmen who realized that adequate service could not be given if the responsibility of control were divided; and

Whereas attempts are now being made to again separate the component units of the Veterans' Administration, thus taking from the control of the Administrator of Veterans' Affairs the essential medical and hospital functions of the Veterans' Administration as proposed in the so-called Hoover task-force recommendations: Now, therefore, be it

Resolved, by the national welfare and service committee of the Veterans of Foreign Wars of the United States, in meeting in Washington, D. C., February 18, 1949, That we do strenuously oppose any plan which would take from the immediate control and jurisdiction of the Administrator of Veterans' Affairs any of the functions of Government which have to do with the care and treatment of veterans. *

Then we further resolved that a copy of this resolution go to the President and the Administrator of Veterans' Affairs, which was done. And I have here copies of the letters to General Gray and to the President, which I will be glad to refer to you.

(The correspondence referred to is as follows:)

Gen. CARL R. GRAY,

Administrator of Veterans' Affairs,

Veterans' Administration, Washington, D. C.

FEBRUARY 28, 1949.

DEAR GENERAL GRAY: At the meeting of the national welfare and service committee of the Veterans of Foreign Wars, held in Washington, February 18, 1949, the attached resolution strenuously opposing the recommendations of the Committee on Federal Medical Services to the Commission on Organization of the Executive Branch of the Government was unanimously passed.

I am also attaching hereto copy of a letter I have today written the President, and a copy of a letter I wrote former President Hoover on December 27, 1948. It is our belief that the separation of hospitals and other medical functions, including medical personnel required for compensation and insuranceexamination purposes, will lead to utter chaos in the administration of veterans' affairs.

I want you to know, General, that we intend to oppose to the best of our ability any proposal to disrupt the present organization of the Veterans' Administration, and to return to a system of medical and hospital care which was clearly proven to be chaotic and inoperable when it was in force years ago. Sincerely yours,

GEORGE E. IJAMS,

Director.

FEBRUARY 28, 1949.

Hon. HARRY S. TRUMAN,
The President,

The White House,

Washington, D. C.

MY DEAR MR. PRESIDENT: The recently publicized report to the Commission on Organization of the Executive Branch of the Government by the Committee on Federal Medical Services contemplates the removal of all medical and hospital activities from the Veterans' Administration, and their transfer to a proposed new department to operate a large number of Army, Navy, Air Force, and Public Health Service hospitals, together with all of the Veterans' Administration hospitals.

Unfortunately, those making up the committee which made this recommendation were not persons who had had any background in the veteran problem throughout the years; and, inadvertently or otherwise, these gentlemen recommended a return to a system of handling veteran hospitalization and medical care which was found to be chaotic and inoperable immediately following World War I, when we were dealing with less than 5,000,000 veterans. The chaotic