The health of the Nation is far too important to be eclipsed by, or to become embroiled in, matters of welfare, education, social security-cash benefits, and so forth. In this regard the Hoover Commission supplemental report on an independent medical agency states: The health agency, if submerged within a multipurpose department, would be more likely to find its health functions impeded by collateral considerations pertaining to welfare and insurance. There are numerous health and medical functions scattered through the Federal Government. If these were brought together into a single health agency they would constitute a sizable group of activities dealing with related matters and requiring specialized technical and scientific personnel. Administratively and professionally, there is strong justification. for bringing together in one agency or department headed by a doctor of medicine all Federal activities relating to health and medicine and of authorizing the medical heads of such groups to report directly to the President as an agency administrator or a department secretary. The Hoover Commission supports this contention. In its task force report on Federal medical services, supplemental to appendix O, recommendations are made for a "United Medical Service Organization as an independent administration reporting to the President, instead of as a bureau of a department of health, education, and security." You will note that the last half of the quoted sentence "instead of as a bureau of a department of health, education, and security" places the Persident's proposed reform in direct conflict with the stated recommendations of the nonpartisan Hoover Commission. Health and medical functions have been an accepted part of the Federal Government since 1798, and Congress has repeatedly added to the responsibilities of the agency in which the more important health programs have been lodged-namely, the Public Health Service. We question the wisdom of placing these well-established functions in an over-all welfare agency where the new and untried social-insurance programs are being proposed. The health of this great Nation is of vital importance. Every American recognizes that indisputable fact. Its importance has been stressed many times by President Truman. During the past year the Federal Security Administrator, in the press and on the radio, has emphasized the importance of the health of the American people. With this in mind, it seems to the members of this association, that enactment of Reorganization Plan No. 1 would be a backward stepone that would endanger the health of the Nation, because the plan would place control of the Nation's health activities in the inexperienced and unskilled hands of social or welfare workers. The Hoover Commission recommends: The agency (United Medical Service) should be headed by a professional career Director General * and (he) should be the highest ranking * * physician in the Government. It will be impossible to recruit outstanding physicians for service in the Federal Government if such men are expected to accept the policy decisions made by a lay secretary who has no professional training or experience in the professional field of health. From time to time in the past, and at the present time, the Federal Medical Services (Public Health Service, Veterans' Administration, Indian Affairs, Army, Navy, and Air Forces) have experienced extreme difficulty in recruiting professional staffs. This difficulty stems from the fact that physicians object to the lack of appreciation of medical problems and the unfortunate results of lay controls previously experienced in these situations. (Analysis of the replies to the postwar questionnaire-A report to the Committee on National Emergency Medical Service, by Frank G. Dickinson, Ph. D., director of Medical economic research, Chicago, American Medical Association, June 4, 1947). Controls which might be imposed by a Cabinet officer who has statutory authority would know no limits. (2) Recalling the political uses made of WPA funds, we believe there would be far greater temptation and danger if large sums not only for relief but for health and education and social insurance were all placed under one-man control. The Hoover Commission says: Appropriations for health should, if possible, be clearly identified as such and not confused with those for social security, welfare or other social programs. There would be particular danger if all the health and medical care funds of the Nation, amounting to upwards of 6 or 7 billion dollars a year under the President's compulsory sickness insurance program, were to be added to all the other funds which the new Secretary would administer. The manner in which the Federal Security Administration proposed to dominate medical activities is a matter of record. (Murray-Wagner-Dingell bill, S. 5, 81st Cong., p. 39, lines 23, 24, and 25; pp. 79–80, lines 24, 1 and 2.) It is only reasonable to assume that the various reorganizations that already have been made or are now being proposed are designed to pave the way for creation of a vast system of national social insurance in which medical functions will be absorbed under a scheme of compulsory "health" insurance, as advocated by President Truman in his message to Congress on January 5, 1949. The Federal activities that would be placed under the jurisdiction of a Secretary with Cabinet rank and an Under Secretary, and three Assistant Secretaries are rapidly increasing in importance so that the power that would be conferred would not be static. Congress is now considering bills that would inaugurate large new Federal programs through grants-in-aid to education, grants-in-aid for medical care, compulsory sickness insurance for the entire popution, larger social-security benefits for the aged and unemployed, and so forth, all of which would confer far larger powers on the proposed Secretary than are now enjoyed by the Administrator of the Federal Security Agency. The prospect of such expanding power in the hands of one person is alarming. The temptation, regardless of which party was in power, to use the vast health, education and security funds to enhance political power and prestige is only human when placed in the hands of men of the past record. The channeling of all the natural propaganda appeal outlets, namely health, education, welfare and social security, into the hands of one man and providing him with a budget second only to the Department of Defense, would give him a potential second only to that of the President. We recommend and urge the members of this committee to reject the President's Reorganization Plan No. 1—at least until after legislation has been introduced, passed and signed by the President, to create an "Independent Medical Agency" as recommended by the Hoover Commission. Unless this is done, and Plan No. 1 becomes law, control of the Nation's health activities will be vested in a lay Secretary of the Department of Welfare. Once in, we fear that health will never escape the ever expanding, self-perpetuating and power-gaining web of the welfare bureaucracy. The Hoover Commission studied this whole problem and considered the President's suggestion as embodied in Reorganization Plan No. 1. After exhaustive research, investigation and careful deliberations, the Hoover Commission concluded: * * * We have reached the conclusion that such an independent organization (Independent Medical Agency) would be preferable to placing this function in a larger department, as the Commission originally proposed. (Page 1; paragraph 3, Task Force Report-supplement to appendix 0.) The CHAIRMAN. Senator Taylor, do you have any questions? The CHAIRMAN. Senator Smith, do you have any questions? Senator SMITH. I would like to repeat the question I asked of Dr. Miller, Dr. Young: Would this separate medical agency or department include the military health facilities as well? Dr. YOUNG. As has been pointed out, that is undergoing considerable reorganization. I would say that it would be best to include it, except for the active military organizations. Senator SMITH. How would you separate it? Dr. YOUNG. There should be an integration between the Army, Navy and Air Force hospitals and personnel, and the Federal medical organizations in the other 44 departments and agencies. There is a considerable overlap which is wasteful, of both personnel and matériel. Senator SMITH. Would you nnclude the veterans hospitals' facilities in the medical agency? Dr. YOUNG. It should be included. In addition to that, the veterans' facilities should be integrated with our private hospitals, because under the Hill-Burton bill, we are spending approximately $75,000,000 a year of Federal money for private hospitals, which are in direct competition with the veterans' hospitals, which is again a waste of money and matérial. Senator SMITH. Thank you. The CHAIRMAN. Senator Schoeppel? Do you have any questions? Senator SCHOEPPEL. I have no questions, Mr. Chairman. The CHAIRMAN. Thank you very much, Dr. Young. We are glad to hear your testimony. Dr. YOUNG. Thank you, Mr. Chairman. The CHAIRMAN. The next witness is Miss Elizabeth Wickenden, Washington representative of the American Public Welfare Association. STATEMENT OF MISS ELIZABETH WICKENDEN, WASHINGTON REPRESENTATIVE, AMERICAN PUBLIC WELFARE ASSOCIATION Miss WICKENDEN. Mr. Chairman, my statement is very brief. My name is Elizabeth Wickenden, and I am Washington representative of the American Public Welfare Association, an organization of State and local public welfare departments and persons engaged in public welfare work at all levels of government. We appear in support of Reorganization Plan No. 1. We have long been on record as favoring the elevation of the Federal Security Agency to departmental status on the grounds that the scope and character of its functions warrant this. We feel, too, that the proposal in the plan to leave the internal organization of the new Department to the Secretary is appropriate, but I would like to make one comment. I have talked to a lot of people in the fields of health and education about this plan, and many of them say to me, "Well, we are worried about that title, Department of Welfare. It sounds as if that meant that you people were going to be running the show." That results, I think, from a problem of semantics, that the word "welfare" is used in two different senses. In one respect it refers, I think, in the Constitution, to the general welfare, the well-being of the people; and in another more specific sense it relates to the functions that are now carried on in the Social Security Administration. We do not feel for a moment that welfare should dominate. We think that these are coordinate functions and we hope that the new Secretary, if there is to be one, will maintain the structure of the Public Health Service, the Office of Education, and the Social Security Administration. We do feel, though, from our actual experience, that there is a real value in having these three functions in one department. It is a little bit different at the Federal level then it is at the State and local level, because most of these functions relate to planning and the administering of grants-in-aid to the States, rather than the administering of actual professional services to individuals. Our State agencies particularly feel that there is a great value in having grants-in-aid to the States coordinated so there is a reasonable consistency of policy, and we have followed with very great interest what has been done in the Office of Federal-State Relations. I know that this committee has a good deal of interest in that subject, so I mention it particularly. Then in addition to that over-all problem of relationship to the States in all of these fields there are many overlapping problems between the different specialties. One that we have been very much. interested in lately is the problem of chronic illness. We have found, for instance, that it involves both medical and social and economic problems, and as an example of how closely we feel they are related, we have joined with the American Medical Association, the American Public Health Association, the American Hospital Association, in sponsoring a commission on chronic ailments. Dr. Miller is one of the leaders in that effort. We are finding in these professional associations more and more reason for cooperative activity and we feel that is equally true in the Federal agency. I could mention other examples in the field of mental health-the relationship of mental health with child guidance and other fields, the problem of occasional rehabilitation, which cuts right across all these three fields and others. Of course, the creation of a department will not in and of itself add or subtract from the functions that are now in the Agency, but it will give the head of that department a prestige in speaking to the public, and within the circle of advisers of the President, that we feel is much needed for this field which concerns itself with the well-being of individuals. The CHAIRMAN. Did you not know that that is one of the principal objections of this plan? That is, the prestige that you speak of? They are afraid, and those fears are well justified, that speech will be in the interest of what they term "socialized medicine." Miss WICKENDEN. Socialized medicine seems to me to be such a small part of the problems of this total department. Now, for instance, in our association, we are primarily interested in the grants-in-aid problem. We think the grant-in-aid to the States is the principal problem. That has nothing to do with socialized medicine at all. it. The CHAIRMAN. I mentioned that is one of the apprehensions about Miss WICKENDEN. Yes. I did want to say in closing that while I am presenting a statement from my own association, that for many years I have worked with a wide variety of groups that are interested in this department, and I think there may be a few who fear prestige in this total field of health, welfare, and education but the great bulk of organizations in health, in welfare, and in education, and among lay groups- I would mention particularly the women's clubs, the churches, the labor unions, some that I have worked with-who would welcome the recognition and prestige for this field of human welfare. I think you can well find a position on both sides in that regard. The CHAIRMAN. Thank you very much. Are there any questions? Senator SMITH. Mr. Chairman, I have no questions, except that I would like to say that I am glad to hear someone say that we need some prestige in Government. Thank you very much. The CHAIRMAN. Are there any other questions? If not, we thank you, Miss Wickenden, and your full statement will appear in the record at this point. Miss WICKENDEN. Thank you, Mr. Chairman. (The statement is as follows:) TESTIMONY IN BEHALF OF REORGANIZATION PLAN No. 1 PRESENTED TO SENATE COMMITTEE ON EXPENDITURES IN THE EXECUTIVE DEPARTMENTS, JULY 22, 1949, BY ELIZABETH WICKENDEN, WASHINGTON REPRESENTATIVE, AMERICAN PUBLIC WELFARE ASSOCIATION My name is Elizabeth Wickenden, and I am Washington representative of the American Public Welfare Association, organization of State and local public welfare departments and persons engaged in public welfare work at all levels of government. I appear before you to express support for the President's Reorganization Plan No. 1 to create a Department of Welfare. Our organization has long been on 94651-49 -5 |