Mr. WHITE. Now as to the future hearings, we will have to determine these. We understand, there is going to be a full committee hearing on Tuesday and it is not certain yet as to whether we will have the meeting starting at 9:15 up to the time the full committee meets, but certainly we will have one on Wednesday.

There being no further business, the subcommittee is adjourned. Thank you very much, gentlemen.

[Whereupon, at 11:19 a.m. the subcommittee was adjourned.]

HOUSE OF REPRESENTATIVES,
COMMITTEE ON ARMED SERVICES,

MILITARY PERSONNEL SUBCOMMITTEE,

Washington, D.C., Tuesday, May 24, 1977.

The subcommittee met, pursuant to notice, at 9 a.m., in room 2212, Rayburn House Office Building, Hon. Richard C. White (chairman of the subcommittee) presiding.

Mr. WHITE. The subcommittee will come to order.

Good morning. We continue our hearings today on military health care and have with us the three Assistant Surgeons General for Dental Services from the Army, Navy, and Air Force.

In past years when we have inquired into health care, it generally was not necessary to get into dental matters, since reports indicated that dental care was progressing satisfactorily and the complaints from the field were rare.

Things have changed. Now we find that problems affecting dental care are as prevalent proportionately as are problems concerning medical care, and we trust that during the course of these hearings we will be able to establish a record which highlights those problems, the reasons therefore, and be in a position to make appropriate findings and recommendations.

We ask you gentlemen to be candid with us and assist us in our efforts to improve the entire military health care delivery system. As in previous days, we will ask each of you to present your statement after which we will have an opportunity for questions.

Since our full committee is meeting this morning at 10 to hear Secretary Brown, we must recess at that hour and we plan to reconvene tomorrow morning at 9, if necessary, to complete the testimony.

General Bhaskar, we will be happy to receive your statement. Prior to your beginning, without objection any witnesses who wish to summarize their statements, your full statements will be placed in the record.

STATEMENT OF MAJ. GEN. S. N. BHASKAR, D.C., ASSISTANT SURGEON GENERAL/CHIEF, ARMY DENTAL CORPS, DEPARTMENT OF THE ARMY

General BHASKAR. Mr. Chairman, I have submitted an official statement, but I will not read it because it does not say very much.

I appreciate the opportunity that this committee has given me to come and appear before you. I take this invitation very seriously. I shall attempt in the next few minutes to tell you as honestly, as candidly, and as openly as I can, the problems that the Army dental care delivery system faces today.

But before I begin, let me tell you why it is that the Army needs a dental care system. You see, when the Army goes into combat, about 12 percent of all soldiers that are withdrawn from the combat lines

are withdrawn for emergency dental care. Almost 1112 percent of all combat casualties that occur for the Army occur in the maxillo-facial area, the area that a dentist treats. About 21 percent of all soldiers who go to health clinics during Army exercises go to health clinics for dental care.

Every soldier who comes into the Army today needs about 9 hours of dental care. So it is absolutely essential that the Army's dental care delivery system be as efficient and as productive as possible.

In addition to the Active Army, sir, we are required either as a moral obligation, at least in the Army, or under law to provide care for about 212 million retired and dependents. So the responsibility of the Army dental care delivery system is really great.

Our potentials to provide this care are extremely limited. I would consider my trip up to this place worth the effort if I can just impress upon you and this committee the fact that certain regulatory and statutory changes are absolutely essential to provide for an optimal and more effective dental care delivery system in the Army.

Now there are numerous problems that I could discuss with you but the time will not permit me to do that, but I would like to touch upon two of the most basic issues that I see as the senior dental corps officer of the Army. The first concerns the dependent and retired care. Unlike the medical program, unlike medical care, there is for all practical purposes, no CHAMPUS-like dental care program for the Army. This means that every retired member and every dependent who is to get any kind of dental care at all, must get it at a military installation. If he doesn't get it in the Army dental clinic, he doesn't get it at all. This is because of many factors that perhaps I will touch upon a little later.

The capability of the Army dental system is such that at about 90 percent of the dental clinics of the country, 90 percent, we are unable to provide or we have curtailed dependent care and retired care.

Now I believe that we have an obligation to the retired people. So, I think one of the most important issues that face this committee and the Army dental care delivery system is to provide some kind of a CHAMPUS-like dental care program for our retired and our dependents.

In 1965 when the CHAMPUS bill was written, only about 1.9 million Americans were under an employer-paid dental program. In other words, only 1.9 million Americans in 1965 had a dental insurance program which was paid by their employers.

Last year I checked and there were 30 million Americans. I checked this February and there were 43 million Americans and today there are 47 million Americans who are protected by some kind of a dental insurance program which is paid by their employer.

I submit to you that the fact that the Army does not provide dental care to our children and the wives of our soldiers and our retired, is one of the factors which stimulates and encourages those people who want to unionize the Army.

So, I submit that one of the most important issues before this committee, if you are seriously interested in the health care of the Army, is to provide some kind of a CHAMPUS-like program for the military. Sir, the second issue which perhaps is the basis of all the issues that I may discuss and which is certainly, I believe at least in my view,

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the most critical problem that has faced me and has faced my predecessors is the fact that the Army dental care delivery system is not in the hands of dentists.

Sir, you were talking to Mr. Hogan, and therefore I want to repeat, that a very important issue is that the Army dental care is not in the hands of people who know most about it.

Mr. WHITE. I understand that.

General BHASKAR. The question is, why do I say that. Let me take you back in history.

Up until 1967, the dental care delivery system at every Army installation was under the control of the line commander, the military commander. In 1967 the dental care delivery system was removed from the military commander's control and put under the physician. From 1967 to 1975 the Army dental care delivery system, because it was under the physician, has progressively deteriorated. The productivity of the Army dental care delivery system during these years was about 17 percent below what it was when it was under the line commander's control.

We have lost a number of dental care benefits for our people. The retention rate of the Army Dental Corps has until recently been the lowest of any corps in the Army with no exception. Too many of the dental clinics in the Army are third rate. They are in World War IItype buildings. My repeated attempts to get some kind of a reasonable construction program going in the Army have been less than successful.

In the Army dental care delivery system we have only 12 to 20, less than 20, administrative officers that the medical department has assigned to work with the Dental Corps whereas there are about 4,400 other officers, that is, Medical Service Corps officers in the hospital system.

So what I am trying to say is that from 1967 to 1975, since the dental care delivery system of the Army was in the control of physiciansand I have nothing against them, I have 17 of them in my family, I love them but they know nothing about dentistry. You know more about dentistry than a physician does. To put a man who knows nothing about a system, as its manager, in charge of it violates all principles of management.

What I am telling you I told the vice chief yesterday, I have told the Army staff and I intend to tell them until they either fire me or listen to me.

Mr. WHITE. Do you think maybe this is a new Korea?

General BHASKAR. Sir, I have to be very honest with you. I have taken time from my day and I see congressmen here, very important, busy people and I would be dishonest if I came and just gave you the party line. You have called me, I hope, to tell you the truth.

Now, then, in 1975, as a result of our requests, the Army Surgeon General, who by the way you listened to the other day and who is a very understanding and very fair man, and with the agreement of the Chief of Staff, we did an experiment in which we gave the Army dental care delivery system a chance to work under the line commanders. But this was an experiment which was authorized only within the United States, within CONUS. From 1975 to 1976, during this 1 year, the dental care delivery system has been taken out from under the physician, not completely but just a little bit, just a breathing space.