this refers only to a wife, widow, or child of a veteran permanently and totally disabled due to service-connected disabilities or dead as a result thereof, currently authorized medical care in VA facilities under section 613, title 38 of the United States Code, not otherwise eligible for care under the Champus program," we have no objection thereto. Although wording reading "*** and other persons as the Administrator may determine appropriate ***" may include personnel of recognized veterans organizations employed at such hospitals and homes, we would be more comfortable if the present wording in this respect is let stand. In addition, we believe canteen services should be extended to outpatient ambulatory veterans who very often are required to spend the entire day awaiting treatment. H.R. 13255, introduced by the ranking member of the full committee, the Honorable Olin E. Teague, would authorize the Administrator of Veterans' Affairs to convey by quitclaim deed, without monetary consideration, some 87 acres at the VA Hospital, North Chicago, Ill., to the University of Health Sciences/the Chicago Medical School Although we have no national position regarding transfer of the land in question, it is a matter of record Senator William Proxmire has asked the Comptroller General for a full-scale General Accounting Office review of the relationship between VA hospitals and affiliated medical schools, with particular reference to alleged improprieties surrounding the North Chicago VA Hospital and its affiliation with the Chicago Medical School. In view thereof, it would appear prudent to defer action on this bill at the present time. H.R. 14469, again, introduced by the chairman, would extend for an additional year the "Veterans' Administration Physicians and Dentists Pay Comparability Act of 1975," Public Law 94-123. VFW strongly supported the original legislation H.R. 8240, to alleviate the problem faced by the Administrator of Veterans' Affairs in the recruiting and retention of qualified medical personnel. According to the May 1976 report submitted to Congress by the Administrator, Public Law 94-123 is responsible for increasing the number of full-time physicians to a new high of 5,815, as of the end of last March. Additionally, loss rates during the 6 months following enactment of the pay bill were less than during a comparable period 1 year earlier. However, the full impact of the bill will be more clearly defined later this year, since the heaviest recruiting periods are the months of June, July, and August. H.R. 14469 is fully supported by current VFW resolutions Nos, 612, entitled "VA Medical Care Program" and 620, "Better Pay for VA Doctors" and, in addition, the supporting of pay parity for health care personnel at VA hospitals with their counterparts in other agencies is one of the priority legislative goals of the Commander in Chief of the Veterans of Foreign Wars of the United States, Thomas C. Walker. While on this subject, the test of time has brought out a serious and unanticipated flaw in the current law. I refer to the oversight wherein no provision was made for increased pay for physician hospital directors. As a result, a large number of such highly qualified physician directors stepped down from their position as directors to practice as physicians, in which capacity, they are able to receive an increase in pay over and above that of a hospital director. Resolutions cited throughout my testimony are appended thereto. I thank you. Mr. SATTERFIELD. Thank you very much, Mr. Schwab. I would like to recognize the Chairman, Mr. Roberts. Chairman ROBERTS. Thank you, Mr. Chairman. I just wanted to put in my usual appearance when the subcommittees meet to say that I appreciate your holding these hearings, and that I am particularly grateful for the attendance of the veterans' organizations. I just want to thank you, Mr. Schwab, and the other members of the veterans' organizations for the support you give this committee. Mr. SCHWAB. Thank you, Mr. Chairman. Chairman ROBERTS. And the veterans of the country. Mr. SATTERFIELD. Mr. Hammerschmidt? Mr. HAMMERSCHMIDT. Thank you, Mr. Chairman. Mr. Schwab, I would like to refer you to H.R. 3347. On page 2 of your statement, in the third paragraph, you state: Section 610 substitutes "Health Services" for "Hospital Care or Nursing Home Care" and eliminates those with nonservice-connected disabilities, unless over 65, in receipt of pension, or whose income is below the poverty level thus deemed unable to defray such expenses. The Veterans of Foreign Wars most strongly opposes this more stringent criteria for treatment of those with nonservice-connected disabilities, for the following reasons: (1) Many veterans with families have a gross taxable income of less than $10,000 per annum and, consequently, are hard pressed to meet recurring financial obligations during these inflationary times and, therefore, are unable to afford health care coverage, which, in the Washington area, currently costs more than $1,000 a year; (2) The most recent available figures from the VA indicate a monthly bed occupancy rate throughout the entire hospital system of 83.5 percent. This means 16.5 percent of the beds in the 171 VA hospitals are vacant, which is the equivalent (bedwise) of 27 hospitals being closed and the figure has been higher in the past, These empty beds over a protracted period are on open invitation to invasion by any meaningful national health insurance program. We believe these beds should be made available to veterans in need of hospitalization and, if necessary to keep them full, to the dependents of those who are permanently and totally disabled because of service-connected disabilities. The way I read this bill, I wonder if it was drafted the way the author, Mr. Satterfield, intended for it to be. I believe the bill's intention is to liberalize those provisions rather than to make them more stringent. Referring to page 7, line 1, of the bill-where it says anybody 65 years of age or older, and adds other criteria in the second paragraph I suggest that the intent was to make sure the two groups listed in the second paragraph were indeed included rather than excluded. I question how you get your interpretation of that language. Mr. SCHWAB. Well, Mr. Hammerschmidt, our position is that any veteran with a nonservice-connected disability, if he presents himself for hospital assistance, that he should be admitted. Mr. HAMMERSCHMIDT. Well, I would refer the matter to our counsel for his interpretation of page 7 of H.R. 3347, paragraphs 1 and 2, to see if he feels that we are writing in inclusions or exclusions in that language. If they are inclusions, according to the counsel's affirmative opinion, then I think we are in agreement. After all, we are trying to arrive at the same goal. But I do want to clarify this matter because I do not think it was the intent of Mr. Satterfield or the committee to go in the exclusion direction, but rather to take the opposite approach, as you wish, Mr. SCHWAB. Thank you. Mr. HAMMERSCHMIDT. H.R. 3349 will permit a veteran to have a prescription filled at either a Veterans' Administration facility or at a private pharmacy. What are the arguments in favor of allowing the veteran to go to the private pharmacy? Mr. SCHWAB. The only problem, of course, is convenience, particularly for those who are living a great distance from the Veterans' Administration facility, and they have to count on mail order prescriptions. Mr. HAMMERSCHMIDT. According to the mail I received from my constituents, I would say you are exactly correct. On page 2 you state that 16.5 percent of the beds in the Veterans' Administration hospitals are vacant, which is an invitation to invasion by a national health insurance program. Will you explain your suggestion that these beds be filled by veterans, and by dependents of permanently and totally disabled veterans? Mr. SCHWAB. Very well, our opinion has been for some time, I think it is brought out in these hearings before, sir, that many, many veterans who apply for hospitalization and are in need of hospitalization, are not admitted. If this be the case, and these beds remain empty, we think that before a national health insurance program is allowed to invade the Veterans' Administration hospitals, that we should take into the Veterans' Administration hospitals, the dependents of those who are permanently and totally disabled. These beds are remaining empty and these percentages over a protracted period of time, and it has been higher, it has been 18.5 percent a year ago, and that is not a healthy situation. Mr. HAMMERSCHMIDT. So for those spaces not used, or inefficiently used, you think it would be far better to allow dependents of serviceconnected veterans, rather than waste those beds? Mr. SCHWAB. Yes, definitely. These people are already eligible under CHAMPUS. Yes, sir. Mr. HAMMERSCHMIDT. Mr. Chairman, I have completed my questioning. Thank you. Mr. SATTERFIELD. Mr. Montgomery? Mr. MONTGOMERY. To followup on the question of Mr. Hammerschmidt concerning the hospital bed vacancy rate, do you have any figures that might show whether or not we can expect a greater demand on these beds by the veterans themselves in the future? I refer specifically to our World War II veterans who are fast approaching the age where they might come down with a variety of ailments. We have a lot of veterans out there now, and my feeling is that they will start using veterans' hospitals as they get older and develop sicknesses. Mr. SCHWAB. Yes, sir, you are absolutely right. There are approximately 13.4 million living World War II veterans. They are nearly 56 now, so they are reaching a period of life where they are subjected to diseases of old age. Mr. MONTGOMERY. What concerns me, Mr. Chairman, if we allow dependents of service-connected veterans to start using the hospital beds, and then we have more veterans needing the hospitals, how do we take care of them? Do we move these dependents out or what? Thank you. Mr. SATTERFIELD. Mr. Hillis? Mr. HILLIS. I just have a couple of questions. I, too, wanted to ask a question on your position on H.R. 3349, which would permit the veterans to have the VA prescription filled either at the Veterans' Administration Hospital or at a private pharmacy. It would seem to me that this is bound to result in higher costs for Veterans' Administration, and perhaps make us look at reducing benefits in some other areas, such as the number of beds, physicians, and this sort of thing. Do you have any comments to make on that? Mr. SCHWAB. No; but if the Veterans' Administration through a drug firm or a drug chain, would enter into some sort of an agreement for meeting the Veterans' Administration price on drugs, in the Washington area, for instance, some drug stores, for example, give 10 percent discounts to senior citizens. Well, such a thing could well be done for people with prescriptions from the Veterans' Administration. I think this could be worked out by the Administrator. Along the same line, it might work to the opposite direction, we had an arrangement in San Antonio at the Audie Murphy Hospital, where the veterans would go to the drugstore. All of the pharmacies got together, and agreed that they would supply the drugs on a replacement cost or actual replacement by the Veterans' Administration, with a charge of $1.50 per prescription. It worked fantastically well, but the Comptroller General said that is probably a violation of the procurement regulations, and this legislation probably would correct that, but the pharmacists have agreed that they would fill the prescription for $1.50 and the Veterans' Administration could replace the drug once a month, or they could pay the wholesale cost of the drug, so we have got a possibility of doing something for the veterans. For the veteran who would need a drug every 6 weeks and so forth, it would just keep coming, maybe for 6 months, before it got cut off, so I want to compliment the chairman of the subcommittee for looking into this possibility. I do not know whether we can do it or not, but if we can, we would do everybody a favor. Mr. HILLIS. I am happy to yield to Mr. Guyer. Mr. GUYER. I think this is a very important area, and the reason I make this further comment, I formerly worked as a public relations director for a company that has a policy for retired people, and in talking with retired people and older American groups, I find that the most consistently handicapped they are financially is this matter of drugs and treatment, and I notice that people like Sylvia Porter now have indicated they ought to have a gold medallion put on all of the cooperating pharmacies, but this is an area that we can do something for our friends, and I want to compliment the intentions and directions toward that goal, because the maintenance of health is one of the greatest concerns we have, and this might be a convenient and legal way to do it, and I hope we can pursue it. Mr. HILLIS. I'm certainly happy I approached this area for discussion, because I do not oppose this, but I thought it was something we should talk about, and it is obvious from the discussion taking place, it could be worked out probably on a basis of near Veterans' Administration costs, and I think it would make a great convenience to the recipients particularly, as you mentioned, those veterans who are 50 miles or farther from a Veterans' Administration outpatient clinic, where they go to a facility to get drugs, so I am happy we went into this for the record. Mr. SATTERFIELD. Mr. Hannaford? Mr. HANNAFORD. Thank you, Mr. Chairman. I would like to raise a couple of questions in relation to H.R. 14469. Mr. Chairman, that legislation extends for 1 year the physicians. and dentists pay bill. In your testimony, you address the question of physicians and dentists, but the resolution also calls for concerted-I believe is the language here-concerted effort be made to make salaries more attractive in order to permit the Veterans' Administration to recruit and obtain top notch medical personnel in the Veterans' Administration hospital system. Have you considered the supportive personnel other than physicians and dentists in this resolution? Mr. SCHWAB. Yes, sir, that was intended also to cover nurses and paramedical personnel in all critical areas. Mr. HANNAFORD. I just would like to reflect for the record that in my district last week I met with the president of the Paralyzed Veterans' Association and four other paraplegics who pointed out to me a situation that was appalling. This is that the Veterans' Administration pays the nursing assistance (which is essential for the lives of these men because they cannot even have their normal body functions, including bowel movements, without their assistance) $3.20 per hour, whereas we pay an animal caretaker $5.10 per hour, someone who cleans cages, and we pay a garden helper $5.10 to pull weeds, and we have a turnover of these nursing personnel which is horrendous. A fast turnover of someone pulling weeds is not that bad because he does not have to have a necessary supportive relationship, but the turnover rate of 84.62 percent per year for these people who are attending to these paralyzed veterans is just terrible. These are the most marvelous men that we have, and I just hope that, Mr. Chairman, Mr. Schwab, that we can address this problem and address it quickly. Our Veterans' Administration hospitals are not paying those essential personnel nearly as much as some of the other private hospitals, for example, the Naval Hospital in my own district. Accordingly they train with the VA at the $3 figure and then they are taken up by the others needing their services. It seems to me we are in the same situation here with these people that we were last year with the doctors and dentists, and I hope we can do something about it now. Thank you, Mr. Schwab. Mr. SCHWAB. Thank you, sir. |