Mr. TUCKER. We appreciate the opportunity to come here and we know we will find it constructive, Mr. Chairman. We will supply any additional information that appears on the record as well as specific questions that are forwarded to us.

Thank you, Mr. Chairman.

The CHAIRMAN. I might say it has been quite helpful to me and I am certain it has been to the newer members of the committee. We will know a little bit more about what we are looking forward to as we work together during the years.

Thank you so very much, all of you.

The committee is adjourned.

Mr. TUCKER. Thank you.

(Whereupon, at 12:29 p.m. the committee adjourned to reconvene at 10 a.m., Wednesday, March 1, 1967.)

AGENCY HEARINGS

WEDNESDAY, MARCH 1, 1967

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE.

Washington, D.C. The committee met at 10 a.m., pursuant to notice, in room 2123, Rayburn House Office Building, Hon. Harley O. Staggers (chairman) presiding.

The CHAIRMAN. The committee will please be in order.

Today is the second day of our hearings on the organization and programs of the various agencies over which this committee has jurisdiction. The hearing today has to do with a briefing from the Department of Health, Education, and Welfare.

The idea of a sound mind and a sound body is not something new but is a base on which a strong and stable government may be founded. For too long we have depended on chance for mental and physical health. In this age we know that we can do something about them. More attentions is being given to producing strong and healthy citizens in this country than in most of the more advanced nations in the history of civilization.

The concept implies that every infant has the right to be born free from mental and physical defect and to be aided, if so desired, through its life, to remain free from these defects.

Today we are to hear from an Assistant Secretary of the Department of Health, Education, and Welfare, Dr. Philip Lee, who will discuss with us the programs of the Department in the field of public health.

Also accompanying Dr. Lee is Dr. James Goddard, Commissioner of the Food and Drug Administration. We are pleased to have you gentlemen with us.

Dr. Lee, you may proceed with your statement.

STATEMENT OF HON. PHILIP R. LEE, M.D., ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY JAMES B. CARDWELL, DEPUTY COMPTROLLER; MICHAEL PARKER, DEPUTY ASSISTANT SECRETARY, LEGISLATIVE SERVICES; AND JOSEPH VENTURA, CONGRESSIONAL LIAISON OFFICER

Dr. LEE. Thank you, Mr. Chairman.

At the table with me now from the Department are Mr. James B. Cardwell, Deputy Comptroller, on my right; Mr. Michael Parker,

Deputy Assistant Secretary for Legislative Services, on my left; and Mr. Joseph Ventura, who is the congressional liaison officer.

Of course we have all been working with members of the committee and I though it was appropriate at this time that they accompany me so that we could get a little better acquainted.

It is a privilege for us to be here and meet today with many members who are old friends, and many new members who I trust will become new friends. It will be a pleasure to work with you in the months to come.

Today I hope to give you a very brief overview of the Department of Health, Education, and Welfare in general, and of its health activities in particular. I hope to give you a general picture of what we do, and our general philosophy in going about our job.

The mission of our health activities is simple: to maintain and improve the health of all our people.

The details of that mission are somewhat more complex. We cannot maintain health merely by curing disease. We cannot maintain health merely by curing disease. We cannot maintain the health of only some of our people, ignoring the health of others.

We cannot overlook the potential danger to the health of our citizens which is represented by disease in other countries. And, in spite of our scientific conquests in the past, we must recognize that our research is not finished and done with: we are yet to develop effective methods to prevent many forms of mental retardation, to treat many forms of mental illness, to control many forms of arthritis, cancer, and heart disease.

To achieve our major health goal, the Department is engaged in five important areas:

1. The continued development of more and better health resources— knowledge, manpower, facilities.

2. Expanded support for flexible programs of local, regional, and State initiative for more effective use of these resources.

3. Expanded programs for consumer protection and improvement in the safety and quality of our environment-the control of air pollution, better methods for solid waste disposal, communicable disease control, and assuring the safety and effectiveness of drugs.

4. Continued efforts to eliminate all barriers to access to good health care, no matter whether these barriers are social, economic, geographic, educational, or medical.

5. The development of health services research to find better means to deliver our available scientific and medical know-how.

They are exceedingly important and complex activities. They are vital to the growth and improvement of our health services industry, which is now one of the largest in the Nation.

In terms of people, it is the third largest industry in the country, involving more than 2.5 million workers-289,000 physicians, 93,000 dentists, 620,000 nurses, 823,000 other professional and technical health personnel, and 721,000 aids and attendants.

There is a chart (p. 169) which we have made available to the committee which briefly outlines this health service industry and the number of personnel involved.

Our national expenditures for health and medical care are now about $43 billion a year. The total Federal share of those expenditures, including those of HEW and other Federal agencies, is expected to be $12.4 billion in fiscal year 1968-more than double the $5.9 billion spent in fiscal year 1966. Primarily responsible for this great increase is, of course, the medicare program.

In the Special Analysis H (p. 172) which was prepared by the Bureau of the Budget, the special expenditures for health are outlined in greater detail and that we have also made available to cover my testimony and I won't go into that in more detail.

For the Department of Health, Education, and Welfare itself, the total appropriation requested (including health and nonhealth activities) was about $12.3 billion for fiscal year 1967 and $13.3 billion is proposed for fiscal year 1968.

In addition, social security trust fund expenditures are estimated to be $25.5 billion in fiscal year 1967 and $31 billion in fiscal year 1968.

Of the $13.3 billion for fiscal year 1967, $12.2 billion-or 92 percentis proposed for State and local health, education, and welfare programs, and this pie chart (p. 170) which accompanies my testimony describes that in more detail.

There are, of course, many important programs: public assistance payments, support for education, programs of research, health manpower development, environmental health activities and the development of community health services.

The remaining $1 billion is for direct operations—including health services such as that provided to American Indians and Alaskan natives, direct medical care and other direct programs, and grants administration. That is attached with out statement. (See p. 171.) Our total staff is expected to number about 105,000 during the present fiscal year, and 109,700 during fiscal year 1968. Of these, about 30,000 will serve in the Washington area, and the others in communities across the Nation-in local Social Security offices and payment centers, FDA regional offices, laboratories like the Communicable Disease Center in Atlanta, and other locally based operations. To understand the manner in which the Department is conducting its affairs, I think we must first consider the organization of the Office of the Secretary.

This chart (facing p. 168) which was provided to members of the committee describes in general the organization of the Department and the operating agencies.

I would like to note that this chart was prepared prior to the reorganization of the Public Health Service and the Food and Drug Administration so that this is inaccurate in its descriptions within those two boxes. Of course these will be gone into in detail today by the Commissioner of the Food and Drug Administration, Dr. Goddard, with respect to the Food and Drug Administration, and tomorrow by the Surgeon General with respect to the Public Health Service.

Under the overall direction of Secretary Gardner are the Under Secretary, Mr. Cohen, the General Counsel, and seven Assistant Secretaries one for administration, one for financial management, one for program planning and coordination, one for legislation, one for edu

cation, one for individual and family services, and one for health and scientific affairs; a special assistant for civil rights; an Office of Public Information; and, in addition, the Office of Field Coordination which coordinates the activities of the regional offices.

The operating agencies of the Department include the Public Health Service, the Food and Drug Administration, the Office of Education, the Vocational Rehabilitation Administration, the Welfare Administration, the Social Security Administration, the Administration on Aging, and St. Elizabeths Hospital. The heads of all these agencies report directly to the Secretary with respect to the administration of the various programs they carry out.

As Assistant Secretary for Health and Scientific Affairs, it is my major responsibility to advise the Secretary on essentially all matters directly concerning health and scientific affairs, particularly in the development of policy and legislation, program coordination, and relationships with other Federal Departments as well as with nonFederal agencies and institutions.

I would say that during the last year and a half with the advent of the medicare program we have made a major effort to open up channels of communication with the medical profession, and particularly with physicians in private practice, and I think we now have many areas of cooperation where there was really no communication 18 months ago.

This is the kind of activity that we participate in.

There is certainly within the Department a free and cooperative interchange of ideas between the eight major operating agencies and the Office of the Secretary. New policies may be germinated in either the Secretary's office or the agencies.

The Office of the Secretary evaluates agency proposals and programs, offering new plans where they seem desirable. One of our most important functions is to help establish priorities; we recognize that this Nation, as rich as it is, will never have enough manpower, enough facilities, or enough money to solve all health problems immediately and simultaneously.

We feel it is essential, therefore, that our available resources are invested as wisely as possible.

Today and tomorrow, you will devote your attention primarily to two agencies: the Public Health Service and the Food and Drug Administration. For a full appreciation of their significance, however, you should recognize that the other six agencies are also concerned to a greater or lesser degree with important health activities.

The oldest of the operating agencies of the Department, the Public Health Service is the focal point of professional competence in the health field within the Department, and is the principal health agency of the Federal Government.

It is particularly concerned with biomedical research and with the development of health manpower and health facilities, the development of standards for health care institutions and services, environmental health, and the support of public health programs at the State and local community level."

Dr. William Stewart, the Surgeon General, is scheduled to meet with you tomorrow to describe in detail the organization and func