REORGANIZATION PLAN JUNE 11, 1946 HOUSE OF REPRESENTATIVES, COMMITTEE ON EXPENDITURES IN THE Washington, D. C. The committee met at 10 a. m., Hon. Carter Manasco (chairman) presiding. The CHAIRMAN. The committee will come to order. The first witness we have this morning is Dr. R. L. Sensenich, chairman of the board of trustees of the American Medical Association. Doctor, I understand that you have a prepared statement. STATEMENT OF DR. R. L. SENSENICH, CHAIRMAN OF THE BOARD OF TRUSTEES, THE AMERICAN MEDICAL ASSOCIATION Dr. SENSENICH. The American Medical Association is interested in the changes proposed in Reorganization Plan No. 2 of 1946. The physician is, of necessity, interested in anything that may affect the health or provision of good medical care to patients individually and collectively in groups. These groups may vary in number from small geographic divisions, or those suffering from certain diseases, or to the entire population of the Nation. Governmental public health measures are especially directed to those health problems that because of their nature or extent cannot be met successfully by the individual and must be dealt with by systematized social means. The major portion of public health activity is, therefore, directed to disease prevention. In more recent years, however, there have been Government grants-in-aid to provide help or to stimulate interest in meeting special health needs. As pointed out in the message from the President, these activities have been widely scattered in the governmental machinery. The American Medical Association has repeatedly recommended concentration of governmental medical activities under a single administrative agency. The American Medical Association has constantly emphasized the fact that the level of the health of the public is dependent upon biological conditions, i. e., the human body, its functions and diseases, and also upon sociological conditions of living, food, housing, sanitation, education, and research and available facilities for normal physical and mental development. Physicians are, therefore, interested in all the divisions discussed in the proposed reorganization. 211 The American Medical Association has, through its house of delegates, adopted a national health program in which local government agencies, State governmental agencies, the Federal Government, educational and research institutions and voluntary groups and philanthropic health agencies may cooperate within their proper spheres in striving for a level still higher than our present attainment of the best health in the world. A copy of the national health program of the American Medical Association is attached. NATIONAL HEALTH PROGRAM OF THE AMERICAN MEDICAL ASSOCIATION Adopted by the board of trustees and the council on medical service, February 14, 1946 1. The American Medical Association urges a minimum standard of nutrition, housing, clothing, and recreation as fundamental to good health and as an objective to be achieved in any suitable health program. The responsibility for attainment of this standard should be placed as far as possible on the individual, but the application of community effort, compatible with the maintenance of free enterprise, should be encouraged with governmental aid where needed. 2. The provision of preventive medical services through professionally competent health departments with sufficient staff and equipment to meet community needs is recognized as essential in a health program. The principle of Federal aid through provision of funds or personnel is recognized with the understanding that local areas shall control their own agencies as has been established in the field of education. Health departments should not assume the care of the sick as a function, since administration of medical care under such auspices tends to a deterioration in the quality of the service rendered. Medical care to those unable to provide for themselves is best administered by local and private agencies with the aid of public funds when needed. This program for national health should include the administration of medical care, including hospitalization to all those needing it but unable to pay, such medical care to be provided preferably by a physician of the patient's choice with funds provided by local agencies with the assistance of Federal funds when necessary. 3. The procedures established by modern medicine for advice to the prospective mother and for adequate care in child birth should be made available to all at a price that they can afford to pay. When local funds are lacking for the care of those unable to pay, Federal aid should be supplied with the funds administered through local or State agencies. 4. The child should have throughout infancy proper attention, including scientific nutrition, immunization against preventable disease and other services included in infant welfare. Such services are best supplied by personal contact between the mother and the individual physician but may be provided through child care and infant welfare stations administered under local auspices with support by tax funds whenever the need can be shown. 5. The provision of health and diagnostic centers and hospitals necessary to community needs is an essential of good medical care. Such facilities are preferably supplied by local agencies, including the community, church, and trade agencies which have been responsible for the fine development of facilities for medical care in most American communities up to this time. Where such facilities are unavailable and cannot be supplied through local or State agencies, the Federal Government may aid preferably under a plan which requires that the need be shown and that the community prove its ability to maintain such institutions once they are established (Hill-Burton bill). 6. A program for medical care within the American system of individual initiative and freedom of enterprise includes the establishment of voluntary nonprofit prepayment plans for the costs of hospitalization (such as the Blue Cross plans) and voluntary nonprofit prepayment plans for medical care (such as those developed by many State and county medical societies). The principles of such insurance contracts should be acceptable to the council on medical service of the American Medical Association and to the authoritative bodies of State medical associations. The evolution of voluntary prepayment insurance against the costs of sickness admits also the utilization of private sickness insurance plans which comply with State regulatory statutes and meet the standards of the council on medical service of the American Medical Association. 7. A program for national health should include the administration of medical care, including hospitalization, to all veterans, such medical care to be provided preferably by a physician of the veterans' choice, with payment by the Veterans' Administration through a plan mutually agreed on between the State medical association and the Veterans' Administration. 8. Research for the advancement of medical science is fundamental in any national health program. The inclusion of medical research in a national science foundation, such as proposed in pending Federal legislation, is endorsed. 9. The services rendered by volunteer philanthropic health agencies such as the American Cancer Society, the National Tuberculosis Association, the National Foundation for Infantile Paralysis, Inc., and by philanthropic agencies such as the Commonwealth Fund and the Rockefeller Foundation and similar bodies have been of vast benefit to the American people and are a natural outgrowth of the system of free enterprise and democracy that prevail in the United States. Their participation in a national health program should be encouraged, and the growth of such agencies when properly administered should be commended. 10. Fundamental to the promotion of the public health and alleviation of illness are widespread education in the field of health and the widest possible dissemination of information regarding the prevention of disease and its treatment by authoritative agencies. Health education should be considered a necessary function of all departments of public health, medical associations and school authorities. The American Medical Association has been in almost constant contact with most of the governmental agencies having to do with > health activities and has cooperated fully within the scope of policies agreed upon. The evident advantages of consolidation of widely scattered activities prompted the board of trustees in January 1937 to make the following recommendation: The board of trustees of the American Medical Association would recommend that such health activities as now exist be so consolidated in a single department, which would not, however, be subservient to any charitable, conservatory, or other governmental interest. It has been repeatedly said that public health work is the first problem of the State. It is the opinion of the board of trustees that health activities of the Government, except those concerned with the miliary establishments, should not be subservient to any other departmental interests. This reorganization and consolidation of medical departments need not, under present circumstances, involve any expansion or extension of governmental health activities but should serve actually to consolidate and thus to eliminate such duplications as exist. It is also the view of the board of trustees that the supervision and direction of such medical or health department should be in the hands of a competently trained physician, experienced in executive administration. The house of delegates of the association approved the action of the board of trustees. The house of delegates in 1938 reiterated "its demand for a Federal executive department to be designated as the department of health, with a doctor of medicine at its head, who shall have general supervision and direction of the affairs of the Federal Government pertaining to the health of the people." In 1944 the house of delegates approved a resolution recommending that the functions of the Children's Bureau of the Department of Labor be transferred to the United States Public Health Service. In the same session of the house of delegates a resolution was adopted requesting "the Congress of the United States to create a department of public health, the head of which department shall be a cabinet officer, and to assign to such department all health activities of the Federal Government." This action was recommended in that it "would result in greater efficiency and in increased benefit to the American people." In 1945 a resolution before the house of delegates pointed out that the United States Public Health Service carries out its activities in prevention of disease and protection of the public health, through State departments of health and other State agencies. It was stated that the health service now conducted by the Children's Bureau of the Department of Labor parallel, and in many instances overlap, the responsibilities of the Public Health Service and require duplication of district facilities and personnel and a confusing duplication of Federal relationship with State health departments and other agencies in the field of public health. It further stated that "it would be more logical, more effective, and more economical to have all public-health responsibilities concentrated in one Federal agency and establish one direct channel of relationship with State health departments." The resolution as approved recommended that the health services. of the "Children's Bureau of the United States Department of Labor should be transferred to the Federal Security Agency until such time as the Congress creates a national department of health with a qualified physician as its director, with Cabinet status." The transfer of the vital-statistics functions of the Census Bureau to the Federal Security Agency would seem to be logical and make for greater usefulness of that service as it is of more importance to the agencies of health and welfare than to the Bureau of the Census to which it is now attached. The repeated resolutions of the house of delegates leave no doubt that the medical profession, represented in the American Medical Association, favors the concentration of all medical activities of the Federal Government in one governmental agency with a qualified doctor of medicine at its head. This administrator to have the general supervision and direction of the affairs of the Federal Government as they pertain to the public health. The administrator should have Cabinet status or, if this is not possible at this time, he should have direct access to the Cabinet level and should not be subordinate to another agency. The health of the people is too important in maintaining the "strength of the Nation" as it was referred to in the message of the President, to be subject to economic restrictions, administrative limitations, or policies developed by other agencies. With the average life expectancy practically at 65 years, agencies primarily engaged in providing nonmedical benefits, aid, and old-age insurance, will be involved in such enormously large administrative and financial volume that it would be extremely difficult to keep the more individualized problems of health in proper perspective. I have not gone into detail in the discussion of the various agencies that are included in this reorganization plan, Mr. Chairman, for the reason that while in a general way we are familiar with some duplications and difficulties, you are in a position to get more intimate information relative to their problems, their duplications, or whatever administrative conflicts there are. For that reason, I have given no time to that. I have simply tried to express to you here the attitude of the American Medical Association toward the concentration of these agencies, insofar as they are interested in medicine, under one head. I might state that the action of the board of trustees back in 1937 took action favoring a concentration of national health activities, but that was not the beginning. As a matter of fact, the American Medical Association for many, many years, in fact in 1870 I think it was, took action calling attention to the advisability of having some national central governing agency interested in the health of the public in those matters in which the individual is unable to care for himself. The CHAIRMAN. As I understand your statement, the American Medical Association favors the establishment of a Department of Public Health with a Cabinet head. Dr. SENSENICH. With Cabinet status. The CHAIRMAN. A medical officer? The CHAIRMAN. But pending the establishment of such a department, the board of trustees has no objection to transferring to the Federal Security Agency the different bureaus that deal with public health, such as the Children's Bureau and Vital Statistics, and other programs that are now carried on by several departments and independent establishments. Dr. SENSENICH. Yes; that is a fact. The CHAIRMAN. You do not think that the transfer in Reorganization Plan No. 2 will in any way cripple the agencies that are affected? Dr. SENSENICH. By closer cooperation, Mr. Chairman, it should improve the action and the possibilities of action of some of these departments, because they are closely related. It seems that something would be attained by having them in closer contact with one another and perhaps a bit more cooperative in the matter of their administration. The CHAIRMAN. The mere fact that the Federal Security Administrator is not a medical officer will not in any way affect the present operations of the different agencies transferred to him, because at the present time they are not under medical officers. Dr. SENSENICH. That is correct. Of course, we have made the recommendation that the medical activities be concentrated under a competent medical officer for the reasons that I have specified here. The CHAIRMAN. That is exclusive of the medical service of the Army, the Navy, the Coast Guard, the Marine Corps, and the Veterans' Administration? Dr. SENSENICH. Yes. Those, obviously, are in another category. The American Medical Association has directed its efforts for nearly 100 years toward making the best possible medical service available to all the people and cooperates with governmental and other agencies toward that end. Since my arrival here, it has been intimated that the proposed changes in organization are planned as the initial step in establishing a regimented, Government controlled system of medical care. We are inclined to accredit to this effort the honesty of purpose that has activated the efforts of the American Medical Association in supporting or opposing other legislative proposals. Should it be apparent that efforts are directed to the establishment of governmental regimentation or measures that would be harmful to |