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increase the services to the people, and that would have to be done by appropriation-affect the matter.
Mr. BENDER. This whole transfer, according to carefully prepared analyses, as provided for in plans 1 and 2 and 3, will provide for a net increase of $254,000,000.
The CHAIRMAN. If the Congress appropriates the money. Mr. BENDER. Well, frankly, if we permit these plans to become effective, we will be called upon to appropriate money, and as a rule we do. We must remember the words of our committee member, Mr. Rich:“Where are we going to get the money?"
Was not this proposed in order to decrease the cost of Government by at least 25 percent? Dr. SENSENICH. That is my understanding, sir.
Mr. BENDER. Doctor, if you do not mind my making the suggestion, I have received a lot of letters from physicians all over the country, and especially from my own State, urging me not to vote for certain legislation, and here you are, the representative of the physicians of the country, urging that something be done right along the line that these physicians are most apprehensive about. It is not consistent.
Dr. SENSENICH. Would it be possible for you to let us have the names of those individuals so we might discuss it with them?
Mr. BENDER. I have a whole file of doctors who are apprehensive about the Federal Government going into the medical business.
Dr. SENSENICH. I grant that, sir. There are many doctors apprehensive of that, including the American Medical Association.
Mr. BENDER. Do you not know this plan provides for exactly that?
Dr. SENSENICH. That is not my understanding of it, sir. That was, the reason for the final statement there.
The CHAIRMAN. According to the doctor's statement, Mr. Bender, the American Medical Association recommended these transfers in January of 1937.
Mr. Rich. Doctor, suppose that you had established in the Cabinet of the President a medical branch of the Government and the President appointed a doctor who was interested in the socialization of medicine, so far as the Government was concerned. What would happen? Would you approve of that?
Dr. SENSENICH. No, sir. We would oppose that. In fact, that situation, if I may add, is not new. Every now and then that is suggested by someone.
Mr. Rich. You are proposing now that we set up this branch of the Government and that the President appoint a doctor in charge of a medical department of the Government. Suppose that individual did not think the same as you. Suppose that he were appointed by the President and he says:
Well, I am now going to let the Government take charge and we will have doctors all over the country under the employ of the Federal Government to look after the welfare of the people. What would happen then?
Dr. SENSENICH. We would do exactly as we have stated in the last paragraph of my statement-oppose it with all the means at our command.
Now, if I may finish, the difficulty about the present situation is that these various administrations are separated in the various areas of the Government and all save one are under nonmedical direction. That one is the Public Health Service.
Mr. Rich. As Mr. Bender said, he has had letters from doctors. I have had every medical society in my district come to me and tell me that they do not want the Murray-Wagner-Dingell bill.
Dr. SENSENICH. That is right.
Mr. Rich. But if you set up this branch of government that you are talking about, how do you know that you are not just building up for that very thing?
Dr. SENSENICH. May I say, sir, we have opposed the Murray-Wagner-Dingell bill to the extreme and will continue to do so. I am well aware of the fact that there might be apprehension about anything that might be proposed in connection with Government changes, but there is also apprehension concerning the Government in the present arrangement. There are those who feel that they would wish to socialize the whole structure, and some of those are in high places. We will continue to oppose that. It is our impression that the concentration of these medical agencies under one head would not in itself be any greater threat to the continuation of the proper kind of individual medical care than it is at the present time distributed among a number of different centers.
Mr. Rich. I agree with you that we ought to concentrate all the medical care in one head. The only thing I fear is that we may eventually go right into what you are figuring now you do not want, and that is what I fear also.
Dr. SENSENICH. We will be right here fighting, sir, when that happens.
Mr. Rich. We had some people not long ago in high positions make fun of the Supreme Court. You read the headlines in this morning's papers and you see what is happening now. I wonder if the people of this country are going to be satisfied with those conditions. You can see what can happen.
Dr. SENSENICH. I am thoroughly aware of that.
Mr. Judd. Is it not possible, Dr. Sensenich, that the failure to take care of the Government through its division and scattering and uncoordination of activities; the failure of the Federal Government and the State and local governments to carry out properly those medical and health functions which ought to be handled by Government agencies, will increase public pressure for something like the MurrayWagner-Dingell bill, which will be held out to them as the panacea which is going to solve all of their problems?
Dr. SENSENICH. That is always a constant threat.
Mr. Judd. It is not because you think the acceptance of this plan would lead to the Murray-Wagner-Dingell bill, but by better handling of the functions that do belong in the public agencies, there is less danger of getting so drastic a bill as that?
Dr. SENSENICH. And a better determination of common policies.. As it is, we have the Children's Bureau. In many States it is operated
through the State Department of Health. In many other States it operates through separate agencies under the Department of Public Welfare, and the policies vary, are not constant, and in some instances are not very effective. If those things are to be done--and we seem to be committed as a Nation to certain amount of Federal grants in aid, and much could be said for and against that particular procedure-it seems that it would be better to have them of uniform character and administered through less expensive machinery and without duplication in the various States where those activities are carried on. That is the purpose of our appearance here today.
Mr. Judd. If you had your choice between the plan No. 2 and the general plan to set up a whole new department in the Cabinet to handle all welfare agencies, including Public Health and so forth, which of the two would you prefer? If the President sent a special message creating a new department in the executive branch of the Government and sent down the organizational plan that reshuffles and tries to get together certain agencies that deal in that work, in that general field, of the two which would you think the better?
Dr. SENSENICH. Health is of such importance that we felt that it should have cabinet status. Now, whether it is possible to have separate departments of welfare and health, or whether from an administrative standpoint that is not possible, that is something that must be determined; but we still maintain, as we have throughout the years, that health is of vital importance and is entitled to cabinet status, as health,
Mr. Judd. If you had your choice, you would have a separate department of health alone, not mixed up with the welfare agencies, education and the rest ?
Dr. SENSENICH. That is right.
Mr. Judd. May I ask your opinion on Reorganization Plan No. 3, the question of St. Elizabeths Hospital?
Dr. SENSENICH. I am not familiar with it, and I cannot pass upon it. I know something of St. Elizabeths Hospital and something of their problems.
Mr. Judd. The plan amounts to taking St. Elizabeths, which is incomparably the finest institution in the United States with respect to phychiatric procedures, and reduce it to the status of a local county hospital. Hitherto it has been a hospital that has taken care of most of the people in the Federal Government, whatever branch of the Federal Government, afflicted with psychiatric disorders. Therefore, it has been an excellent research institution as well as a teaching institution. It has really led in the field from Dr. White's days in the field of psychiatry, and this just reduces it to a county hospital. I think that there could be some question about that. If you have the time or opportunity I wish that you and other experts connected with the organization would look into that and give us the benefit of your advice.
Ďr. SENSENICH. We would be very glad to do so.
Mr. JUDD. I have a statement here from the Association of State and Territorial Health Officers of Boston, Mass., that I would like to insert as a part of the record at this point.
The CHAIRMAN. It may be inserted.
. (The statement referred to is as follows:)
Boston, Mass., June 7, 1946, ... On behalf of this association I wish to submit the following statement : 15. The Association of State and Territorial Health Officers is cognizant of the need of coordination, under a single head, of the civilian health activities of the Federal Government. The several States and Territories have been receiving grants-in-aid from both the United States Public Health Service and the Children's Bureau of the Department of Labor for their public health programs. Originally, these grants were made under the Social Security Act, and more recently, the grants from the United States Public Health Service have been made under the recodification of the laws pertaining to the public health known as Public Law 410 of the Seventy-eighth Congress.
At the present time the several States are required to make reports to both agencies, present their budgets, and conform with a variety of regulations issued by these two agencies. In an endeavor to reduce the number of different reports required and in an endeavor to coordinate the directives coming from the various Federal health agencies, it is the recommendation of this association that in the recognization of the Government, as is being planned by the President, serious consideration be given to the establishment of a Department of Public Health with a Cabinet officer in charge. It is further recommended that permanent career men be selected for the key positions in this Department and that they be given an opportunity to retain their positions on a permanent basis.
The association has learned that this proposal has been made for the organization of a Department of Public Health and Welfare with a Cabinet officer at its head. If the organization is carried through, the association respectfully recommends that adequate measures be taken to insure that Public Health receives sufficient freedom of action to carry on its important function of maintaining optimal health for all the people. It is urgent that, if such a combined department is formed, permanent career under secretaries or assistant secretaries be in charge of the two activities and that they be of equal rank. This latter, of course, is a less desirable alternative than the formation of a separate Department of Public Health.
These recommendations are made in the interest of better public-health administration on a Federal level and the coordination of all civilian public health activities in a single department, thereby rendering liaison and cooperation with the several States and Territories the more efficient and effective. This, in turn, would bring about an improvement in general public health work throughout the entire country and enable this Department to administer any future legislation pertaining to public health with much greater efficacy, with a smaller administrative overhead for services rendered.
The Association of State and Territorial Health Officers therefore favors, in principle, the President's message concerning the Reorganization Plan No. 2. It is our opinion, however, that this message does not go far enough. It is the opinion of the State and Territorial officers that the Children's Bureau should become an integral part of the United States Public Health Service and that eventually, instead of a Department of Health and Welfare, there should be established a Department of Health.
Vlado A. GETTING, Secretary-Treasurer. "The CHAIRMAN. The next witness will be Mr. Albert H. Ladner, Jr., a Commissioner of the United States Employees' Compensation Commission.
STATEMENT OF ALBERT H. LADNER, JR., UNITED STATES
EMPLOYEES' COMPENSATION COMMISSION . Mr. LADNER. Mr. Chairman and gentlemen of the committee, I appear as one of the Commissioners of the United States Employees' Compensation Commission, which is composed of two women, the Democratic Party, and myself, the minority member. We are opposing this plan. I suppose that the lady Commissioners are a bit modest about appearing before the committee, so I came down to speak for the Commission as a whole.
The Reorganization Act of 1945 directs the President to determine what organizational changes are necessary to accomplish specific objectives.
We oppose the plan on the ground that they want to abolish the bipartisan Employees' Compensation Commission, which was created by statute as an independent tribunal in 1916, to administer the Fed-: eral workmen's compensation law, and transfer its functions to the Federal Security Agency.
The plan states that it will accomplish one or more of the objectives specified in the law, without further identification.
Among some of the reasons is the statement that it will facilitate orderly transition from war to peace. This objective does not pertain to the work of the Compensation Commission, which is a peacetime function carried on for 3 years under the commission form of administration.
They also set forth that it will reduce expenditures and promote economy. The plan makes no claim for, nor does it specify, that there will be a reduction of expenditure or economy of operation,
The Commission has been commended by the Committee on Appropriations for “the economical way in which the Commission has operated. Such record is deserving of a real plaudit."
Now, as to the matter of increased efficiency. The plan makes no claim for an increase in the efficiency of the functions of the Commission. In fact, the plan appears not to concern the functions of the Commission but rather to strengthen the internal organization and management of the Federal Security Agency. The interests of employees, employers, and insurance carriers affected by the Federal workmen's compensation law apparently were not given consideration.
A fourth reason, to group, coordinate, and consolidate agencies and functions according to major purposes.
The major purpose of the Federal Security Agency is in the field of welfare and health. Workmen's compensation laws confer statutory rights under a system which is a substitute for common law rights, The administration of such laws has been judicially recognized as a quasi-judicial function. Its major purpose is unrelated to the function of the Federal Security Agency.
One of the major functions of the Compensation Commission is to act as the tribunal, hearing and deciding claims in which the parties are private employers and employees. No like function is exercised by the Federal Security Agency.
Reduce the number of agencies by consolidating similar functions under a single head and abolish unnecessary agencies and functions.
The functions of the Compensation Commission are not similar to those performed in any other agency of the Federal Government. A bipartisan commission form of administration for such functions has long been recognized as the ideal form of administration of such quasi, judicial functions. In the great majority of the States, about 80 percent, the Workmen's Compensation law is administered by an inde. pendent commission or board. In no instance have such functions been placed indiscriminately under a department of welfare, such as is pror, posed in the plan.
Eliminate overlapping and duplication of effort. The functions of the Commission do not overlap those of any other Federal agency and are not elsewhere duplicated in the Government.