TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
This and subsequent descriptions of events and trends are in:ended to be unbiased and factual, pre-senting both sides of controversial matters so that conclusions may be formed from critical appraisal
of things as they are. These statements do not necessarily reflect the opinton of the writer nor are they to be interpreted as official opinion of the Academy.
FAMILIAR HEALTH BILLS APPEAR IN THE 82nd CONGRESS
T
HE manifold problems related to the Nation’s medical manpower overshadow other aspects of health legislation in the early days of 82nd Congress. These problemsare dealt with so fully in the daily press, in weekly releases from the American Medical
Association and local medical societies, that there is little to be gained in commenting
upon them here ; the story would be old before it appeared in print. There are,
how-ever, other measures to which we wish to call attention. Certain major health bills which
were given active consideration in the 81st Congress have reappeared-as we predicted
they would-in the 82nd Congress. These are, in chronologic order of their
introduc-tion:
NATIONAL HEALTH INSURANCE
A bill (HR. 27) to provide a national health insurance and public health program
was introduced on January 3 by Representative Celler of New York. This is the
Administration’s version of compulsory national health insurance, identical with HR.
345 introduced into the last Congress by the same author.
Support for this measure appeared in President Truman’s budget message to Congress
when he again renewed his recommendations for the establishment of a medical care
insurance program. He said: “Such a program would require a 2-year starting period
before health benefits become available. During that time, a small payroll tax of
one-half of 1 percent would be levied to accumulate a starting reserve, estimated at $275
million for 1952, and covered into a trust fund to defray initial administrative and
de-velopmental expenses. These expenses, which would be made directly from the trust
fund, are estimated at $35 million for 1952.”
This recommended appropriation, as in the case of other proposed appropriations for
bills not yet enacted, will not be made unless the related bill is passed by Congress.
Senator Murray, Chairman of the Senate Labor and Public Welfare Committee, is said
to have indicated that nothing will be done with the National Public Health Insurance
Bill until after the Committee has received the report of a special committee set up to
study health services and health insurance. This latter committee is under the
Chair-manship of Dr. Dean Clark, formerly Medical Director of the Health Insurance Plan of
Greater New York, and now Director of the Massachusetts General Hospital. The report
originally was due on February 1, but it is now called for by March 31.
SCHOOL HEALTH SERVICES
Also on January 3, Representative Coudert of New York introduced a bill (HR. 42)
to provide for school health services. This bill is identical with its counterpart, HR. 4352,
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introduced into the 81st Congress by the same author. It may be noted that the new
version still contains the clause which has been cited as objectionable by the American
Medical Association, i.e., permitting treatment of physical and mental defects regardless
of economic status of parents.
FEDERAL AID TO MEDICAL EDUCATION
A bill (S. 337) to provide an emergency five year program of grants and scholarships
for education in the fields of medicine, osteopathy, dentistry, public health, and the
nursing profession was introduced January ii by Senator Murray. This bill is
spon-sored by all the Democratic members of the Senate Labor and Public Welfare Committee
to which the bill has been referred. Emphasis now is placed upon the immediate need
to meet the prospective requirements of the armed services. A companion bill, H.R. 1781,
identical to S. 337 has been introduced into the House by Representative Klein of
New York.
The President gave special attention to this matter in his budget message. He said:
,‘Our chronic shortage of doctors, dentists, and nurses will be aggravated as more of them are called into the Armed Forces. Therefore, we need, more than ever, prompt
enact-ment of legislation that will help to increase enrollment in medical and related schools,
by assisting them to meet their costs of instruction and to construct additional facilities
where needed. Scholarships should be provided to attract larger enrollments in nursing
schools, and grants should be made to states for vocational training of practical nurses.”
The President included in his budget a tentative appropriation of $30 million to
implement proposed legislation to authorize:
1. Premium payments to medical, dental, degree nursing, and public health schools
for each student enrolled in excess of its average past enrollment and smaller payments
per student based on average past enrollment.
2. Grants to medical, dental, degree nursing, and public health schools for
construc-tion of additional facilities.
3. Grants to states for practical nurse training.
4. Scholarship aid to students in fields in which there is a shortage of qualified
appli-cants, particularly t’tursing.
In comparison to S. 1453 in the 81st Congress, this new bill contains several increases
in the proposed allocations. Federal assistance could reach 50% of the total cost of
in-struction ; the old bill provided 40%. Whereas the former bill provided $5 million for
purposes of construction and equipment, the sum of $25 million is now proposed. In
other respects the new bill is essentially the same as the old bill with provision for
allowances to schools for additional new students, scholarship stipends and amounts for
other health personnel.
It may be recalled that in the 81st Congress the bill for federal aid to medical
edu-cation was passed by the Senate but was not reported out by the House Interstate and
Foreign Commerce Committee. The Senate Labor and Public Welfare Committee has
448 JOHN P. HUBBARD
sentative Burnside, has for some weeks been in the process of preparation with the help
of several medical school deans. The Burnside Bill, as currently drafted, proposes a five
year $300 million program of expansion of medical and dental schools. One half the
sum would be used for outright grants to construct and equip new medical schools ; the
remainder would be for enlargement and improvement of existing schools in the health
professions, including but not limited to medicine and dentistry. Teaching hospitals also
would be eligible beneficiaries, provided there was no conflict with provisions of the
Hill-Burton Act.
LOCAL PUBLIC HEALTH UNITS
As previously noted in this column, the bill to provide for development and
mainte-nance of local public health units was passed by the Senate in the 81st Congress, was
reported favorably by the House Interstate and Foreign Commerce Committee but did
not get by the House Rules Committee. This same bill now appears again as S. 445
introduced on January 1 1 by Senator Hill. In commenting upon this matter in his budget
message, the President said : ‘‘The civil defense program will confront many communities
with important public health responsibilities. Moreover, shifts in population arising
from stepped-up defense production and increased mobilization will place heavier
burdens on many communities to provide adequate sanitation, protect food and water
supplies, furnish preschool and school child health services, and otherwise to prevent
disease and promote the health of its citizens. Yet, a sizeable number of them lack the
services of an adequately staffed local health department-even for their normal needs.”
RESEARCH IN CHILD HEALTH AND DEVELOPMENT
Another familiar bill carried over from the last Congress is S. 676 introduced by
Senator Douglas to promote federal support of research in child health and
develop-ment. The bill provides for appropriations of $7.5 million for grants-in-aid and
fellow-ships. A similar bill (HR. 1879) has been introduced in the House by Representative
