TRENDS
IN
HEALTH
LEGISLATION
AND
ADMINISTRATION
By JOHN P. HUBBARD, M.D., Contributing Editor
This and subsequent descriptions of ez’en!s and trends are intended io 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 opinion of the writer nor are
they to be interpreted as official opinion of the Academy.
N
OW that the national elections are in the background, we may expect to see Congressional decks being cleared for action in the 81st Congress. It is therefore in order to review the achievements of the 80th Congress in respect to health legislation.The magnitude of the federal government’s role in the development and financing of programs in the field of health can readily be appreciated by the fact that Congress appropriated approximately $165,000,000 for public health activities during the current
fiscal year. Contract authorizations will raise the amount to more than $275,000,000.
Besides these appropriations, the federal government assumes the total cost for many
of the medical and hospital needs of the veteran population.
Among the appropriations voted by Congress for various health programs for the fiscal
year commencing July 1, 1948, are the following:
Control of veneral diseases $17,230,000 Tuberculosis control 9,291,000
General public health work 13,865,000
Control of communicable diseases 7,490,000 National Institute of Health 13,670,000 Cancer researth and control 14,000,000 Hospital construction program 40,000,000
Construction of a medical research center 40,000,000 Maternal and child health services 11,000,000
Services for crippled children 7,500,000
LEGISLATION PASSED
Heart Disease Program : Congress enacted the National Heart Act. This law provides
for
(
1)
increased cardiovascular research, (2)
improvement and expansion of heart disease detection and diagnostic services, (3) training of personnel both in the fields of research and matters relating to the diagnosis, prevention and treatment of heart disease. For these purposes, Congress voted an appropriation of over $3,000,000 for the current fiscal year. This program, which is to be administered by the Public Health Service, iscomparable with those already operating in the fields of cancer and mental health. The law establishes the National Heart Institute and a National Advisory Heart Council
con-sisting of 12 non-federal members, of which Dr. Paul D. White of Boston has been appointed Chairman. Included within the appropriation is an authorization for grants-in-aid to states for community heart disease programs in the amount of $500,000.
Dental Disease Program :Congress passed the National Dental Research Act to establish
a program to increase research in problems of dental health and to increase training of
personnel in matters related to the diagnosis, prevention, and treatment of dental diseases. For these purposes, the law authorizes an annual appropriation of $750,000.
HEALTH LEGISLATION AND ADMINISTRATION 623
The Act also authorizes $2,000,000 for the construction of a research and training center to be known as the National Institute for Dental Research. This Institute is to
be used by the Public Health Service as a center for research and experimentation in dental
diseases.
The Public Health Service is also authorized to make grants for research and training
directly to universities, hospitals, other institutions or qualified individuals. Research and
training projects must have the approval of an advisory council including experts in the
field.
In addition to the appropriation for the National Dental Research Act, Congress voted
$1,000,000 to enable the Public Health Service to establish field demonstration units for the following purposes: (1) to publicize and promote interest in the use of sodium fluoride for the prevention of dental decay in children’s teeth, (2) to demonstrate the correct technics for applying the procedure and (3) to aid the training of public health personnel.
Mental Health Program : A further expansion of the national mental health program
was approved. Grants-in-aid for the development and maintenance of community mental
health services were increased to $3,550,000-$550,000 more than last year’s
appropria-tion. Increases were also allowed in research and training grants.
LEGISLATION NOT PASSED
National Health Program. The Taft Bill (S. 545) and the Wagner-Murray-Dingle
Bill (S. 1 320) were the subject of very extensive hearings which have been referred to
and reviewed in brief in earlier issues of this column. In the simplest terms, the Taft Bill may be described as a proposal to provide $200,000,000 a year in grants to the states for health services for those unable to pay ; the Wagner-Murray-Dingle Bill proposes to
establish a system of compulsory health insurance. Neither bill reached the floor of the Senate. The Senate has asked the Labor and Public Welfare Committee to submit by
March, 1949, a report and recommendations on a broad national program, following a
further study of existing health problems and proposed methods of meeting these problems.
The National Science Foundation: The National Science Foundation Bill (S. 526)
passed in the first session and was vetoed by the President. A second bill, S. 2385, was
passed by the Senate on May 5, 1948. This latter bill was designed to meet the President’s objections to S. 526, the primary changes being (1
)
that the President, not the executivecommittee, would appoint the director of the Foundation and (2) that the Director would be responsible to the President instead of to the executive committee in dispensing funds. This bill passed the Senate and subsequently was reported favorably to the House by the
Interstate and Foreign Commerce Committee but then died in the House.
Local Health Services: H.R. 5644, the so-called “Local Health Services Bill,” proposed
to provide grants to states for development and maintenance of full time local health units in all areas of the state. This bill was reported favorably to the House by the Interstate and
624 JOHN P. HUBBARD
authorize the Public Health Service to make grants for medical education and for dental
nursing and public health education. The bill included an appropriation of $18,000,000 for the first year for medical schools with additional grants to schools of nursing, schools of dentistry, and postgraduate schools of public health. Appropriations for construction
of schools were also authorized.
Maternal and Child Health : S. 1714 (the current version of the Pepper Bill) provides
for greatly increased grants, especially for maternal and child health programs and crippled children’s services. It authorizes eventually tripling grants for maternal and child health
so that every mother not covered by national health insurance would get medical, nursing and hospital care “during maternity” and every child under 18 years old would be entitled
to full medical, dental and hospital care. This bill was not reported out of Committee. Poliomyelitis: H.R. 6732, a bill to support research and training in the field of
polio-myelitis was reported favorably to the House.
Expensive Drugs: A bill (S. 678) proposed to provide federal assistance to states in
making expensive drugs available to needy persons. This bill was not reported out of
Committee.
Department of Health, Education and Security: A bill (S. 140) was reported favorably
to the Senate to create a Department of Health, Education, and Security. The primary purpose of this legislation is to elevate the existing health, education, and public welfare agencies to departmental status under a head with cabinet rank.
In this connection it should be noted that a bipartisan commission was established under
the direction of former President Herbert Hoover to study and prepare plans for the reorganization of the federal government. The Commission is to submit its
recommenda-tions to Congress early next year covering not only structural changes but also
recommen-dations on functions “in the light of their cost, their usefulness, their limitations, and
