TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
Statements appearing in this column do not necessarily reflect the opinion of the editor nor are they to be interpreted as the official opinion of the Academy.
FEDERAL DOLLARS FOR HEALTH SERVICES, RESEARCH
AND MEDICAL EDUCATION
B
EFORE the first session of the 82d Congress adjourned in October, the bill for federal support of medical education came in for a final flurry of activity. It was trussed up with a debilitating amendment, interred in Committee, and at the last minuteexhumed without the amendment and placed on the Senate calendar-for consideration
on another day.
The Senate bill (5.337) , originally introduced by Senator Murray (Montana) , had
bipartisan support in the Senate Committee on Labor and Public Welfare and was
re-ported out of committee by unanimous consent of its members. In the hope of bringing it added support, its sponsors emphasized its importance as a measure to strengthen national
defense through aid to medical, dental, nursing, public health, osteopathic and allied
technical schools. Under provisions of the bill, money would be granted by formula to
these schools based on the number of students normally enrolled, with additional money for those in excess of normal enrollment. As originally written, each medical school would receive $500 for each medical student through normal enrollment, and $1000 for
each student in excess of normal enrollment. The bill also provided $10,000,000 annually
for five
years to enable the Surgeon General to make grants for construction andequip-ment of both existing and new schools. Scholarships and maintenance for accepted stu-dents were also proposed under certain circumstances. There would also be created a
National Council of Education for Health Professions ; additional special technical
corn-mittees would advise the Surgeon General in the administration of the program.
After long delays, and in an effort to expedite passage of 5.337, a new schedule of proposed financial assistance was worked out by the Senate Committee on Labor and
Public Welfare. The construction aid and scholarship provisions were unchanged but
there was a marked decrease in the grant based upon normal enrollment and a great
in-crease in the size of contribution to institutions with increased enrollments. Under the
new plan, schools of medicine would receive $200 for every student enrolled (instead of
$500 as originally proposed) . plus $2000 (instead of $1000) for each student in excess of past average enrollment. Under the original bill, these grants-in-aid would cost the
government a total of $250,000,000 for the first five years of operation. As amended, the
cost
would be approximately $180,000,000.This amendment, obviously designed as an incentive to medical schools to increase
TRENDS 849
was made that medical schools would be very strongly tempted to increase their enrollment beyond their facilities and faculty resources. Furthermore, it was pointed out that the amendment would unfairly penalize those schools which had already increased their en-rollment to their utmost capacity in response to the recognized need for more physicians. Such schools which might be unable to increase their enrollment further would receive grants based only upon present enrollment at the reduced per capita rate and would not
re-ceive the larger amount provided for an increase in the number of students. In the final
de-bate which led to re-committing the bill to the Senate Committee on Labor and Public Wel-fare, Senator Taft, who had formerly co-sponsored the bill, withdrew his support. He stated that he was opposed to 5.337 with the proposed amendment ; he claimed that his change in position on the bill resulted from the opposition coming from medical school deans in relation to the increase in incentive payments. Senator Taft voiced his anxiety that such incentive payments would only lead to overcrowding and, referring to the bill proper, would permit the government to intrude itself upon selection of students.
A few days before Congress adjourned, 5.337 was reindorsed by the Committee on Labor and Public Welfare, minus the incentive-payment amendment that led to its down-fall, and was returned to the Senate calendar. Thus the issue was closed for this session
of Congress, but it should not be assumed that proposals for federal aid to medical edu-cation are a dead issue. They will undoubtedly be revived when Congress reconvenes.
While the Senate bill for federal aid to medical education and its companion bills in the
House were feeling the weight of organized opposition with insinuations of government control of medical schools and pleas for economy, the Senate appropriated many millions of dollars for various activities of the Federal Security Agency which provide direct finan-cial aid to hospitals and teaching institutions. An objective observer might be pardoned for feeling some degree of confusion over the apparent inconsistency.
Listed below are the funds voted for the fiscal year 195 1-52 for those activities of the
Federal Security Agency which are of special interest to the medical profession. Although
grants related to medical education do not appear in this list as such, they are nevertheless included in many of the categories such as the National Institutes of Health and the Chil-dren’s Bureau. Witness the fact that the Public Health Service disclosed that nonfederal institutions and individuals received $44,371,188 in grants during the fiscal year 1950-51.
The bulk of these grants went into cancer, heart and mental disease research, but at the
same time medical school grants for research are in many instances a material benefit to the teaching resources of those schools. An additional $5,213,554 of the total went to assist in improvement and expansion of instruction and another $9,459,000 was provided for construction of laboratories and other physical facilities. Fellowships accounted
for
$1,568,371.Altogether the Federal Government finances over 60% of all medical research in this country today. Has this preponderance
of
federal dollars led to federal domination ofIn the total appropriation for the Federal Security Agency for the fiscal year 195 1-195 2,
the following items are of interest to the medical profession:
Funds available Funds requested Funds voted
for fiscal 1951 for fiscal 1952 for fiscal 1952
Venereal diseases $ 12,863,500 $ 11 ,800,000 $ 11,653,360
Tuberculosis 9,400,000 9,000,000 8,745,000
General public health 16,084,000 16,084,000 15,960,000
Communicable diseases 6,260,600 6,150,000 5,915,747
Sanitation and industrial hygiene 3,670,030 3,800,000 3,648,158
Hospital construction grants (new) 85,000,000 75,000,000 82,500,000
Hospital construction-liquidation of authorized 1 10,000 ,000 120 ,000,000 100 000,000
projects .
Hospitals and medical care (operation) 29,024,000 30,200,000 30,200,000
National Institutes of Health 13,913,000 15,800,000 13,500,000
National Cancer Institute 19,886,000 19,947,000 19,500,000 Mental Health Activities 9,505,000 10,800,000 9,518,987 National Heart Institute 14,554,400 10, 150,000 10,000,000 Dental Health Activities 1 ,954,850 1,750,000 1,598,654
Construction of Clinical Center, Bethesda, Md. 15,125,000 18,590,000 17,685,540
Vocational rehabilitation-payments to States 20,600,000 23,000,000 21,500,000
Children’s Bureau-grants to States 30,250,000 33,000,000 31,500,000
Public Assistance grants-old-age, blind, dis- 1 ,280,000,000 I,300,000,000 1,150,000,000
abled, etc.
