TRENDS
IN
HEALTH
LEGISLATION
AND
ADMINISTRATION
By JOHN P. HUBBARD, Contributing Editir
This and aub.equent de.criptiona of events and trends are intended to be unbiased and factual, presenting
both s*des 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.
FEDERAL FUNDS FOR TEACHING
A
MONTH ago attention was called to the fact that the U. S. Public Health Serviceand the U. S. Children’s Bureau have been urged to study the problem of medical
education and make plans to subsidize medical schools. This recommendation fell on
fertile soil, and may be expected to bear fruit in the near future. It is timely, therefore, to review the extent to which medical education is already supported financially by the
federal government.
The National Cancer Institute, a branch of the National Institute of Health of the
U. S. Public Health Service, has been allowed a total appropriation of $14,000,000 for
the fiscal year ending June 30, 1948. In addition to providing for cancer research, the act
which establishes the Institute (Public Law 244 of the 75th Congress) authorizes the Surgeon General ‘‘to provide training and instruction in technical matters relating to the
diagnosis and treatment of cancer ; to provide fellowships in the Institute from funds
appropriated or donated for such purpose.’ ‘ In accordance with this authorization,
$1,500,000 has been allocated for the current fiscal year for “medical school education
grants.” Grants not to exceed $25,000 are allowed for four-year medical schools for
teaching related to cancer ; grants not to exceed $5,000 for the two-year schools ; and
grants not to exceed $5,000 for dental schools. As of February 1, 1948, a total of
$894,728 has been made to 40 medical schools ; grants of $58,209 have been made to
1 2 schools of dentistry. These funds provide for teaching salaries and equipment for
teaching (about half of an individual grant is usually budgeted for equipment and teaching aid) . In addition to these grants, which are related primarily to undergraduate
teaching, a fund of $250,000 has been established for clinical trainee-ships, for the
purpose of assisting young physicians with special interest in cancer problems to continue
their training long enough to acquire special knowledge. Seventy-five trainee-ships have
been granted on a per diem basis at a rate not to exceed $10 a day.
It is the hope of the Cancer Institute that the assistance for which provision is now made
will effect better integration of the many individual courses now given on cancer in
medical and dental schools.
The National Mental Health Program, in addition to its other activities, provides for
,‘training personnel in matters relating to mental health.” Under provisions of Public
Law 487 of the 79th Congress, the Surgeon General is authorized “to provide training
and instruction in matters relating to psychiatric disorders . . . and to provide such
training and instruction, and demonstrations, through grants, upon recommendation of the National Advisory Mental Health Council, to public and other non-profit institu-tions.” For the current fiscal year ending June 30, 1948, an appropriation of $7,500,000
was authorized for the National Mental Health Program and other activities. Of the total
de-HEALTH LEGISLATION AND ADMINISTRATION 427
velopment and improvement of facilities for training mental health personnel. Grants have been awarded to universities, hospitals, and clinics at undergraduate, graduate, and
postgraduate levels, for training in the fields of psychiatry, clinical psychology, psychiatric social work, and psychiatric nursing. Provision is also made for scholarships and
fel-lowships in psychiatry, psychology and related subjects.
In addition to the grants made directly to teaching institutions, a sum of $3,000,000
has been allocated for grants-in-aid to states for local mental health programs. A
con-siderable proportion of these grants also are available for fellowships for graduate or
postgraduate students.
An increase in the appropriation for the National Mental Health Program has been
recommended by President Truman for the fiscal year ending June 30, 1949. In his
budget message to Congress the President recommended an appropriation of $10,416,000,
an increase of almost $3,000,000, to provide additional grants for training of mental
health personnel.
The U. S. Children’s Bureau is a third source of federal funds for medical education. Dr. Edwin F. Daily, Director of the Division of Health Services, describes* this aspect
of the Bureau’s activities as follows:
“The Social Security Act of 1935 authorizes the Children’s Bureau to make
grants-in-aid to State agencies for extending and improving maternal and child health and crippled
children’s services. Many of the State agencies have used portions of these grants for the
training of personnel needed to render the services. All such grants must, by law, be
made to the official State agency and cannot be made directly from the Children’s Bureau
to teaching institutions, as allowed under the national cancer program or the national mental health program. State health agencies have used these funds under agreements
with several medical schools, including the Universities of Nebraska, Colorado, Utah, Louisiana, Arkansas, and Meharry Medical College, to further education and service
programs. These projects are not confined entirely to teaching purposes but cover service
costs as well, as for example, in the Premature Program at the University of Colorado or
the Louisiana State University. Several Schools of Public Health, of Dentistry, Nursing,
and Medical Social Work have also received Federal Maternal and Child Health funds
from their State health departments for developing postgraduate courses needed for the
personnel providing services under these programs. During the current year more than
$1,000,000 of the $18,500,000 of Federal funds available for maternal and child health
and crippled children’s services is being expended by the States for the training of
personnel and in connection with educational institutions.”
A fourth source of federal funds for medical education, and one which is not widely
known, is in support of Howard University. In 1867, Howard University was established
as a federal institution for Negro education. The University was transferred from the
Department of Interior to the Federal Security Agency in 1940. At the present time, the
federal government’s share in the budget of the University as a whole is 5 1
%
.Seventy-eight per cent of the present budget of the College of Medicine is provided by the federal
government, with the remainder being met by private endowments.
THE NATIONAL HEART DISEASE PROGRAM
428 JOHN P. HUBBARD
squabbling, it is gratifying to see an element of harmony in the sponsorship of a heart program. Representative Keefe (Republican) introduced H.R. 5087 on January 21, 1948,
and Representative Smathers (Democrat) introduced H.R. 5159. Both bills propose to
provide for research, prevention, diagnosis and treatment related to diseases of the heart and circulation, including hypertension.
The bills propose grants-in-aid to universities, hospitals, laboratories, other agencies, and individuals and for ‘‘training research workers ; training undergraduate and
post-graduate personnel in matters relating to heart diseases ; and developing and assisting
States and other agencies in the use of the most effective methods of prevention, diagnosis and treatment of heart diseases, including refresher courses for physicians . . .‘ ‘ (The
latter clause is included in H.R. 5159 but not in H.R. 5087) . If this legislation should
be enacted, an additional source of financial support of medical education would be established.
It is proposed to create a National Heart Council, appointed by the Surgeon General. This Council would serve in an advisory capacity in much the same manner as is now
done by the National Advisory Cancer Council and the National Advisory Mental Health Council.
In order to finance the program, the bills authorize an appropriation for ‘‘such sums as
the Congress may determine to be necessary to carry out the provisions of this act.’ ‘ The
amount is not stated but is left entirely open for further Congressional action. Worthy of note in this connection is the fact that Congressman Keefe is Chairman of the House Appropriations Subcommittee which handles annual funds bills for the Federal Security
Agency.
An item of special interest is the fact that the bills authorize salaries ranging from
$10,000 to $15,000 “for the services of specially qualified scientific and professional
personnel”-a hopeful portent of salaries adequate to attract to government positions
professional and scientific personnel of high caliber.
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Hearings on the Taft (S. 545) and Murray-Wagner-Dingell (S. 1320) bills for a
national health program were resumed on January 26, 1948 before the Senate Labor and Public Welfare Subcommittee on Health. Chief witness of the opening session was Mr.
Isadore Falk, Director of the Bureau of Research and Statistics, Social Security
Ad-ministration, who was questioned at length as to the part played by the Federal Security
Agency in the preparation of S. 1320. Others who have been heard include Dr. Marjorie
Shearon, collector of facts and opinions in support of S. 545. It is anticipated that these hearings will be concluded soon.
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Another item of immediate interest is a message from President Truman to Mr. Oscar
R. Ewing, Administrator of the Federal Security Agency. The President asks Mr. Ewing “to undertake a comprehensive study of the possibilities of raising health levels and to report to me at your earliest convenience upon feasible goals which might be realized by the American people in the next decade.” Having been charged with this assignment, the FSA may be expected to develop a 10-year plan predicated not only upon adoption of
national health insurance but also upon elevation of the FSA to cabinet status as
