ects in order to break loose any findings that might have greater potential for useful application than they had thus far received. Several good ideas were unearthed by this review. The provision of comprehensive health, education, and counseling services for unwed school-age pregnant girls was identified as an effective way to reduce the likelihood that these girls would cut short their education, have additional unwanted pregnancies, or become dependent on welfare. Promising programs to teach reading, to train teachers, and to train physicians' assistants were also uncovered, and the agencies are now stepping up their promotion of these ideas.

In carrying out this review of completed R. & D. projects, however, we learned that there really aren't a great many good ideas sitting on the shelves in the agencies waiting to be promoted. The prospect of any substantial payoffs, therefore, must depend on managing our R. & D. programs so that more useful and convincing results are produced. We must make sure that our limited R. & D. resources are focused on important questions, that projects fit together, and that they do not wastefully overlap.

To these ends, the operating agencies have now established R. & D. planning procedures and are working on the improvement of project design. We no longer tolerate the failure to submit R. & D. project reports. Each report is scrutinized to determine what, if anything, has been learned, whether the project should be replicated on a more sophisticated or larger scale, whether the results justify limited application and limited dissemination, or whether they should be widely. promoted. In one major research area, enactment of the President's proposal to establish a National Institute of Education will greatly strengthen our capacity to make this kind of determination.

The process by which R. & D. results are disseminated is also being improved. For some users, it is enough to provide easy access to project reports through information retrieval systems like those operated by the National Library of Medicine and the National Clearinghouse for Drug Abuse Information. For others, the R. & D. offices which produce the results will need to make increasing use of demonstrations, conferences, and direct personal contact. Training programs and State and local planning projects can also serve as conduits for ideas.

EVALUATION

EVALUATION is the way we try to find out how well we are doing. Given the squeeze between uncontrollable costs and rising expectations, our society can no longer afford to indulge the "don't just stand there, do something" syndrome that has so often characterized reactions to current appeals. It is not that "doing something" is necessarily wrong. At a time of disillusionment with the integrity of government, however, ineffective responses to needs we do not really know how to meet can only compound distrust and reinforce alienation. In George Washington's day, it may not have done much harm to indulge the belief that

What does this accomplish except to create expectations beyond all possibility of fulfillment and then, because they were not fulfilled, dash the hopes of those who have the greatest needs?

Then, there's the nagging problem of inequity in helping those who need help. The Federal, State, and local cost, both public and private, of assisting individuals whose dependency might have been prevented is running at an average annual rate of about $19 billion. And yet the cost and quality of assistance to such individuals varies widely. If our assistance to all these people met the standards applicable to the most-favored one-third, the annual cost would be nearly $7.5 billion more than it is now.

If, in addition to raising benefit standards for those now receiving assistance, we increased eligibility by uniformly applying a standard for assistance corresponding to the most liberal one-third, another enormous expenditure increase would be required.

Consider just the following list:

Fulfillment of the Right to Read objectives.

Homemaker services, mental retardation services, and vocational rehabilitation services for all who need them.

Developmental day care services for needy children.

Good compensatory education for every disadvantaged child.

To meet even these few goals, we would have to increase our spending by roughly $27 billion per year and recruit and train 6 million more professionals, paraprofessionals, and volunteers!

When we begin to take into account other large claims health care, higher education, urban redevelopment, transportation, and environmental protection, for instance-we rapidly enter a realm of almost unimaginable numbers. The needs are real, but we cannot conceivably meet them all comprehensively and all at the same time.

Glaring gaps between needs and their fulfillment are thus inevitable. That does not mean, of course, that we should not try to narrow them. On the contrary, it is the job of this Department and our sister agencies in the States and localities to fight as hard as we know how to do this. Our sympathies and our missions both demand it. But a "need" is subjectively perceived, and this perception reflects the expected response. The more unrealistic, therefore, are the expectations of our fellow citizens, the more we who struggle to meet those expectations tend to be looked upon as failing.

A consequence is the erosion of confidence in government itself, especially as a means of bringing about desirable change. Americans have never been particularly trusting of government, but still, something is much amiss when surveys show a continuing decline in the percentage of adults expressing a degree of trust in their government.

"Let's face it," the President said in his state of the Union address last January,

"Most Americans today are simply fed up with government at all levels. They will not-and should not-continue to tolerate the gap between promise and performance in government.”

We in HEW must, and we can, help to restore confidence in government. We can do so by making ourselves more responsible. We can do so by making ourselves more responsive.

Today, I should like to tell you about specific actions being taken to shape this Department into a more responsible and responsive instrument for meeting the needs of the people we serve. Many of you have contributed to one or another of these shaping actions, but few have had the opportunity to see how they tie together in a coherent pattern. In a way, this is my progress report to you.

TOWARD RESPONSIBILITY-INTERNAL PROCESSES

CONSTRAINTS

IN

'N THE CURRENT fiscal year, 85 percent of HEW's budget is "uncontrollable" in the sense that neither the executive branch nor the appropriations committees of Congress have the power to add to or subtract from the amounts required to fulfill such binding statutory commitments as social security benefits and health services for the poor. Only a change in legislation already on the books could alter our commitment to these important purposes.

The estimated increase in this kind of "uncontrollable" expenditure in our budget from this year to next year will be nearly $8 billion*—almost as much as the entire HEW budget, including trust fund expenditures, for fiscal 1957, the year I came to HEW as Assistant Secretary for Legislation.

Most of the remaining 15 percent of the HEW budget-the so-called "discretionary" part-is committed to worthwhile activities initiated in prior years, such as research on physical or mental illness. We can hold the line in some places and make limited reductions in others to make room for new and exciting initiatives, but not even such urgent claims as drug-abuse treatment or cancer research can be used to justify offsetting cuts in other HEW programs. We have, as you know, some 280 of these programs, and most of these-whether environmental education or adult illiteracy, mental retardation or product safety-could effectively use more money.

These are the constraints of the past and present on the future. And the future has its own set of constraints.

We start with HEW's share of general tax revenue estimated on a basis that assumes conditions of full employment. To this we must apply the fiscal 1972 budget base of $71.7 billion, add the above-mentioned $8 billion in uncontrollable increases, and make such allocations as we can afford to newly enacted programs. Only what remains can be used for new initiatives, including the not-yet-enacted welfare and health insurance reforms.

These two boundaries-one behind us and one in front of us-lead to the inescapable conclusion: We must choose.

*Includes $3.6 billion in social security benefit increases in H.R. 1.

The President has the most complex and broadest choices to make. He must, within the constraints imposed on him, select from among efforts to improve the environment, to improve transportation, to make the Nation more secure at home and abroad, to bring sense and humanity to our welfare system, and from among a host of other worthy and pressing objectives.

The Secretary of HEW must choose among efforts to bring health services into poor neighborhoods, to increase the educational opportunities of children living in those same neighborhoods, to reduce the isolation of the aged, to offer alternatives to delinquency and drugs, and among many other objectives, all of which again are worthy and compelling.

And down through the tiers of government it goes, the inescapable necessity of choosing.

Choice is the basic reality, and for us it is doubly difficult and saddening because whatever we have to give up is not something bad or trivial, but something that is only somewhat less important, if that, than what we have selected to do.

Because choice is so important, because so many lives are affected by our choices, we must constantly improve the way in which choices are made. And those who review our choices-friends and foes alike-should understand how and why we made them.

How may we improve the way in which we make choices, the way in which we reach decisions?

IMPROVING DECISIONMAKING

WE

E MUST, first of all, create a process of rational decisionmaking that is both open and honest. The choices must be made clear and understandable, their advantages and disadvantages fully stated, and the alternatives brought into the light-as in the use of expanded nutrition or family planning services, instead of more medical services, to obtain a certain amount of improvement in health.

These requirements necessitate, in turn, that we carefully analyze issues, evaluate each of our existing efforts with respect to their impact on the problems they are supposed to affect, and systematically draw together all of our analytic and evaluative information to determine how any one decision will affect the Department as a whole. This places a heavy burden on us to gather and interpret data, but we cannot otherwise determine what the major problems are and what in fact is likely to help and at what cost. To be sure, values, feelings, and attitudes will always, as they should, play a large role in the final choice, but the effort to improve our analysis of the issues cannot help but increase the likelihood that the resulting decision will be sound.