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QUESTION 18:

Budget requests submitted to OMB for · Medical Care, Medical and
Prosthetic Research, Medical Administration and Miscellaneous
Operating Expense, and construction Appropriations?

ANSWER:

The following chart delineates the FY 1974 OMB requests for the above-mentioned appropriations:

1974 Estimate Appropriation

(In thous.)

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There are some startling facts included in these materials. For example:

The VA requested $173 million more for medical care for fiscal year 1974 than OMB decided, in its wisdom or nonwisdom, was needed, and VA's own doctors had estimated the need at fully $240 million more than that amount.

The VA itself requested $16.5 million more for medical and prosthetic research, and OMB's response was to cut the request back $5.8 million below the fiscal year 1973 appropriation amount.

The VA requested approximately $29 million to establish some 161 new specialized medical services, such as cardiac units, alcoholic treatment units, drug treatment centers, home dialysis programs, intensive care units, nuclear

medicine units, and pulmonary labs. All these were denied by OMB with the result that no new specialized units will be started in fiscal year 1974.

Other interesting facts are that the VA estimated the necessary average hospital census at 83,000 in its projections to OMB and OMB slashed it to 80,000 and at the same time added outpatient visits the VA itself had not anticipated.

Turning to construction needs, we find some startling revelations:

1. There is no money for air-conditioning of VA hospitals in this budget, as compared with reasonable progress in air-conditioning over the last 3 years. Funds for air-conditioning or planning airconditioning at eight VA hospitals were axed by OMB; some of them are in places where it gets quite warm: at Poplar Bluff, Mo.; Hartington, W. Va.; Kerrville, Tex.; Salisbury, N.C.; Gulfport, Miss.; Waco, Tex.; San Juan, P.R.; and Wichita, Kans. I would like to see the OMB decisionmakers give up their air-conditioned ivory towers in the EOB as readily as they deprive sweltering sick and disabled veterans in climates like these from a decent state of comfort.

2. $16,333,000 were deleted for urgently needed research and ed

3. One hundred beds and $7.4 million were slashed from the Loma Linda, Calif., hospital construction project without any demographic study on which to base such cuts. That is rather typical of a great many of the cuts in the different and diverse programs cut by OMB.

4. Worse yet, $21,712,000 were deleted for the urgently needed West Los Angeles Hospital to replace the condemned Wadsworth Hospital buildings. Why, is unclear. I intend to find out. We know why they were cut out, we don't know how they justified the cutout. The why of course being simply seeking to cut our budget down.

5. $15.9 million were stricken for the very badly needed Bronx, N.Y., replacement hospital which has been the subject of our very close scrutiny over the last several years. The scandal in conditions there were in part related to the conditions that were investigated. Now, that sort of faded from public attention. Apparently the administration proposes to drop the effort to really do what is needed doing there.

6. $5.2 million was cut out for the Columbia, S.C., new bed building, a project for which the ranking minority member of this subcommittee has labored most diligently for so long. I refer to Strom Thurmond.

ucation space.

There is much more, but that is the flavor. Mindless, apparently thoughtless, reductions here, cuts there, all laid down by arbitrary OMB fiat. Yet we can't question the real decisionmakers themselves to learn the real reasons why.

We intend to do our best to get to the bottom of this and to prevent any unwarranted program cutbacks and provide for necessary program expansions. Let me add, they will fit within our overall budget ceiling, lower than or consistent with the President's overall budget ceiling, because I believe there are cuts we can make elsewhere in less necessary programs, unnecessary programs, to insure that we can do what needs doing for the veterans of our country.

Finally, I want to stress that we are continuing to investigate areas where savings in the fiscal year 1974 budget can be carried out, and I am hopeful we can find some.

If any witnesses today can help us get our attention focused on places where cuts can be made consistent with first-class medical care, we want those called to our attention.

And, why did the Veterans’ Administration bow to a demand by the Office of Management and Budget that it slash by more than half its request for hospital construction funds in fiscal 1974 from the $211,118,000 originally recommended by the VA down to $100 million-flat? Which was obviously just taken out of the air, and obviously has no identification to needs.

We will also try to find out why the VA has requested no funds and taken no steps to implement Public Law 92–541, the VA Medical School Assistance and Health Manpower Training Act of 1972, which I authored in the Senate last Congress and the President signed into law on October 24, 1972.

We in Congress are getting rather tired of the ignoring of laws by the administration in an administration that states it is the law and order administration because there is neither law nor order in their approach to the law that is enacted by the Congress.

Now, I know that our able VA representatives in their testimony this morning will presumably attempt to show how everything is “A-OK” with the VA hospital program. It is their job to take that position. But I also know they have been saying that at these hearings since 1969, exactly that, and they have been contradicted by our expert witnesses and their own subsequent actions time and time again. The VA witnesses for these last 4 years have been telling us that they didn't need more funds, although they requested more funds before they got here and didn't need more hospital staff although they requested more hospital staff before they got here, and didn't need more medical equipment although they requested more medical equipment before they got here. Then, when we appropriated $450 million above the initial budget requests for the last 3 fiscal years, they went out and increased staffing by 8,600 in 1 month alone and continued hiring new hospital personnel so that by the close of fiscal year 1973 we will have provided for the addition of 19,000 new VĂ hospital workers since 1970. And I am proud that over all the opposition we have faced, we have managed to accomplish that. And the VA also used these same funds for equipment replacement, for construction, and for other urgent needs all of which they had officially denied existed when they appeared in congressional hearings. And I am glad the law was carried out in this respect. Over this time period they managed to spend most all of the $450 million Congress added to their budgets.

Now, to get to the work of learning more about all this. We start out with our first witnesses this morning, Mr. Rufus Wilson, Associate Deputy Administrator, and Dr. Marc J. Musser, Chief Medical Director, and supporting VA witnesses.

After that introductory statement, we welcome you, and we know that you will be as helpful to us as you can be.

STATEMENT OF RUFUS WILSON, ASSOCIATE DEPUTY ADMINIS

TRATOR, VETERANS' ADMINISTRATION, ACCOMPANIED BY DR. MARC J. MUSSER, CHIEF MEDICAL DIRECTOR, DEPARTMENT OF MEDICINE AND SURGERY; WINTON D. ROSS, DIRECTOR, BUDGET SERVICE, OFFICE OF THE CONTROLLER; VIGGO P. MILLER, ASSISTANT ADMINISTRATOR FOR CONSTRUCTION; AND A. T. BRONAUGH, ASSOCIATE GENERAL COUNSEL, THE VETERANS ADMINISTRATION

Mr. WILSON. Thank

you,

Mr. Chairman. First may I say that in addition to being accompanied by Dr. Musser as you have indicated, we do have another group of witnesses with us who could be called upon if necessary.

I am accompanied by Mr. A. T. Bronaugh, the Associate General Counsel; Mr. Winton Ross, the Director of the Budget Service of the Veterans Administration on my right; Mr. Elliott Wells, who is the Budget Staff Director of the Department of Medicine and Surgery; Mr. Dan Rosen who is the Director of the Management Services Staff of the D.M. & S.; Mr. Charles Peckarsky of the Administrator's Special Staff; Dr. Dayton Krajicek, the Director of our Dentistry Service; Dr. Thomas Newcomb, Chief of our Research Service; and Mr. Harry McKnight, who is the Deputy Chief of the Drug and Alcoholic Dependence program.

With your permission, Mr. Chairman, I have a 6-page statement which I would submit for the record and just briefly summarize. Following that, Mr. Chairman, I would like to ask Dr. Musser to make some comments. And the Doctor, sir, has a series of charts that he would like to flash up on the screen, and I think you have copies of those charts before you, too, so that you will be able to follow them without having to turn around and strain yourself.

My statement, Mr. Chairman, says briefly that the budget for the Department of Medicine and Surgery for the fiscal year 1974 would be about $2.7 billion, which will be the highest of course in the history of the Department of Medicine and Surgery.

It says that it will provide for inpatient treatment for a total of 1,108,900 beneficiaries, an increase of 27,500 over 1973, and 164,711 over 1972.

It says that outpatient medical visits will increase; a total of 275,000 outpatient dental examinations and 264,000 outpatient dental treatments will take place. And we will train some 62,000 medical and paramedical personnel, and that we have funds for the activation of six

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