dem bicycle. And as long as we continue to work together, we will get some of these things done, and we will make progress in health care programs no matter how many bumps and chuckholes are put in our

way.

Senator KENNEDY. Senator Magnuson, do you think the Congress is committed to make the program significant enough to do the job?

We have heard from the administration that it wants to send Corpsmen into only those underserved areas which have the money to financially underwrite them. I would like to try to find out from you, as we are going through this legislation, whether you think the Congress is going to appropriate sufficient funds to not only get health manpower and these personnel in areas which are underserved, that have the ability to pay, but also those that are underserved that do not have the ability to pay.

It seems to me that this is really one of the principal thrusts for the legislation, is it not?

Senator MAGNUSON. I am just confident that Congress will overwhelmingly approve a program that will do both.

Of course, I read in the morning paper that our HEW appropriation bill is going to get vetoed again-that would make two health appropriation bills vetoed since 1969.

I am the most vetoed Senator in Congress.

Here we are with these programs we have just talked about. Then the President's budget recommendations are even lower than they were last year.

Now, after Congress has overwhelmingly approved these programs I do not understand why the budget recommendations for these programs are so small.

The Health Service Corps is a particularly good program as are others of this type of program.

Senator KENNEDY. Let me ask if I could, Senator Magnuson, the regulations now give a priority to the underserved areas that have the ability to pay; they get the manpower, they get the preference, rather than the underserved areas that do not have the ability to

pay.

I was telling the Secretary that I saw no place in the legislation for that authority, and no place in the legislative history for that authority. That was not the intention of the supporters of the bill. Quite frankly, if it were left up to me, they would go into those areas that are in the greatest need.

Senator MAGNUSON. They should have the priority.

The whole legislative history of the bill points to just that conclusion. We have no objection to the other, either. We have got to get more manpower to do both. But the legislative intent of the bill was to zero in on these places that needed additional health personnel the most. regardless of their income levels. The legislative intent is the opposite of the priorities that the administration has imposed.

Thank you very much.

Senator KENNEDY. Thank you very much, Senator.

Senator MAGNUSON. I thank you for the opportunity of testifying, Senator Kennedy.

Senator KENNEDY. We will now resume with our administration witnesses.

TESTIMONY OF MERLIN K. DuVAL, M.D., ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR. VERNON E. WILSON, ADMINISTRATOR, HSMHA, DR. H. MacDONALD RIMPLE, DIRECTOR, NATIONAL HEALTH SERVICE CORPS-Resumed

Senator KENNEDY. Could I ask, Dr. DuVal, how long should the Corps stay in an area, what is your feeling?

Do you have a policy on this?

Dr. DUVAL. You mean the individual assignee, we have been using 2 years.

Senator KENNEDY. Then what happens? Will they be taken out of an area?

Dr. DUVAL. Of course, the person comes in. It will depend on what his own personal aspirations are for his future at the end of this period of time.

Obviously, we are attempting to work not only with him, but with the community and the local professional group to encourage him to remain in that community in a different status.

As I indicated in a response to a question, I think such success as this program has, will be measurable to the degree that it will be successful in having these people remain in the communities in which they have served their assignment.

Senator KENNEDY. There is really nothing in our history that would suggest any time limitation; this is a decision that is made from an administrative viewpoint.

Dr. DUVAL. We acknowledge the legislation did not speak to that in the constrained sense, and we might consider assignments longer.

Our first effort was to get the number of maximum applicants for the program, as reasonably possible, and we have to tie in the potential recruitment of the program to the military draft, and since that assignment under the military draft is 2 years, it seemed appropriate to make those 2-year assignments.

Senator KENNEDY. What was your idea, that you would have somebody go in a community for 2 years, and that would be the end of service to that community? Or would another person then take over for 2 more years?

Dr. DUVAL. Virtually all of those possibilities that you mentioned could apply.

The actual approach to the candidate would be to ask him to serve in that assigned area for 2 years.

At the end of that period, we would hope, even if he wanted to remain in the corps. he could remain in that community as an assignee.

Senator KENNEDY. What does the community understand, do they understand that after 2 years the man will be replaced and that they will then be on their own, or are we building people's expectations, and then they find that they have nobody?

Dr. DUVAL. The community understands this is a pilot experiment. in which the Government is attempting to help solve the problem at the local level by the assignment of the person.

In the end of the 2-year assignment, we are not promising to continue, but we would hope, No. 1, the person would remain in the Corps, or No. 2, he or she may remain there in a voluntary capacity, or, No. 3, inasmuch as it has been declared an underserved area, that community would be eligible for another person.

Senator KENNEDY. Where do we get pilot?

How much longer do you want us to extend the legislation, so the administration understands we do not have just a pilot program here, but we have a piece of continuing legislation?

Dr. DUVAL. The choice of the word "pilot" on my part goes only to the fact that it has been distinctly issued for the Government in terms of the contemporary and the past history on an assigned person into a primarily civilian responsibility, and that in that sense, this is a new enterprise, and as one begins to whet the appetite of a community, and as you have heard build expectations, it seems to me there is an element of responsibility we cannot chuck off lightly here, is has to be done in good faith, with an attempt to continue thereafter, so the first step would be in the nature of a pilot experiment.

Senator KENNEDY. This is a congressional determination, is it not? We have passed the law, we outlined the time period, we have the continuing legislation? Why does the administration feel that this is a pilot program? Maybe you have some reservations, but it is congressional intent.

Dr. DUVAL. I am not sure that requires an answer, Mr. Chairman. because it stands on its own as a statement.

I think our concern once again is only the fact that in view of the manner in which Congress approaches the many problems it does approach, it does put in place programs which by themselves will start its new efforts. Then as they begin to come up the scale sufficient to take on the entire program, it may be in the overall impossible, or be demonstrated to be impossible, that you cannot do all of them to the degree that is really necessary. This is the area in which the gap between the public expectations and performance will begin to increase, and we felt we should share this responsibility with Congress, making sure that expectations and delivery stay approximately parallel.

Senator KENNEDY. Would it be helpful for the Corps to provide travel expenses, with site visits of potential Corps members, that permit retired medical personnel to serve in the corps without diminution of retirement pay?

Dr. DUVAL. I would think there are many features of this that are attractive, and it is one of the things we have under advisement, and we will submit as one of the details of the 1974 budget proposal.

We are doing this now in some instances I am told by Dr. Wilson. Senator KENNEDY. It might be too late.

Would it help to allow equipment supplies to be turned over to local public agencies so that the community would be relieved of starter expenses?

Dr. DUVAL. We have also taken a position inside the Department. There are instances in which this probably would be very desirable. and maybe we would be including this as one of the recommendations in which I made specific reference in the testimony, when we come forward with the 1974 budget amendments. In view of the fact that this is not necessarily universally the best possible answer, we have to

fit this into other considerations, but at the moment, we are looking at this very favorably.

Senator KENNEDY. Thank you very much, Dr. DuVal.

There are a couple of issue papers on the Emergency Health Personnel Act, which are unofficial documents and lay out the various issues. I do not know whether you are familiar with them. If not, you are certainly to have copies of them, and if there is any comment you want to make relative to them, I think it would be useful to the members of the committee, in considering the different alternatives.

I would like to make those a part of the record; and if you would like to make any comment on them, you are welcome.

Dr. DUVAL. Thank you for letting us appear this morning, Mr. Chairman.

(The information referred to and subsequently supplied follows:)

ISSUE

ISSUE PAPERS ON THE EMERGENCY HEALTH PERSONNEL ACT

Should the legislative authority for the NHSC be extended beyond

June 30, 1973?

Discussion:

The Emergency Health Personnel Act of 1970, P.L. 91-623 was enacted

on December 31, 1970 despite the intitial opposition of the

Administration.

The President in his February 18, 1971 Health

Initial

Message incorporated into the Administration's health stategy the concept of the National Health Service Corp and announced a budget request for $10,000,000 to implement the new authority. Funds were not, however, finally appropriated until May 1971. assignments of personnel were made in January 1972 just over one year after enactment. The delay in assignment of personnel was due in large measure to the wage and price freeze and cutback of Federal employment.

There exists basic disagreement as to the underlying philosophy of the NHSC. Some congressmen and their constituents conceive of the Corps as a permanent commitment of the Federal Government to provide direct services to underserved areas. The Administration has

maintained that the Corps is no a final solution to the health care problems of shortage areas but rather represents a manpower training and services delivery experimentation program which may help to develop and demonstrate new methodologies for such things (1) improving manpower distribution, (2) reorganizing services utilization patterns in scarcity areas, (3) attracting skilled personnel to rural

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