facilities and, lastly, that the care of the statutory beneficiaries could be delegated to other Federal or non-Federal facilities.

We believe this view is short-sighted and strongly advocate a new mission for these hospitals, consonant with the needs of the 70's. We feel that they should continue to provide comprehensive medical care to their beneficiaries, an obligation that is mandated by statute and by a tradition that dates to 1798. Further, we question whether the Congress will look with favor upon any weakening of this program by administrative direction. In fact, it would appear that present law lodges in the Public Health Service full responsibility for medical and hospital care of merchant seamen, which responsibility, I would think, could not be properly delegated to the Veterans Administration or any other agency without the express action of the Congress.

We also recognize an enormous additional potential for such a cluster of Federal medical facilities: to pioneer and develop model health care delivery systems, which can be exported to the public in general; to foster research in new health care delivery techniques; to participate in the solution of the medical problems of the communities in which these centers are located, thereby utilizing the capacity of the system to provide needed medical care to under-served community populations; to serve as a clinical and operational base for the proposed Health Service Corps; to broaden the teaching and training programs for health experts and paramedical personnel; and to provide health manpower for the Federal career system and the private sector of the community.

We earnestly solicit your support for the maintenance and improvement of these hospitals and clinics.

Sincerely,

EARL W. CLARK,
HOYT S. HADDOCK,
Codirectors.

PUBLIC HEALTH SERVICE HOSPITAL AND CLINIC DATA-DECEMBER 1970

8 Hospitals and 30 Outpatient Clinics located in 32 states plus Puerto Rico and D.C.

The CHAIRMAN. In the first paragraph you say it has been reliably reported that a proposal is in the White House. Would you care to comment on that?

Mr. CLARK. I would prefer, Mr. Chairman, unless the committee. suggests otherwise, not to divulge those sources. We have several sources where this is understood. It is not just in HEW, although I think this year HEW is moving more closely to the Bureau of the Budget than it did back in 1965.

But we understand the discussions have been held and recommendations made. I think there are other witnesses who may want to speak more individually on that than I, but unless you insist I would prefer not to divulge my sources.

The CHAIRMAN. Are there any questions?

Mr. MURPHY. Mr. Chairman, I want to congratulate the gentleman on an excellent statement.

I would like to say just this year I was a speaker at the graduation of 50 persons who had finished a labor-sponsored program at the Public Health Service Hospital in Clifton, Staten Island. These men had gone through a 9-month intensive training program with their medical skill and ability to care for the merchant seamen on board the ships on which they serve as well as passengers, place them in a category just under a medical doctor.

The capability of those men in performing their medical expertise in conditions and in areas where no doctor could meet the emergencies that they have to meet is certainly an indicator of the need and necessity to have a Public Health Service training plan.

I would like to supplant your comments and say this Public Health Service plan is necessary for merchant seamen. We have a hospital situation in the United States where a single bed is rated at $100 occupancy per day, and that cost certainly is not going to diminish.

I liken public medicine and private medicine to the problems we have in this country in private power and public power, and how do we arrive at a standard for the cost of medical standard unless we have some type of national public health standard?

Unless we know what this type of medicine and medical care is going to cost, how can we throw all of our medicine into, let's say, private hands and watch this spiralling cost actually price us out of the medical business?

Mr. CLARK. Back in 1965 when we did this study, the hospital care in private institutions at this time was estimated at being over twice the expense in the PHS hospitals. I am sure that the skyrocketing of medical costs since that time has gone through the roof.

After they throw as many of these seamen in the veterans' hospitals as they can, the rest will be cared for under contract, that is in the areas where they do not have veterans' hospitals, and there are quite large areas of the country where that would happen.

I can't visualize how high the costs will go under contract because those would be private physicians and private facilities.

Mr. MURPHY. Precisely, and one of the arguments advanced to me. by the Public Health Service a couple of years ago when a multiphasic physical testing mechanism was installed at the hospital was this very cost-conscious understanding on the part of the Public Health Service that they could perform medical service at a minimum

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cost as compared with a private facility, and here we are embarking on a mission to throw into the private sector with no standard, not just for the seamen, but for the American public.

Mr. CLARK. Íf I may at that point, Mr. Murphy, since it relates directly to your question and discussion, we filed-and, Mr. Chairman, I should like to address this to you, also, and the committee-on December 2, we filed with the Honorable Harley O. Staggers a letter in support of H.R. 19246.

That is a bill which would authorize money for use in the ghetto areas around the country where medical and hospital care and dental and nursing care is somewhat deficient. We testified in favor of this. I think your own distinguished Congressman, Mr. Rogers, was in the chair perhaps at that time, in testimony on this bill.

Now, what that bill would do would be to increase the beneficiaries in the Public Health Service hospitals because the bill provides that that care be given in these hospitals.

I don't know how you can have such a dichotomy. I am speaking now not of the Congress, but totally-Congress and the Executiveon the one hand we are saying we need more care in the ghetto area, we need this H.R. 19246, and on the other hand, we say, do away with the Public Health Service hospitals.

I would like to file a copy of this letter in your record also because I think it relates to the total responsibilities that the Public Health Service would have if this bill is passed. The movements are converse and in opposite directions.

Mr. MURPHY. Does this gentleman know the Congress has not received a Presidential health message nor any consequential health legislation?

Mr. CLARK. I have not seen it.

Mr. MURPHY. No one has seen it because it is nonexistent.

Mr. CLARK. Would the Chair permit the filing of this letter in the record?

The CHAIRMAN. Yes.

(The letter follows:)

LABOR-MANAGEMENT MARITIME COMMITTEE,

Washington, D.C., December 2, 1970.

Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: We are writing on behalf of the Labor-Management Maritime Committee to express our appreciation for your introduction of H.R. 19246 and the scheduling of hearings on this most important piece of legislation. We hope that it will be approved by the House and signed into law prior to the adjournment of the 91st Congress.

Let us take this opportunity to point out that the funds that are authorized to be appropriated in this legislation are small indeed in comparison with the benefits that would be derived in terms of providing health manpower in urban and rural areas where severe shortages of physicians, dentists, and nurses, as well as other members of the health care team, prevail. In addition, this legislation would give the Public Health Service the opportunity to take a more aggressive role in providing leadership to improve the organization and delivery of health services. Furthermore, this legislation would greatly strengthen the personnel system of the Public Health Service. We favor its passage.

Respectfully,

EARL W. CLARK,

HOYT S. HADDOCK,

Codirectors.

Mr. CLARK. On the question of eligibility of beneficiaries I have a document here-and I think the facts have not changed since 1965. It is not a lengthy document, but it gives the dates on which beneficiaries to the Public Health Service hospitals were acted upon by the Congress.

What I mean by that is you have here a list including the commissioned officers of the Public Health Service, the Coast Guard, the unemployment compensation cases, and so forth. I think this would be helpful to the committee in the record. You could see also how, beginning in 1912, the marine hospital designation was taken away and it was made Public Health Service. It was done because they were bringing in more than marine cases. That is why they changed the name. They were expanding it beyond marine cases.

Let me say this: We don't think we should be silly enough to insist upon a hospital staying open where the caseload of seamen does not warrant it. I mean by that, you don't want to have more captains than you do footmen. We don't want to defend the indefensible, but the fault is not in that category.

The fault is that the service of the Public Health Service has not been expanded to meet the needs of the community so that you don't have to rely any more solely on seamen, You rely on other beneficiaries who are in bad need of care.

What are we going to do? Tear down these hospitals and build some more?

To show you the progress of adding other beneficiaries, I would like to have these pages which I will identify, with the permission of the Chair, pages 40, of this document, which I will identify as Medical and Hospital Care for Merchant Seamen, volume 1, published in 1964 by the Labor-Management Maritime Committee, pages 40, 41 and the top of 42, because it will show you exactly what has been done in the past.

(The information follows:)

LEGISLATIVE HISTORY OF PUBLIC HEALTH SERVICE BENEFICIARY ENACTMENTS

ACT AND CLASS OF BENEFICIARIES

June 23, 1913: Commissioned Officers of the Public Health Service Also included full-time field employees of the Public Health Service when sick or injured in line of duty. (Medical Officers had been previously designated as beneficiaries by regulation issued in 1902.)

January 28, 1915: Established Coast Guard and blanketed in Revenue Cutter Service and Coast and Geodetic Survey-Beneficiaries of both those Services included.

Act of 1916: U.S. Employees Compensation Act--All persons eligible for treatment or hospitalization thereunder were made eligible for Marine Hospital

care.

August 28, 1916: Officers and Crews of the Lighthouse Establishment (May 22, 1926-Consolidated with the Coast Guard).

Act of 1917: Act to Establish National Leprosarium for Treatment of Leprosy. Nature of disease itself determines the admissions.

August 9, 1917: Beneficiaries of War Risk Insurance-Bureau of the Treasury Department. (August 9, 1921-Transferred to Veterans Bureau. Also since that date, beneficiaries of Veterans Administration admitted on a reimbursable basis.)

July 1, 1918: Among other things, made Officers and Crews of certain vessels of Bureau of Fisheries (Now Fish and Wild Life) eligible for care without charge.

March 3, 1919: Coast Guard Officers and Enlisted Men.
Employed Seamen on Vessels of Mississippi River Commission.
Employed Seamen on Vessels-Army Corps of Engineers.
Keepers and Crews of United States Life-Saving Service.
Officers and Crews-Vessels of Coast and Geodetic Survey.

Seamen Employees on Army Transports on Other U.S. Army Vessels other than Officers or Enlisted Men.

May 18, 1928: Retired Coast Guard Officers and Enlisted Men (July 30, 1937Codified prior Statutes relating to Medical Care for personnel of Coast Guard). Act of 1929: Act to authorize construction of hospitals for treatment of narcotic diseases. Created Narcotic Division in Public Health Service. Nature of the disease itself determines admissions.

March 3, 1931: Officers and Employees of the Public Health Service of U.S. ports when on duty at National Quarantine Stations or on board National Quarantine Vessels-Also when detailed to duties in foreign ports.

March 21, 1936: Civilian Seamen employed on vessels of the U.S. Government (more than 5 tons) and seamen employed on State School Ships.

July 30, 1937: Dependents of members of the Coast Guard.

April 26, 1939: Dependents of members of the Coast and Geodetic Survey. July 1, 1944: Civilian personnel of former Lighthouse Service not militarized under the Coast Guard and Lighthouse Service personnel having eligibility under former Statutes continued as eligible.

Retired Officers of the Public Health Service. (The dependents of the Coast Guard and Coast Geodetic Survey covered under the Acts of 1937 and 1939 above were also continued.) Enrollees of the Maritime Service Members of the Merchant Marine Cadet Corps. War Shipping Administrationincluded only seamen employed on U.S. or foreign flag vessels. (This Act also provided to beneficiaries care without charge.)

Persons detained under Immigration and Naturalization Service. Seamen employed on foreign flag vessels owned and operated by citizens or corporations of the U.S., as a wartime measure only, were entitled to Marine Hospital care without charge.

From January 1, 1944 through June 30, 1948, active duty personnel of the Navy and Marine Corps (wartime measure)-may be extended at other times only on a reimbursable basis. (Out-patient care was also provided under this Act.) (Reference 1, Listing based upon content in pp. 32-52.) Mr. CLARK. I think this needs to be expanded in terms of our current medical needs around the country.

Mr. DOWNING. Can you give us the various categories of beneficiaries?

Mr. CLARK. Yes; and I would say if there have been new ones, I am not familiar with them. I think this is perhaps the latest. We might check to see if there have been any others since the last date which was July 1, 1940.

I will abbreviate this, if I may.

June 23, 1913-Commissioned officers of the Public Health Service. January 28, 1915-Established Coast Guard as beneficiaries and it also blanketed in Revenue Cutter Service and Coast and Geodetic Survey. Beneficiaries of both these services were included in the act. of 1916.

Act of 1916-U.S. Employment Compensation Act, all persons eligible for treatment or hospitalization.

August 28, 1916-Officers and crews of the Lighthouse Establish

ment.

Act of 1917-That established the National Leprosarium in Louisiana.

August 9, 1917-Beneficiaries of War Risk Insurance. That had to do with World War I.

Then we had on July 1, 1918, officers and crews of certain vessels of the Bureau of Fisheries and Wildlife.