better coordinate your planning if the funds are administered by a

health agency.

Mr. PICKLE. Don't you think this would create additional expense if you transferred this function over to the Surgeon General?

Dr. TEAGUE. I am sorry, I don't know.

Mr. PICKLE. You just have a "general" feeling that you would like to have it transferred over.

Dr. TEAGUE. When a person applies to HHFA and wants to build a nursing home in my State, we administer it in the health department at the State level. At least we approve the application to HHFA as a part of our overall plan, and it just seems to me that the people here who administer the nationwide Hill-Burton program could also have a part in these applications for mortgage insurance loans.

Mr. PICKLE. Do you think if it was transferred over to the Surgeon General that this would in effect give more Government control over the health problems and needs of the country?

Dr. TEAGUE. I don't think so. I just can't conceive of that. It is an insured loan. That is what it amounts to, and the advantage of borrowing it that way other than through some other mechanism, would be the low-interest rates, or the longer period of amortization. Mr. KORNEGAY. Would the gentleman yield at that point? Mr. PICKLE. Yes, sir; I yield.

Mr. KORNEGAY. Dr. Teague, of course they are going to have to meet certain standards and specifications, anyway, regardless of who has the authority to lend the money. Isn't that right?

Dr. TEAGUE. That is right.

Mr. KORNEGAY. So, from the standpoint of adequacy of the facility, and meeting the high standards that would be imposed, that would be carried out through the administrators at the State level?

Dr. TEAGUE. Yes, sir. By the way, may I make one comment on one section in this bill? It is the part that provides some money for State administration of this program. There is no Federal money that goes to the State health department for administering HillBurton. The States appropriated some money, back in 1946, to start these programs and in most States this has not increased since.

Meantime, the program has doubled, tripled, and quadrupled, including the amount of inspection services needed. I would certainly be very much for the portion of this bill that provides that up to 2 percent of the total funds might be used for administering the program, not to exceed $50,000 for any one State, and no State can cut back on the money they are now spending this is over and above what they are now spending. Then, we would put on some very necessary staff people to help with the planning, and the programing, and inspection services, in the Hill-Burton and the nursing home

program.

Mr. KORNEGAY. That is all.

Mr. PICKLE. I didn't understand your question. What was your question again?

Mr. KORNEGAY. He is talking about transferring the authority from the FHA over to the Surgeon General. My question was that the standards had to be met, and my point was the fact that it is

just like building a house. The contractor or the architect sets the standards, the design, and yet you go to the bank, or the building and loan, to get the money. If the architect was setting the price on it, or the amount of money to put in it, there just wouldn't be any ceiling on the thing.

That would be the point that would concern me about this transfer. Mr. PICKLE. Yes. I share that view.

Mr. KORNEGAY. But you have a check and balance here when you have some banker in the picture.

Dr. TEAGUE. There is one thing about these standards that bothers us a little bit. The FHHA approves narrow corridors for homes for the aged, and we in the Hill-Burton program have different standards. I think that all health programs ought to be in a health-oriented agency, whether it is insuring a loan or what, because we do have something to say about the standards-much more to say about the standards if it is in a health agency than if it is in a financing agency. What the Federal Government is really doing here is just insuring a loan at a certain rate of interest.

Mr. KORNEGAY. My point as this, Dr. Teague, and it is not to get on anybody at all: in anything, it is good to sort of have a check and a balance on it.

Dr. TEAGUE. Right.

Mr. KORNEGAY. And I am thinking about this. Take an architect who is an artist. He wants to make a creation here, he sets the amount of money that he is spending, and yet it isn't his money. Then, there is just no ceiling on where it is going. You see?

Dr. TEAGUE. Yes, sir.

Mr. KORNEGAY. As I look out the window to the right here, maybe we in Congress ought not to raise the point, but it is a point.

Mr. PICKLE. Thank you, Doctor. I wanted to get your views on it. That is all, Mr. Chairman.

Mr. STAGGERS. Any questions?

Mr. DINGELL. No questions, Mr. Chairman.

Mr. STAGGERS. Doctor, we certainly appreciate the fact that you come here from Kentucky to give us the benefit of your views in representing the American Public Health Association. I think, as I said to start with, they were very short, very concise, and very emphatic. Thank you, gentlemen.

Dr. TEAGUE. Our association appreciates the privilege and opportunity. Thank you.

Mr. STAGGERS. Fine. Have a nice trip back home.

Dr. TEAGUE. Thank you.

Mr. STAGGERS. At this time we will call on our colleague from Georgia, Charles Weltner, to introduce his constituent. I would like to say, in behalf of Chuck Weltner, that he is not only well liked and an able colleague of ours, but he is distinguished by one quality that to me is sorely needed in American life today, and that is the courage of his convictions.

Chuck, we are glad to have you with us, and if you would proceed to introduce your constituent we would be happy to have you do so.

FURTHER STATEMENT OF HON. CHARLES L. WELTNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA

Mr. WELTNER. Thank you, Mr. Chairman. Members of the committee, it is a pleasure to appear to introduce my constituent, Mr. Charles O. Emmerich, Jr., a resident of the Fifth District of Georgia, who is serving with distinction as chairman of the De Kalb County Board of Commissioners. Mr. Emmerich appears here today as chairman of the committee on health and education of the National Association of Counties, and he is the spokesman for that association. He is a man whose views have been called upon before by this committee.

Last year, I had the privilege of introducing him before Mr. Roberts' subcommittee, during the hearings held on the far-reaching mental health and retardation bills. I commend Mr. Emmerich's abilities and his views to this committee, and thank you for this opportunity. Mr. STAGGERS. Thank you, Chuck. Mr. Emmerich, with that fine sendoff from our colleague, we will certainly be happy to hear from you and have your views. Will you state your name and position for the record.

STATEMENT OF CHARLES EMMERICH, COUNTY COMMISSIONER OF DE KALB COUNTY, GA.

Mr. EMMERICH. Mr. Charles O. Emmerich. Mr. Chairman, I would like to forgo the reading of this statement-you have copies— and let me just submit it for the record.

Mr. STAGGERS. That will be done. We would be glad to have your summary of your position.

Mr. EMMERICH. Thank you. I would like to summarize it right quickly. I think it would be almost foolish of me to spend a great deal of time expressing our feeling on the Hill-Burton program. This is one of the fine things that has come out of Washington and it is a fine program where the State, the Federal Government, and the local governments have played an important part in doing an excellent service to mankind. This I think is terribly important. would like for a couple of seconds to refer back to my own State of Georgia where we are spending in the neighborhood of $18 million annually for critical, needed facilities and we are spending in the neighborhood of $100 million for facility services.

I

At the same time we still need about 5,000 additional beds—I am talking about general hospital beds and we could use about 10,000 additional beds for the mentally ill and retarded, and about 12,000 beds for long-term care, including nursing homes. This list could be even lengthened. The fact is the list that we have on hand now runs about $76 million of needs at this time.

Georgia also has a deficit of about 80 percent in its both rehabilitation facilities and diagnostic treatment centers, which is extremely important to this whole health program. When you add this need to the other 49 States you can easily grasp the size of the program that we are talking about and the overwhelming needs.

I wouldn't try to dramatize this program. I don't think it could be overdramatized. The need is great in our country and I hope

that nothing will be said that will harm the program in general. This we would sponsor and agree with. The National Association of Counties which represents 3,043 counties in this country, have participated in this program. They have actually been a part of 2,224 Hill-Burton projects where the combined expenditures amounted to $1,645 million and the Federal share of this was $619 million. This seems to be a good investment from the standpoint of the Federal Government too.

This does not include another 164 projects where cities and counties worked together and had projects approved. The thing that I like about the new bill, which to me is very important, is, first, the funds provide for modernization. This is a longfelt need and we have realized for many years that something should be done about it. This is particularly true in the great metro areas throughout the country. You now have in the neighborhood of 212 such metropolitan complexes that are growing up and sometimes politically are not so strong statewide, but from the standpoint of population and need it is very obvious and very great and it is my hope that you will do everything to keep this part of the program in the program and, for that matter, strengthen it.

I believe of the three suggested bills that the bill we discuss this morning has the least amount in that area. We could actually probably have profitably gone up to a third of the money available in this new field because we are so far behind in our modernization program.

I think too that there are other parts of the program that are worth thinking about and one is the allocation of funds which has been discussed here this morning. We like the old formula that has been used for years as far as the new facilities are concerned, but when you get into this new program-this is a brand new program-while I like flexibility in administration I think that we ought to tie down some of this to be sure that we actually are going to get this new service in the area where it is needed.

It ought to lean in the direction I believe of the great cities that are being formed and I think this is important. Our organization has not taken a definite stand on this particular point, but I do quote here a part of a report which has not been printed, but we have had the privilege of reading, which was made by the Advisory Commission on Intergovernmental Relations and they come up with a stated policy which I think is good and one that is in my report there. We have actually sponsored the report itself, so I think I would be in keeping in saying that we would probably be responsible for this idea, and they are here saying when referring to equalization provisions that we should aim for a reasonable and uniform level of minimum program performance in every State; that uniformity in the mechanics of the equalization provisions is preferable over a variety; and that statutory specifications are preferable to administrative discretions.

This is a questionable item, but we feel it has merit and I hope you will consider this in your program.

These are the general remarks we would like to make. I know this is a very short period to appear here, but this program is so important to our country and its health that we wanted at least the chance to come here and say thank you that you are willing to take your time to listen to the public and thank you for the privilege of presenting the ideas as outlined in this record.

30-883-64- -12

(The statement referred to follows:)

STATEMENT FOR THE NATIONAL ASSOCIATION OF COUNTIES ON H.R. 10041, HOSPITAL AND MEDICAL FACILITIES AMENDMENTS OF 1964 BY CHARLES EMMERICH, CHAIRMAN, BOARD OF COUNTY COMMISSIONERS, DE KALB COUNTY, Ga.

Mr. Chairman and members of the committee, my name is Charles Emmerich and I am appearing here today on behalf of the National Association of Counties, an organization representing county government throughout the Nation. I am chairman of the board of county commissioners of De Kalb County, Ga., and serve in a similiar capacity for the committee on health and education of the National Association of Counties.

The success and continued need of the Hill-Burton program is well known to all persons associated with it. County government's experience particularly qualifies it to request an extension of the program and an accelerated pace.

You will note from the following table that county governments have sponsored 33 percent of all approved Hill-Burton projects. This percentage does not include the 164 joint city-county projects, built at a cost of $144 million. Counties have contributed in excess of $1 billion to these Hill-Burton projects in addition to the millions spent on other health facilities not associated with the program. Hill-Burton projects, 1948–June 30, 1964

We feel the time is long overdue for this program to recognize more fully the need to modernize our large urban county and city hospitals. The need for modernization is not limited to those areas; however, they should receive a substantial percentage of the funds made available for modernization.

We appreciate the fact that H.R. 10041 provides considerable latitude in transferring funds from one category to another if such transfer will better carry out purposes of title, or if there has been no approvable application. Notwithstanding, we favor a larger dollar figure being specifically earmarked for modernization than does H.R. 10041.

PLANNING

We naturally support the concept of comprehensive planning for health facilities. It is interesting to note the trend in Federal legislation to encourage comprehensive planning, and oftentimes making it a requirement for Federal assistance.

In this respect, we suggest that comprehensive planning for health facilities should not be limited to a coordination of other health facilities. It should also consider the other factors inherent in comprehensive planning, such as transportation, water and sewage facilities, open space, etc. We suggest the committee consider the feasibility of having the planning envisioned in this proposal coordinated with other planning going on in the area, such as the 701 comprehensive planning program of the Housing and Home Finance Agency.

ALLOCATION OF FUNDS

As we understand H.R. 10041 and the draft bill submitted by the administration, the funds for modernization would be allocated to the States under a different formula than those funds allocated for new construction. Due to its relevance to this proposal, we should like to bring to the attention of the committee a recent report and accompanying recommendations adopted by the advisory commission on intergovernmental relations. As you know, this commission is composed of representatives from every level of Government and includes in its membership the secretary of the department administering this