COMMITTEE:

JOHNE.FOGARTY
APPROPRIATIONS

2D DIsTRICT, RHODE ISLAND

Moves Grr on Congress of the United States
Se cestonnaiet 150. House of Representatives

PRoviDENCcE 3, R. I.

Washington, B. €.

October 23, 1957

Dear Friend:

A few weeks ago I had the happy
privilege of addressing the annual convention of
the American Hospital Association at Atlantic
City, Neds Knowing of your close affiliation
with and interest in the field of hospital admin-
istration, I thought you might like to have the
enclosed copy of the speech I made on that occa-
sion.

I'd be pleased to have any comments
you might care to make after you have had the
opportunity of reviewing my remarks.

With kindest regards, I am

Very sincerely yours,

<
John E. Fdégarty
Member of Congress
THE AMERICAN HOSPITAL ASSOCIATION

On The Occasion Of Its

59th ANNUAL CONVENTION

ELECTS

THE HONORABLE JOHN EF FOGARTY

MEMBER OF CONGRESS

TO HONORARY MEMBERSHIP

In Recognition Of His Outstanding Efforts Toward

The Improvement Of The Nation's Health

ATLANTIC CITY, Nod. OCTOBER 2, 1957
REMARKS OF HONORABLE JOHN E. FOGARTY, M. C.,

2nd DISTRICT OF RHODE ISLAND, AT ANNUAL CONVENTION
OF THE AMERICAN HOSPITAL ASSOCIATION IN ATLANTIC
CITY, WEDNESDAY, OCTOBER 2, 1957.

It seems to me there is a kind of poetic justice in this occasion. For
many years, I have sat in Congressional hearings and listened to the testimony
on health legislation proposed by the American Hospital Association and other
groups in the health professions. It was very kind of you to give me the
opportunity to have my hearing. I only hope you will benefit at least a
fraction as much as I have been benefited by listening to you.

I was very pleased when Dr. Crosby invited me to be with you today,
because I have been convinced for a long time that we need more opportunities
to talk about the health problems that concern all of us. These problems are
as complex as any that face us today--national or international. And the
decisions we make in the months ahead may influence generations to come.

There are still a few people in our country who cling to the notion that
legislation--especially Federal legislation--is something to fear. They think
that as surely as day is followed by night, legislation will be followed by

regulation.

I find it a little difficult to understand this attitude because I
know--as you do--of some very successful programs carried on in harmonious
cooperation by the Federal Government, the States and communities, national
organizations, universities and others. Therefore, I have the fullest
confidence that we can~-as we have before--work out the means by which the
Federal Government can serve the best interests of all the people, without
trespassing upon their rights, weakening their initiative or diminishing their
authority. Again and again, we have demonstrated that our Government is truly
the instrument of the people.

During my sixteen years in Congress, as a representative of the people
of Rhode Isiand, health legislation has been one of my major interests. As
Chairman of the sub-committee in the House ef Representatives which considers
appropriations for the Department of Health, Education, and Welfare, it has
been my honor to give some leadership in providing the Federal support, in
maintaining the State and local rights and responsibilities, which our national
health programs must have if we are to advance the conquest of disease.

During the years of my membership on this Committee, some of the
greatest advances in medical history have been made, and I have heard it said
that the past decade has seen more medical research and public health progress
than any comparable period in all the history of our country.

Last year, the Washington Report on the Medical Sciences, an impartial
and non-partisan publication, commended our legislative endeavors saying that
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", « « strong Congressional leadership . . . steered the bills through,
shaping and reshaping them to meet practical requirements and seeing to it
that ample funds to implement new laws were provided.”

It has given me great pride to have a share in this. You may be sure
that I shall continue my devotion to further advances in health legislation.

This afternoon, I would like to discuss two basic questions that concern
all of us.

First: What kinds of health services will be required of our hospitals
in the years ahead, and what types of facilities must we provide to extend
these services to the people.

Second: How can we finance the services and facilities we need?

EHarlier this year, the late Dr. Alan Gregg issued a challenge to all of
us when he said that we must make better use of the immense store of knowledge
we have today to give our people the opportunity to realize "the positive goal
of maintaining health... . " This concept of health maintenance is a blend
of both preventive and curative medicine, with emphasis on prevention. I am
convinced that it will be the kind of medical care practiced in the future.

In its simplest terms, preventive medical care is nothing more than
using the wonderful medical knowledge we now have to prevent illness and build
up our health, Pediatricians have been practicing this type of preventive
medicine for years. Other branches of the medical profession have now begun
to move more positively in the same direction for several reasons. First, the
increasing volume of knowledge available has made it possible for the physician
to give his patient more complete and more effective instructions for maintain-
ing his health. Second, the necessarily increasing costs of medical care have
given patients added incentive to guard their health. Slowly, but surely, we
are coming to recognize the fact that we can have preventive medical care for
a few dollars a month. If we wait until we get sick to do something about our
health, it may cost us several times more per day than we would spend per
month to prevent illness. In addition, illness may cut off income and disrupt
family life.

But what does this trend toward preventive medical care mean to our
hospitals?

I believe it is safe to predict that, within the next 25 years, virtually
every general hospital in the Nation will be providing at least as much preven-
tive service as curative service.

Many of you have already gone far in this direction. For example, you
are providing equipment and services for the use of your medical staff in the
early diagnosis of cancer, tuberculosis and other diseases which may bring
costly, long term illness to your patients. In recognition of the fact that
rehabilitation is an essential part of modern medical care, many of you are
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providing these services. Others are experimenting with home care programs.
More and more of you are working closer with your local health department,
welfare department and similar commmity health services. You are, in fact,
moving closer each moment to the day when hospitals will be the focal point of
health services for all of us, throughout our entire lives.

I realize that progress toward more preventive hospital service is related
directly to the difficult and aggravating problems that confront a hospital
administrator from day to day. For example, the problems rising costs bring to
your desk each day, the irksome turnover in lower-paid jobs, the constant need
for more nurses, the ever-present threat of the deficit.

However, the Government is attempting to give you some help, at least in
some areas. Under the Hill-Burton program, as you know, Congress has appropriated
funds for research in a variety of Pields related to hospital administration,
such as development of a scientific personnel system, a survey to develop
standard terminology in connection with blood banks, among many others equally
as interesting and important.

The Public Health Service is making admirable progress in the program
to help hospitals make better use of skilled nursing personnel. The Division of
Nursing Resources reports that nearly 150 hospitals in 16 States have undertaken
surveys to improve nursing services. The Congress also provided funds for the
education of nurses who will take over administrative and teaching positions.
These and other Federal programs, will, I am sure, help to ease the burdens you
bear.

In view of the high purpose to which our hospitals are dedicated, it seems
a shame that there isn't some easy, miraculous formule by which the problems of
administration can be solved. I am quite sure that dedication to healing the
ills and guarding the well-being of mankind is closer to Godliness than the
virtue of cleanliness. But this nearness to Divinity enjoyed by a hospital is
no substitute for good management.

We have come a long way from the old days when a cast-off mansion was
considered to be a desirable place for the care of the sick. Today's complex
center for medical care is designed to fit the specific services it provides to
patients, as well as possible plans for expansion.

Much of this remarkable progress is due to the consistent efforts of the
American Hospital Association to make our hospitals the finest in the world, and
to the accreditation program which assures the highest standards of hospital care,

Another major factor is the Hill-Burton program, established by Congress
in 1946 at the request of the American Hospital Association, the American
Medical Assocation and many other organizations and agencies. I am convinced
that the perseverance and vision which served the Nation so well then, will
again be at our command as we plan for the future. In the li years of this
bi-partisan, Federal, State and local program, we have developed comprehensive
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plans, State by State, for the construction of health facilities. Hospital
design has been advanced by two decades or more. More than 3,500 projects have
been approved for construction, with most of them now completed and in operation.

It seems quite evident that the general hospitals of the future will have
a far greater range of services, including expanded outpatient departments,
rehavilitation facilities, and areas for the chronically ill. It seems possible
that many hospitals will develop accommodations for patients who do not need the
full range of hospital services. I believe the greatest change will come in the
planning and administration of facilities and programs outside the hospital
where medical direction is needed.

Nursing homes provide a good example. Unfortunately, we are still in the
"cast-off mansion" era of nursing homes. I was shocked, as I know you were, to
note that the National Fire Protection Association has declared that nursing
homes are at the top of the list of unsafe places to live. In the last ten years,
fifteen tragic nursing home fires have taken the lives of nearly 300 people.

We know the need for nursing homes is very great. It is estimated that at
least 25 percent of the general hospital beds now occupied by patients with
chronic iliness could ce released for other patients, if nursing homes were
available. Under the Hill-Burton program 86 non-profit nursing homes have been
approved for construction. Most of these are affiliated with hospitels. They

re modern, safe, convenient, pleasant to live in and far less costly to build
than a hospital. It is true that there are fine proprietary, voluntary non-
profit and public nursing homes in the country, but the need is urgent and we
must build many more as rapidly as possibile. In doing this we must safeguard
the future inhabitants by maintaining adequate construction standards and
promoting a high level of success. On the other hand we must guard against soe
called institutional atmosphere and retain as much of the home environment as
possible. The facilities will be in fact the home for years of many of their
guests.

The experience of this Association and tts members can be of very great
value, as we develop future pians for providing these facilities and others.
Although they are not hospitals, they are cirectly related to hospital care, and
your knowledge of planning and administration will be invaluable.

The Hill-Burton program has been tremendously successful in aiding the
growth of health resources, but I do not think we can continue indefinitely to
retain the limits of the present pattern of operation. I would urge you,
therefore, to think in terms of developing new proposals to meet future needs
with the aid of the basic Hill-Burton legislation.

The financing of hospital and medical care is one of the most difficult
proolems confronting us today. Major sources of finance will, I believe, continue
to be private insurance and government.

Health services by their very nature must cost a lot of money because
they often involve complex treatment which can only be administered by many
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people with great skill. The value of these services to each of us is beyond
reckoning. What man will place a price on the surgery that saves his life?
Who will set a fair fee for the early diagnosis and treatment of malignant cancer?

The growth of health insurance in the past quarter century is the single
most remarkable development in the entire fielc of medical economics. ‘The
American Hospital Association has earned the gratitude of the Nation for its
ieadership in the development of Blue Cross.

I have always felt that it would be possible for us to establish a
system of health insurance with private resources, and I am tremendously pleased
to note that more than 118 million persons in the country now have some form of
heaith and medical coverage. But since this method of paying for health services
has a direc’ bearing upon the future financing of our hospitals and upon the
very health of our peopie, I think we cannot afford to permit ourselves to be
overwhelmed with our own success. We must hold it at arm's length to see it for
what it really is.

Since the time when health insurance was first proposed, we have
concentrated upon its value in helping the individual to pay for certain types
of medical care, most of which was unpredictable. Considerabie emphasis has
been given to firming up the financial soundness of this type of insurance, and
rightly so. Now, it seems to me, we have reached the point where we must
recognize that the ultimate success of private health insurance depends upon
the quality and quantity of coverage it provides.

What good is a health insurance policy to a man with a broken back, if
only a fraction of his expenses are paid, if benefits are cut off before he is
out of the hospital, if his policy is cancelled? It's easy to say he gets as
much as he pays for. But that argument only ignores the fundamental principles
upon which health insurance must be developed and upon vhich its future depends.

It is essential that health insurance must be financially sound. But
we must apply the principles of insurance with constant awareness of the fact
that it is an instrument to protect the welfare of the individual and his
family.

The physician and the hospital have played the major role in shaping
health insurance for the benefit of the individual. But I would like to take
this opportunity to urge you to exert your influence even more effectively in
shaping the pattern of health insurance to fit the needs of the future.

One of the greatest opportunities lies in the field of protection against
catastrophic ilimess. Insurance in this field, so far, is very limited in many
ways. We know that the incidence of long-term illness with seriously crippling
effects is relatively low. Still the need for protection is nation-wide. And
it must be protection which is not hedged about with limitations of benefits to
specific categories and cancellation clauses.

I was pleased to note that your Association is meeting with the American
Medical Association and other groups to work toward increasing coverage of older
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people. It seems to me that there are two practical ways to approach the
problem. Firat, group insurance can be extended to include workers and
their dependents with policies which are not subject to cancellation.
Second, premiums can be increased during the more productive years to offset
the increased risk of coverage after retirement.

The single greatest need is for the comprehensive one-pachage policy,
combining both prepaid medical care and health insurance. In addition to
providing greater protection, it has the very importent quality of encouraging
the individual to seek preventive medical care. Most of us have not yet begun
to appreciate the importance of periodic health examinations and counsel with
our physician to help maintain health. However, if this service can be incor-
porated in the average health insurance policy, we will have much more incentive
to seek medical counsel with reasonable regularity.

Although the lack of actuarial data may retard the development of this
kind of coversge, I believe both the insurance industry and the public will
receive benefits from it which now seem almost visionary. When that day comes,
health insurance will be firmly established as a reliable and predictable
source of hospital income.

In discussing payment for health services by Government, I think we
must recognize two basic facts:

First, it is now generally accepted that the health of our people is
a major national resource and that the Government, therefore, has a direct
responsibility for the health of everyone.

Second, Federal Government funds should be employed to stimulate the
expenditure of funds from the States, communities, and private sources. The
Hill-Burton program is an excellent example of this point. During the past
eleven years, the Federal Government has appropriated a total of almost one
billion dollars for this program. But the States, communities, church groups,
philanthropic organizations and millions of private citizens have raised two
billion dollars in matching funds to build hospitals and other health facilities.

Over the years, we have worked out a few rules of thumb for Federally
financed programs that seem to be fairly durabie. For one thing, we have
accepted the simple fact that health is not the exclusive property of any one
political party. Most of our health legislation is bi-partisan. Much of our
health legislation is based on the principle that the areas in the country
wnere the health needs of the people are greatest, receive the greatest pro-
portion of Federal aid. I think we have aiso established the basic principle
that no government program which provides health services or facilities for
our citizens can be permitted to impair the freedom of the individual physician,
nor interfere with the free choice of the patient in the selection of a physi-
eian, nor with the relationship between the patient and the physician of his
choice.

When Congress convenes again in January, there will be many bills on
health legislation placed in the hopper. The number seems to increase every
year. One of those will be my own proposal, the Health Education Facilities
Construction Act, to authorize a five-year program of grants for the construction
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of medical, dental and public health education and research facilities. As

I pointed out when the bili was introduced in May of this year, the shortage
of health education facilities today is probably the inmost serious bottleneck
in our whole medical system. These schools which produce the general practi-
tioners, the specialists, and the research scientists fall far short of ac~
commodating the fully qualified and competent young men and women in America
who are anxious to train and qualify in medical, dental, and public health
fields.

Both private health insurance and Federal appropriations are essential
to the future of healcn services in our country. But the Congress cannot
shape health legislation without your guidance. We must look to you, as we
have in the past, for technical knowledge, for the appraisal of needs, for
the creation of proposals to meet those needs. In nearly all cases, the quality
of information presented by professional groups like yours, and the leadership
you provide, determines the extent to which funds are made available by the
Congress.

How that we have come to give full value to the health of our people
as & national resource, I think the leadership you provide in the creation
of health legislation has taken on new dimensions. The responsibility that
goes with such leadership demands the vision to see tne future beyond the
charted areas of today. It demands the courage to free ourselves from old
ways of doing things because they are the comfortable and easy ways. In short,
it demands the qualities of stateamamship. I believe devoutly that upon this
statesmanship rests the destiny of our Nation.