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. HOY 14 1672
Mr. Richard Berman
Special Assistant for Policy Development

Gerald R. Riso 7 ---4dah, ise
Deputy Administrator for Development

Reactions to RMP Paper

Overall, we agree with the idea that the paper has tried to convey
but do not think the idea has been developed as well as it needs to
be.

My overall problem in addressing the issue is to overcome incon-
sistent directions ve are receiving from downtown on the future of
certain programs. In a number of tastances, we have been told that

in the interests of decentralization and revenue sharing we should
abolish certain national programa dircetions and controls and encourage
the transfer of resources to other levels of governments with rela-
tively few programmatic earmarks or restrictions. Simultaneously,

the RMP program concept is attacked by some because it lacks central
program controls and lacks national priorities.

In more specific terms, another problem we have with the paper is that
RMP as a mechanism for communicating with a private provider is not
adequately handled. Our view is that we all have an interest in
changing the delivery system and that the community at large has a
right to participate in the process of change. However, we have to
recognize that the changes have to be agreed to and participated in
by the health provider community. There is no system of compulsion
that is available to this government that would force what is basically
a privately financed, privately run and privately staffed system to
undertake changes in the delivery system nor do we advocate one.
Therefore, we have to establish a means by which the Federal government
can effectively influence the health provider establishment. RMP to
date, has been the mechanism that has been accepted by much of the
provider community in pursuing changes in the delivery system. Despite
fews to the contrary that it 1s not responsive to national needa, the
program content of RNPs throughout the nation does reflect national
priorities in many instances. The device is established, does work
and is reasonably effective. The roles your paper outlines are per-
fectly legitinate for R¥Ps to undertake.

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Page 2 - Mr. Richard Berman

Part of the baste quarrel with RP appeara to be the absence of “tangible
results" from the investment of RP other than the fact that it is

a mechanism. We could and hava filled files with spe ifie project
results and I do not really know what would be gained by that. If

he concept is accepted, the question remains whether or not people
ave content with tha way in which the program is being "managed".

If ndninistrative processces are unsatisfactory then we ought not to
ba talking about the RAP concept. However, 4£ the quarrel is with the
concept, then we ought to recognize that RMP lies further ahead in
the. dircetion in which most other programs are currently being required «
to so. If we are not willing to accept that under decentralization and
yeveruc sharing, Federal prerogatives may have to take a back seat

to local prerogatives and if we wish to place federal safeguards upon

the problens that could be caused by people exercising their own judgmant,
then we ought to reverse the entire trend we are moving. That appears
not to be the case. Having just reviewed the CHP paper this morning,
which does pretty much with CHP what_has been done with RMP, I find

it rather difficult to make this 180° turn within fifteen minutes.

sa.

Thank you.

ee: Dr. Vilson
Dr. Stone
ve Jack Brown
Dr. Margulies