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*#E0O015B*
FOR RELEASE MONDAY, A.M.

JANUARY 16, 1967

REMARKS BY

CHARLES L. HUDSON, M.D., PRESIDENT
AMERICAN MEDICAL ASSOCIATION

&T CONFERENCE ON

REGIONAL MEDICAL EROGRANS

JANUARY 15-17, 1967*

' *Delivered at Dinner Meeting
Sunday evening, January 15, 1967
at Washington Hilton Hotel,
Washington, D.C,
REMARKS ON REGIONAL MEDICAL PROGRAMS (P.L. 89-239)
Presented at
The Conference on Regional Medical Programs
January 15, 1967
by
Charles L. Hudson, M.D.

I am pleased to have this opportunity to add my voice and that of the
AMA to those who will participate in this meeting discussing Regional Medical
Programs. I am sorry that previous commitments will not permit me to stay
on with you in the succeeding days, but my interest will remain with you
vegardless of my absence,

As everyone here knows, scientific advances have tended to divide and
stratify our profession, not only in what we do but in our principal ©
interests. As we become more specialized and diversified, it should be
recognized that we become more interdependent. To counteract this
divisiveness we should set ourselves to the task of formulating plans
to assemble dissimilar elements of health service into an integrated whole.

The problem posed in this endeavor is a mode of accomplishment of this
task, How shall we do it? We in the medical prcefession tend to favor the
retention of systems ‘that work'' and co best within our resources, to
prcveed in an evolutionary fashion, perhaps more cautiously than suits
the tasteof everyone. While we are not “the last to lay the old aside",
neither in clinical practice do we tend to be “the first by whom the new
are tried.” |

Government, on the other hand, a financing rather than a service
mechanism, with its great resources of money and influence, has the
capacity, and I would say inclination, to effect rapid and major changes
in patterns and pxocedures. Between the cautious and tue precipitant

approaches there is often conflict, even though the objectives of both

approaches be the same,
=2e

We are present, in thie conference not to emphasize our differences
but to determine as best! we'can how the resources of government under the
law can best be directed toward the health care system that is primarily
serviced by the private sector.

The origins of Public Law 89-239 to my knowledge are to be found in
the Report of the President's Commission on Heart Disease, Cancer and Stroke,
from which document, certain of its recommendations were selected for
legislative implementation. As I understand it, it is extremely difficult
to reproduce in the language of the law, exactly what a narrative report
rontains. But it seems reasonable to assume that the sections selected for
the Bill retain some relationship to that report from whence they originated.
And thus the Senate Bill 596 was interpreted by the profession, as
recommending areas of service provision called "complexes' that described
not only highly specialized:medical and surgical treatments in a medical
school center but also diagnostic and treatment stations in the periphery.
We inferred that this, a closed entity of indeterminate size, excluding
others already practicing in the area, was intended to demonstrate ina
disparaging way perhaps, the inadequacies of our physicians. A quantitative
capability to replace these physicians or a visible means of improving
their capacity to provide health care did not appear feasible under this
plan. This we viewed not only as an unwelcome intrusion, but also some-
thing extremely confusing to the public as well.

The raison d' etre of such complexes we learned was the provision
of services to people who were the target of the legislative thrust, based

on the allegation that a barrier of ignorance of what was new impeded the

flow of health care through current conventional channels.
Believing the premises upon which these actions were based to be false,
and concerned that this was a revolutionary change in the system of health
care not in the public interest, the AMA did not support the legislation.

Then, later, several of us from the AMA were on a mission to Washington
to advise the Department of Health, Education and Welfare regarding the new
P, L. 89-97. Hearing the passage of the legislation on heart disease, cancer
and stroke in the House of Representatives was imminent, we reported to
President Johnson our belief that passing this the Senate version upon the
heels of Medicare would be repugnant to the physicians of the country and
would adversely affect their attitude toward any and all federal support
programs, especially Medicare.

As a consequence,a revised version of the Senate Bill was prepared
with the assistance of the AMA. It passed the House, prevailed in Conference
Committee and became the law.

It is the AMA's interpretation of P. L. 89-239 and its regulations,
that services will be given incident only to the needs of education and
research, that the program, rather than a geographic entity, is a sphere
of influence, largely educational intent and capable of exchanging informa-~
tion and personnel between the center and the peripheral institutions which
are now called hospitals.

With this understanding--rather than with any definitive interpretation
by the National Institutes of Health I must honestly add--I have recommended
the program to the constituent and component parts of the AMA in counties
‘and states and they have responded not only as members of local advisory

groups, but also by leading in the application for approval of programs.
whe

Our search for another mechanism in this country for postgraduate
medical education and the adaptability of P. L. 89-239 as an excellent
model for such a purpose, have led me to give public support to the use
of this legislaticn for educational purposes. I feel that the impact
of P. L. 89-239 if used in this way, on the health care of the nation
will be infinitely greater than if implemented primarily in another
fashion. The dissemination of the program's influence through the
physician, especially those at the periphery, will be broader than if
its substance is used up on services to a limited number of individuals.

To conclude on the note on which I began, I believe the assignment
of roles in an integrated system will best be determined by a cooperative
effort on the part of all segments of the profession rather than if it
were made by legislative edict. It is true that differences in roles will
be perpetuated by variations in breadth or depth of education and training,
by the complexity of the skills required of us and by the character of the
occupations we elect to pursue.

The scarcest and probably the most essential element of the program
is the educational and research center, where one might anticipate the
most refined knowledge and techniques to be found. Inherent in this
recognition is the hazard that judgments of high position in a vertical
scale will disparage any other contributor to the whole scheme. Other
contributions while less refined perhaps, may be equally valuable. For
that reason I hope communication within the program will be open, free,

mutually respectful and multidirectional.