Cee one title LX may be a means to } axciss ee ee vehicle for such action and urge that it be given prompt, sophisticated ana con- structive consideration. The people of our ation deserve no less strain upon the fqbric of our society, im- posed by organtred crime and corruption. Of course, to agree upon that goal is not the same as to reach it. In view of from all parts of the Nation, Vividiy tres” nstrate the severity ation. In my own region, the operation of the of the present situ- po ee “74 tri-State regional medical program in , causation and prevention of crime and [| New Hampshire, Massachusetts, and @: imperfect knowledge of the factors HEALTH BUDGET CRISIS--THE RE- GIONAL MEDICAL PROGRAM Mr. KENNEDY. Mr. President, on sev- eral o¢casions in recent weeks I have spoken of the current health budget crisis in the Nation and of our necd to provide greater funding for the variety of Federal health programs that are so crucial to the success of our efforts to meet this crisis. At this time, I should like to consider one of the most impor- tant of these programs, the regional medical program. . : _ The regional medical program was established in 1955. In essence, the pro- gram was designed to achieye—through research, continuing education, and training—a marked improvement in the care of patients with heart discase, can- cer, stroke, and related diseases. It was hoped that the program would develop better methods for the exchange of in- formation among those involved in the Gclivery of health care i medical schools, medical centers, community hos- pitals, and other health institutions and organizations. , ae Since 1995, 55 regional medical pro- grams covering the entire country have been established, and an unprecedented number of participating physicians, medical schools, medical centers, hospi- tals, State and city agencies, end volun- tary health organizations have become involved. : Y complex procedures for identifying “Na dealing with eriminals, it is difficult formulate Jaws which will he efféc- ive against organized -crime. Further-, more, the subject of criminal law is cir- cumscribed by constitutional: rules de- pending uvon fine distinctions and subtle analysis. We have sot no easy task for ourselves. . - Nevertheless, the nature and urgency of this problem demand prompt action, whenever constructive proposals can ke made. President Nixon sounded the call: As a matter of national “public policy,” I must warn our citizens that the threat of organized crimé- cannot be ignorcd or tolerated any longer. It will not be elim- inated by loud voices and good intentions. It will be eliminated by carefully conceived, well-funded and well-executed action plans. , . . Stecess also will require the help of Congress... : (Message from the President of the United States Relative to the Fight Against Organized Crime, H.R. Doo_No. $1- 105, Sist Cong., ist Sess. 2 (April 23, TQ69).} An example of such a constructt measure may be title CX of S. 30, on racketeer influenced and corrupt orga- nizations. That title adapts the remedy of forfeiture, and the equitable remedies long used for economic ends in the anti- trust laws, to the problein of organized crime infiltration of legitimate organiza- tions. In urban ghettcs, where “black capitalism” offers hope for local self- syndicate-infiltrated businesses which use force to eliminate local com- stition and then charge extortionate prices for staple commodities and serv- ices. While the other titles of S. 30 approach. the organized crime problem in a varicty of ways, each of them is the product of a lonz, painstaking process of bipartisan development by the subcommittee with the help and support of the Justice De- one of the most potentially fruitful pro- grams we now have to enlist the energies of all elements of the health community. is getting well underway, it is encounter- ing serious funding difficulties. In the fiscal year 1969, $83 million was appro- priated for the program. In that year, as in several of the previous years, @appro- priations were somewhat greater than partment. I sincerely believe that the expenditures, because the administrators entire bill demands and deserves detailed of the program understood that the pro- and thoughtful consideration by the 8fam was in an infant stage. As 4 result, Judiciary Committee and then by the they funded only the mest innovative Senate. Areas for improvement may ex- proposals. ist; but the bill as a whole is a careful How, however, the program is bezin- attempt to accommodate the public in- ning to move rapidly. Taking into ac- terest in effective Inw enforcement with count the carryover funds, the admin- individuel rights in a specific and eom- istration has requested the sun of $100 plex area of criminal law. As we eonsicer million for fiserl 1979 under the open- the bill, prond calls for “low and order,” end authorization, in spite of the current like bara invosations of “preferred budget problems. The House, however, rights" of individuals, would be inade- has appropriated only $76 million for qunte guides for action. We must con- he program. This $24 million cutbaci sider each of the ten substantive tities has severely shaken the conficense of with open nvinds as to possible improve- all who have become involved in the pro- ments, while not losing sight of our gram throughout the Nation, I believe broader. mandate, challenge and op- that the cutback may cause the progress portunity to-enact effective legislation in we have made in meny regions to gtind this area. _ toa halt. In view of this tragic and growing in- In recent wee'ss, 2 large number of let- fluences of orzanized and other crime texs have peon written to Senators about upon our society, the welZare of ail Amev- the severe impact of the cutback upon icans—-especinily these most disadvan- particular ional medical programs. taged—reat At the conclusion of my remarks, I will : i : ta from 22 letters wi tives that we seive every ep- Y yre Lhe fied . i wtf ayet “t ; I believe that this program represents Yet, just at the time when the program * Rhode Island may well be sharply cur- tailed. Dr. Robert P. Lawton, the Deputy Director of the program, has asked: What will be the effect of the low House appropriation on regions? Suffice to say that if this number fs all that fs ts appropriated, the effect on tri-State will be devastating. It is my personal judginent, If RMP were to have no more appropriation for 1979 than: the House approved for grants, that it would pe necessary to shut down some regions in order to keep the others alive. This is my national view. New England is potentially too important as an example of interstate co- operation, Including effective coordination of RMP and CHP [Comprehensive Health Planning], not to warrant every possible regionalization dollar. . I believe that these reports from across the country present an appalling picture. I strongly urge that we give full fund- ing to the a ninistration’s request for the regional medical program. In the Nation as a whole, we now have far more doctors and. organizations working together ‘cooperatively in re- gional medical programs than anyone expected several years ago. We cannot afford to disillusion these people, who have done so much and who have worked so hard for the success of the pregrarm. Mr. President, because of the impor- tance of this issue, I ask unanimous con- . sent that the list of excerpts from letters on the regional medical program be printed in the Recoro. : There being no objection, the excerpts were ordered to be printed in the Recono, as follows: : Exceypts From LetTens ON THE Bunce Caisis IN THE REGIONAL MEDICAL PROGRAN ALABAMA . In Alabama, Dr. Benjamin B. Wells, Pre- gram Coordinator of the Alabama Regional Medicel Prograin reports: “Tne reduction of funds that would fol- low frorn the projected cuts in the Federal! budget. will emasculate the Regional Medi- cal Program in Alabama. . “In pursuit of our original charge, we have mounted an all-cut effort to secure the interest, support and active involvement of health care institutions, groups, individuals and the general public throughout thts state. We have carefully avoided giving the notion that we were or should be a major source of funds for the Improvement of health services, but we have encouraged 3 large number of cooperative ventures through the use of our core staff and the establishment of linkages to the University Medicol Center in’ Birmingham. Unless we? can press forward at this tims, the momen- tum of two years will be quickly lost. “Many similar efforts are at the most eri- tical point in their evolution, Our failure to progress at this time may resulé in years of delay before similar multilateral commit- ements can be reformulated.” . ARIZONA Qie Arizona Regional Medical Progrem, coordinated by Dr, D. W. Melick, will be in evere dipjiculty: “For the past two years we have been In the planning phose of our operation, Tre planning, in order to bring forth the bes* in 3 siHeations been a tedious and iy * tions, We are awalting funding, a Bese eT te A Ae NE ERE A ———S from. planning to operational status, We - have had approval of the Nailonal Advisory Counell for certain of our project applica- If this ts ccrthncoming, we expect to go into the oper- Sonal phase January 1, 1970. “Ppailure to fund our program will under- . bw _7™tne all of our efforts in careful and maetic- ous. planning. Of more importance, tt will wsrupt the enthusiasm we have engencerefl. HIAWAT!, ALIERICAN SAMOA, GUAM, MICRONESIA In Hawcii, Dr. sasato Hasegatca, wito co- ordinates the Program for that stete as tell as American Samoa, Guam, and Micronesia, States: “As you know, He other regions through- out the nation, we have been slowly devel- -oping a program which would stimulate cre- It will result in a good deal of frustration - for the citizens of our State who have as-. sisted us in getting our plans in presentable form, It will delay ws from presenting to our citizens, visible evidence of action, Action Is certainly necessary to pacify those Individ-- uals who may criticize us tor a Prolonged _pezlod of planning.” COLORADO, wroMING Dr. Howard V7, Doan, who directs the Colo- rado-Wyoming Regional Medical Progrem, has also indicated the dificulties if low fund- ing of RiTP’s cecurs: “At the present time we have nine oper- ational projects. Most of them indicate a ‘healthy growth anticipated for the next two years as a result of increased Interest on the pert of health professionals in the region and @ growing awareness o2 the potential of ” the Program, “In addition, we have six or seven develop- ing projects, five of which are now under review by the National Advisory Council. If our funding Is held eat the present level, it “will be ‘difficult to irnplement any of these without placing current projects in Jeopardy. We have, for exaraple, a comprehensive proj- ectin heart disesse which has been developed in collaboration with the Colorado and Wye- . ming Heart Associations. This project will be funded at a most austere level If our budget requests are not honored. I doubt the wisdom of beginning any major project if it cannot be cperated properly. We have giother project under review which 1s broad d covers almost the entire fleld of cancer in idren. This project is one of the finest I € ever seen, and our failure to subsidize ut will be a share.” DELAWARE VALLFY In New Englend’s Greater Delaware Valley Regional Rediccl Program, Dr. George R, Clammer, tts Executive Director, reports: “We would anticipate that the rasjor effect of the reduction will be to significantly cur- tafl funding of new operational projects. This would cccur at a time when we expect the trowlzg Involvement within our Region to result in more requests for operational proj- ets. In addition, we elready have several &pproved projects which. have not been funded as yet and which msy not get oT the ground, “It 1s likely that these eff ; significantly from the inter st in end enthu- sfasni for RMP which has dev leped in our Region as a result ef extensive etrorts during the past two ycars.” DISTRICT O2 COLUMBIA Here in VWashington, D.C., the Metropoli- tan Weshington Regional Medical Program will be prevented front attaining its polene tial, Dr. Arthur E. Wentz, Prograny Coordi- ets will detract nelor reperts: “With aimoct one and otc- ets of unfunded anproved Bt om: half niuliion dol- Desils for this ub Region if is becoming fucreasingly moult for the Fianning and Program Come 2 ho engonder continued interest, much uy tom, in the presentation of addi-+ E a a4 gram ds oO ¢ 3 5 1s to afford a compreh tensive suting § no otot ‘applications, activity and the establishrncn’ of co-opera- tive arrangements which would lead to bet- ter medical care for the region's Inhabitants. Tho program has now reached a stage of development where it has achieved a@ level of acceptability that Is second to no other simi- lar agency in its field. Because of this, more proposals and ideas are coming Into the of- fice and more project applications are pass~ ing local review with subsequent submission | for national review. “Now, if the House action is indicative of what will eventually be the national funding policy for the near future it will directly af- fect the implementation of recent project assuraing that they pass na- tional review, to the degree that there will be delays in attaining planned goals, or even. worse that some goals may never be attained. Further any inability of the reglon to fund rorthy projects will affect the eredibility of the program and its representative ofti- elals, Lastly, a lot of the time-and effort of the last three years devoted to getting people together, talking with one another, exchang- ing ideas with each other will have been wasted. Additional time and effort togethe with increased funds will have to be applied before the region cnco again reaches the present level of efficiency and acceptability.” ILLINOIS The Illincis program, as Marilyn J. Voss, Public Information Assistant, indicates, has tts share of funding problems: “If RMPS does not get a larger budect ap- propriation—namely that sev jon TEMP proj- ects approved with a budget of $611,106, will not receive the funds to enable them to be initiated, Thus, the Ilinols Regional Medical Procram would be operational in name only.” In addition, 14 docters who have worked extensively in the program all signed a letter stating: -“We regard the inability to support the seven community projects now approved both by the Nivision of Regional Medica! Programs and by the Council of the Regional Medizal Programs as nothing less than disastrous. This program was created by action of the Congress, and we as clilzens in the State of Illino!s were cneouraged and urged to work together voluntarily and without componsa- tion to create within the State a vigorous and strong organization capatdle of carrying the benofits of medical resoarch to the p2- tient. We have spent many hours and days in this undertaking. Wo are now faced with the prospect of having the Congress witudraw that supports which it had assured us would be forvnceming. We should Hke to emphasire particularly that the seven projects approved are the first ones ever submitted by the Till no!s Regional Medical Program to the Divl- sion of Regional Madical Programs for fund- ing, Thole preparation hes Invelved many months of dedicated work by a iarge number of our finest citizer ILLEINCIS AND EISGOURI (BI-STATE RMP) Tie BMissouri-Iliaois Program, hnown as the Bi-State Regional Mecieu! Progra, has mace great strides, and Dr, William Stone- man Til, who coordinates the Progrem, re- an @ grant dcoal of insrifa has St. Lows and the surround. te pracdical schools ts or, Doth are dug region. are Now wo. BN TK KO et MM SE AU is participating. Project proposals have been npproved and initiated to extend medical center capabllities to community hospitals and other groups throughout the region to improve the care available to the patient in his home community. “At this critical point in time, a decision appears to have been made to cut back substantially on funding te the extent that essentially no funds for new activities will be. available during the current fiscal year. The. effect of such a policy on local initiative in our region will be very serious. Under those circumstances, the inability of this program to make any significant impact on the ca- pacity of the health care system In the face of the massive fecleral infustons of money into health care demands (Medicare, Medi- eaid) is self evident.” INDIANA Indiana-would also suffer, cs Dr. Robert B, Stonehill, tts Regional Medical Program Co- ordinator indicates: - “Reductions in the Regional Medical Pro- grams budget made by the House of Repre- sentatives, if carried over into actual ap- propriations legislation, will have e, definite dampening effect on the indiana Regional - Medical Program. “We now have a number of projécts in various stages of development. All of them are aimed at regionalization of resources and services. If they are not funded, mementum toward further regionalization will be greatly | slowed. Further, the. excellent beginning we have made in developing cooperative efforts will deteriorate and the initiation and de- velopment of new, worthwhile projects will come to a halt.” . IOWA / Dr. George Hegstrom, Chairman of the Jowa Regional Advisory Group, indicates: “Here in Iowa we have had much success In convincing practicing physicians, hospl- tals and otner health persous ond institue tions that through the Iowa Regional Medi- eal Program they have an opportunity to ef- fect meaningful changes in Iowa’s health eare system in a way that Is particularly appropriate and acceptable to the Iowa Region. “A true coopers tive spirit has emerged. * Smooth and effective mechanisms for mak- ing decisions greatly representative of both the medical center and the community level are reaching a high level of develop:nent. The siage hos been set. What a loss to the peo- ple of Iowa if this system for improving the quality of care et the place where people live is left to rot away from its lack of use.” KANSAS The cooperslive effort of Kansas would be weakened, as Dr, Robert Brown, Coordinator of that State’s Program shows: “It Is obviously disastrous to provide ca- operative efforts” for doing things at the Community Level only to have to report back to those groups that the Kansas Regional edical Program will be unahie to provide the financtal assistance 2 to carry out these Programs. “Planning with a cepability of doing has contributed greatly to the momentum of the Kaneas. Regional 2fedical Program. Fiscal restriction would wudouktedly dompen the enthusiasm of people ab the Conmnhy Level to spend time and effort in 2 Program which c2nnot deliver the rewards for that efiort expended.” LOUISIANA . Dr. J. A. Sabatier who directs the Louisiane Medical Program, hes eloquently steled the problem of the Louisiena Regicnel Medical Program: "The ONT tntttal May full fundi ing of December 4, 1969 gens, remular meetiugs have been held for Local Planning Chairmen and Comraittee Members to acguains them more thoroughly with the goals and objectives of the Regional *tedical Program. Muitiple articles have beer Clie and distributed along with newslet- vers to & Wide audience in an attempt to gain better wniderstanding of the Program. All of this patient, methodical, painstaking devel- ‘opment of confidence and respectability for the Program Is in danger if the Program is seriously retarded.” . a OLKLAHOSIA pr. Dale Groom, Director of the Ohlchoma Regional Medieal Program reports: “As J see it, this major retrenchment in Regional Medical Programs on & national seale is not only a backward step put, more important, it undermines years of planning and effort on the local scene not only by RMP but by all. the other health agencies with whom. we try to work. There is no ques~ tlon but thet Regional Medical Programs were over-sold in the flush of enthustasin when Corzress appropriated sums exceeding those which tne infant organization could assimiinte. One cannot simply tur on well- conccived and well-planned health programs overnight. Reerulting and training medical manpower requires more time than opening up new offices. At any rate, fledgling RLIPs sought out leading citizens and educators to constitute their Advisory Boards; their stafi went oub to communitics throughout their regions to solicit and organize cooperation of local health rezources; surveys were made of health needs; reedical associations, hos- pitals, nurses and paramedical personnel were brougnt into the councils of the brave now endeavor. And now because of cutbacks which could hardly be foresecn, we are un- able to follow through on the collaboration ead, in many cases, the promises which were extended In good faith. Really, this strikes ee st the Integrity of the whole effort. If we fail row, tt will be doubly hard to take up the _ seaues again at the same high level. Moreover, —“G am sure we will begin to lose our great- est capital of all, namely the quality of leadership ang the good name which Re- gional Medical Programs have built-up in their brief ascendency. oO “J believe that now it is evident to all of us in PM that we are at a decisive cross- roads, that this year is crucial, that we cannes stand still but must go one way or ths other. Actually what we need for suc- ess3 in this health effort is only a tiny frac- tion of current non-health expenditures of ow country. Jam hopeful that our national enzo of yalues will prevail and that the sup- port necessary for the success of this riost important national resource will be re- etoved.” TENNESSEE The Tennessee Mid South Program, as Dr. Paul £, Teschan, Director reports, will be in troudl: if it docs not receive needed funds: “Five projects emounting to $274,000 ere being hold in abeyance and options for em- ployinent of key personnel are being lost. Since these projects will be activated in the region (as contrasted with projects lecated in or deriving principally from the untver- sity centers in Neshville) this major re- flonal thrust is being blunted, with contin- ulng ecrious injury to the image of the Pro- TamM.23 a regivucl one. “The budgetary restrictions coupled with the reports in the prezs and the speculations in the “Dlie Sheet” of which wa are ail aware have rel an undercurrent of speculation ‘concerning the projected via- yee cy - my cy 7 of even this federal pros mere Knowledgeable iudivid- trustwvortian Gea. For the CONGRESSIONAL RECORD — SENATE unls, who perceive that there fs no visibte alternative to RMP in linking university centers and the provider structure, a sense of bitterness and incredulity ean also be de-_ tected. The latter development is particu- larly underscored when approval for a nu- clear aircraft carrier, multiple landings on the moon, and an antiballistic missile sys- tem of dubious workability scom to get by relatively easily. . . VIRGINIA For the State of Virginia, Dr. Eugene R. Perez, Director of the Program reports: “Relative to the reduction of the Regional Medical Programs budget, I believe it is oD- vious that it will result in definitely cur- tailed activity of the Pregram In Virginia, With less raoney to operates, obviously one will be able to do less. Unfortunately, this will be a strain on alt concerned, as it will _ be necessary to set strict priorities. The most unfortunate aspect, I believe, is the timing of the budget cuts. I think that all regions have had pretty much the same experience, and I know thas it has taken two to three years im Virginia to get the. confidence of the various groups, and to establish the necessary cooperstive ar- rangements. We have accomplished the fore- going in Virginia, and now thal we are ready to spread out and make the Program effective it will be difficult because of less money. I am afraid that this will blunt the “momentum of the Program. In summary; less money, less Program, less Interest, less participation, and less ef- fect upon improved patient care of the citi- zens in the region.” : VEST VIRGINIA Cherles D. Holland, ceting Director of the Program in West Virginia reports: “To answer the question in your recent menorandiuni of the effect on the West Vir- ginia Regionel Medical Program cf the tlouse cut in Regional Medical Program funds for 1970, I can only report that wo have bee: recommended for operational status begin- ning January 1, 1970—but have not been funded. I believe that our entire Program is in jeopardy because of the House action,” WISCONSIN . In the State of Wisconsin, Dr. John S. Hirsehvocek reports thet: “The Wisconsin Regional Medical Program has two proposals under review and await- ing funcing by the Division of Regional Medical Programs. Each of these will have little chance of boing funded if the appro- priation bill Is passed by the Congress at the level recornmended by the House. One of these projects Is budgeted at°$564,374 for its first year. It is concerned with the devel- opment of & comprehensive approach to managing chronic renal disease. It includes support for home dialysis training for pa. tients and their familes and the development of a transplant strategy to provde rapid matching and transplantation within a fow hours. The second project will require a first- year budget of $909,229 for the operation of a health profession manpower improvement and expansion program in the Creater Mul- waukee area. Tho purpose of this project is to provide a variety of in-service training experiences for physicians and ovhers to learn new technology and to develop working skis for people who presently do not have them. Both projects have great implication for ti: improvement of health cara in the Wiscoa- sin region, With the lraited funds which would be avalluble under the appropriation recemmended by the Housa, these obviously will have little chance of being funded. Th. flevibiiify and readiness of Foesienst a + : Cie ve ant to fall start.” z beter: -and their supporters. » Loved THE TREATY TRAP—A BOOK BY LAURENCE WELLMAN BE NSON Mr. MURPHY. Mr. President, every once in a while a book comes along that I feel is of such paramount importance that I recommend it to Senators as “must? reading. Such a book is “The Treaty Trap,” 2 comprehensive and defi- nitive history of the performance of political treaties by the United States end European nations, written by Laurence Wellman Beiienson. I would also recom- mend this book with its unparalleled study of treaties to the representatives and delegates at both the Paris peace conference and the strategic arms im- itation talks in Helsinki, since both are concerned with major treaties of our times, : Lo The only book of its kind to recount the cperations analysis and breach of treaties during the past 300 ycars—this documentation is long overdue. . Mr. Beilenson has three major themes. His first demonstrates that alliance treaties, treaties to keep the peace and international -guarantees have been alike in their steady breach. Second, in scrutinizing actions to find metives, Mr. Beilenson widens his analysis to embrace the wellspriugs of national action—in- cluding self-interest and glory of rulers The intriguing third theme shows that even cynical statesmen, while ybreaking their own promises, have succumbed to treaty- reliance. “The Treaty Trap” shows that the rnodern pattern only repeats the anci- ent. As the story unfolds, the evidence piles up to prove that all major nations have been habitual treaty breakers. How far should the United States rely on political treaties for aid In war or to keep the peace? What asumptions about performance or breach of slich treaties should the United States make in deciding whether to enter into future treaties? With those fundamental questions chiefly in mind, Laurence W. Bellenson, a& prominent Les Angeles attorney, ¢x- amines the history cf treaties since ear- Hest times. The net result is a highly au- thoritative, readable, and perceptive work. : A word about the author, Laurence Wellman Beilenson, who brings to this book the benefit of extensive knowledse of history, Jay, end military science. He is a graduate of Phillips Andover Acad- emy, Harvard College, and Harvard Law School. A veteran of two wars, he was during World War It a. commanding American liaison officer with the Chi- nese Army. I.ong inferasted In interma- tione] affairs and history, Mr. Beilenson devoted 8 years to research in prepar- ing “The Treaty Trap.” + REJECTING THE SIMPLE SOLUTION Mr. RIBICOFF. Mr. President, I w2s inzpressed by a speech delivered retently by Mr. Joseph A. Califano, Jr., at Haver- ford Cat Califano’s exparience