OFFICE MEMORANDUM e STANFORD UNIVERSITY

To

FROM

SUBJECT:

APR 2

Dare: April 17, 1971

Memorandum for the Record
John L. Wilson, M.D.

Luncheon Meeting with Representative Rogers, Chairman of the Subcommittee
on Health Legislation, U. S, Congres®

During the past few days Representative Rogers and his aide, Mr. Lawtcn,
have been touring the medical schools of California, Dr. Clinton Powell,
of the University of California, arranged for Mr. Rogers and Mr. Lawton
to come to Stanford for a luncheon meeting on this date, Those present
at the meeting besides Dr. Powell, Mr. Lawton and Representative Rogers
were Dr, Joshua Lederberg, Dr. Henry Kaplan, Dr. Count Gibson, Dr.

David Hamburg, Mr. Robert Lindee and |. The meeting lasted from

12:00 noon to 1:30 p.m. and a wide range of subjects was covered. The
following important topics were reviewed with Representative Rogers

who indicated that he would welcome memoranda from us with expressions
of opinions and advice:

1. Primary Health Care. Dr. Gibson described the Livingston Project
briefly and indicated the type of health team approach which he
believes appropriate to many communities throughout the nation
where physicians! services are absent or inadequate, Dr. Gibson
stressed the importance at this time of support to medical schools
for the development of educational and research programs in Primary
Health Care and made suggestions regarding the manner in which
legislation might be formulated for this purpose,

2. Cancer Research Authority. Drs. Kaplan and Lederberg described their
respective reactions to current developments at the natjonal level
with respect to cancer, There appeared to be general agreement that
responsibility for the special cancer program would be most appropriately
placed in the National Cancer Institute provided that review, ad-
ministrative and other procedures of the NCI were modified in such
a manner as to facilitate the program and assure its quality.

 

3. Emergency Health Manpower, Representative Rogers has sponsored
emergency health manpower legislation which is now law, He has been
visiting U. S, Public Health installations in order to study the future
role of the U. $. Public Health Service in providing for health care
manpower in the future. Questions were raised regarding financial
incentives, long-range impact and the importance of complementary edu-
cational and other programs in order to improve the effectiveness
of emergency manpower assignments under Representative Rogers!’ bill.

 

o OFFICE MEMORANDUM © STANFORD UNIVERSITY © OFFICE MEMORANDUM

WNANYHOWIW 391ddO © LIISHTAINN aNOANVIC e WARN lRAGIGA GHOANYWIS e@ WNOINYTHOWIW 291440 © LALISHFAINN GHOINYVIS e
7.

-2-

Capitation Support to Medical Schools, Representative Rogers stated
that he favors legislation which will provide a capitation sum to
medical schools for each medical student admitted, The sum of money
currently in the bill is $3500 per student to be continued throughout
the student's medical education, Mr. Rogers recognizes that this sum
does not cover the cost of education in medical schools, but he
believes that it is a start and an amount likely to be acceptable to
Congress. He stated that he did not favor the principle of paying
the medical schools a capitation fee on the basis of the number of
students who graduate. He raised the question of accompanying the
capitation award with formula, project and other types of grants to
medical schools in order to provide for flexibility, new developments
and increased enrollment incentives. He specifically asked regarding
the number of students and faculty at Stanford and regarding the
possibility of Stanford increasing the class size, He was informed
that increase in enrollment is under study but that no decision on
this had been reached.

 

Commission to Study Federal Licensing Standards, Mr. Rogers asked
whether it would be advantageous to study the question of federal
licensing standards which would, if established, allow for mobility
of medical graduates among the states.

 

Nursing Education, This subject was mentioned briefly near the close
of the meeting as one in which Mr, Rogers has a special interest,

He. also asked whether Stanford was developing allied health manpower

programs and passing reference was made to the Physician's Assistant

Program here,

National Study of Health Manpower and Educational Needs, Representative
Rogers indicated that legislative programs will be based on studies

of this nature. There was some discussion of the advisability of
conducting a study at the national level which would result in a
comprehensive and long-range plan for medical education and manpower,
Mr, Rogers asked whether or not additional medical schools were needed
and stated that he was proposing to put a recommendation for five
additional medical schools in his bill. The group was very hesitant
to answer Mr. Rogers! question regarding the number of medical schools
needed jn the nation at this time but did in general seem to favor
establishing the precedent for federal support for additional medical
schools by indicating a specific number of new schools in his bill,

It was noted that the Veterans Administration is being considered as
the site for new medical schools, Quite clearly Mr. Rogers did not
favor the Veterans Administration as the site for the development of
medical schools.

 

Health Maintenance Organizations, A point was made to Mr, Rogers re-
garding the effect of health maintenance organizations on medical

centers such as Stanford, It was pointed out that funding principles
within the health maintenance organizations may decrease the referrals
-3~

to medical centers and in this fashion decrease the quality of medical
care available to those patients requiring the resources of the medical
centers, Mr. Rogers suggested that catastrophic insurance added to
the health maintenance organization concept may provide for ease of
referral and reimbursement,

9. Medical Research and Training, A strong point was made that it is
vital to continue the support of medical research and postdoctoral
training in order that solutions to health problems may be found and
academicians prepared, The need for various categories of teachers
and investigators was pointed out and the short supply of faculty and
practitioners in the fields of radiology and mental health was parti-
cularly mentioned, Representative Rogers was encouraged to resist the
tendency to decrease the funding for research and advanced training
at a time when there is considerable pressure to concentrate existing
resources on the health services aspect of the overall health care
problem,

 

10. Contingency Repayment Plan. Representative Rogers is interested in
various means of providing support for medical education and specifically
mentioned the contingency repayment scheme as under consideration by
him, This was discussed briefly and certain of its advantages and
disadvantages were reviewed. A point was made of the necessity for
such a plan to be on a national scale in order to assure its effective-
ness, {t was questioned whether implementation of such a plan in a
few schools would prove to be of great benefit,

Representative Rogers stated that he would like to bring his full committee
to the West Coast for a visit if he could, He was encouraged to visit
Stanford with the committee if possible, We should decide whether to ex-
tend to Representative Rogers a formal invitation to visit Stanford, Please
let me know your views on this matter.

By a copy of this memorandum | am asking those who attended this Tuncheon
to let me know on which of the above topics you will be willing to write
a position paper for dispatch to Representative Rogers, Mr. Lindee wil!

coordinate our response,
Whe k. toil
JLW:sec John L. Wilson, M.D.

ce. br, Joshua Lederberg
Dr, Henry Kaplan
Dr. Count Gibson
Dr. David Hamburg
Mr. Robert Lindee
Executive Committee
Dr. Kathryn Smith