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Dear Mr. President: Y/r3/bo

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Bach day that passes decreases the possibility of enactment by
the 86th Congress of legislation that will recognize and take initial
steps to meet the present and increasing shortage of physicians and related

health services personnel.

You may recall that I have written you three times in the past year
seeking to arouse your interest and elicit your support in this matter
that has such a critically important relationship to the Nation's health.
I have appreciated your replies to my communications. But I am deeply
concerned that there has been no evidence of the willingness of the
Administration to act--either in its own legislative and fiscal proposals,
or by giving active support to the measures that have been proposed by

others.

I am aware that the Department of Health, Education, and Welfare
is considering a legislative proposal which would provide matching grants
for the construction of facilities to be used for teaching as well as
research in the health sciences. I will be supportive of such legislation
if it is transmitted to the Congress, since it undoubtedly parallels
in principle the legislation I introduced last year which would authorize
$50 million a year for five years to expand and improve the facilities
of existing schools of medicine, dentistry, and public health; $100 million
to be available over a ten-year period for the construction of new schools
in these fields; and favorable matching provisions for these projects that
would demonstrably expand the number of physicians and related personnel

in training.
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Recently I have also introduced a legislative proposal to authorize
an annual appropriation of $10 million, to be matched by an equal amount
from the States, to provide scholarships for medical, dental, and
osteopathic students on the basis of their ability and need as determined

by State plans.

Neither my construction nor my scholarship proposal has received

the endorsement of the Administration. This is regrettable.

These construction and scholarship proposals, Mr. President, would
not fully meet the urgent present and threatening future needs. But they
are moves in the right direction, and we must take now that action for

which there is precedent under existing policies.

These comments are not made in any partisan or political sense. It
makes no @ifference to me, as I am sure it does not to you, whether the
action taken stems from the Congress or the Executive Branch, or whether
it bas Democratic or Republican auspices. The important thing is for the
Federal government to provide leadership in meeting what may well be a
national crisis. It must be prepared to meet its share of the responsibility
to assure that there will be enough well-trained professional health
persomel for tomorrow's needs. In a very literal sense, the future

health of the American people is at stake.

I would remind you again that action of the kind I urge does not
eonstitute either a break with precedent or a venture into unexplored
fields. Many studies, including most recently the excellent report

entitled Physicians for a Growing America, prepared by a group of distinguished
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consultants to the Surgeon General of the Public Health Service and commented
on favorably by the Secretary of Health, Education, and Welfare, confirm
that we must act now te alleviate what will certainly be a growing shortage
of physicians and other health personnel. Such present programs as the
Health Research Facilities Construction Act, the Hospital Construction

Act, and the National Defense Education Act clearly demonstrate that
construction of facilities and provision of scholarships and loans for
higher education are appropriate Federal undertakings in areas of

recognized need.

The only possible reason that can be advanced for failing to act
positively and constructively to meet this need is cost. I sm not impressed
with the contention that the Federal government cannot afford to press
forward toward assurance of a minimum decent living for all people and
toward provision of publicly financed facilities--schools, hospitals,

laboratories--on the scale which the Country needs.

Let me, if I may, bring to your attention a few thoughts I presented
before the House of Representatives on March 29 of this year.

“This is the richest country in the world, but we tend to act poor
when the time comes to consider more adequate financing of the things that
we should do as a community and as a Nation. What we really lack is not
the economic capacity, but more often the will, the sense of purpose and the
vision to move ahead instead of standing still.

"The claim that the Nation cannot afford more medical research, more
hospitals, more medical schools, or more school classrooms, is usually not
the real reason people are against increased effort in these fields. The
same is true of the claim that all of these programs would be better carried
out if only they were returned to the States. This is nonsense. Return
of the total responsibllity for these functions to States would mean starving
them to death. In point of fact, the States are doing their part financially.
In 1959 the States collected between $1.5 and $2 billion additional tax
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revenue. These are legislated increases, and not just higher tex returns
because economic conditions are good. States and localities are collecting
about a third of all governmental taxes--they collect about $30 billion

per year, and all Federal taxes amount to about $70 billion per year. ‘They
are not shirking their tax responsibilities. They are pushing their ability
to tax closer to the limit all the time.

"No; the real reason for opposing sustained, modest increases in
Federal health and welfare activities, for example, is that some people
just do not think these things should be done by Government because they
cost money, and they do not believe in having the Federal Government finance
these activities simply because it has the tax resources to do a good job.

"Yet, looking to the future, even conservative groups assume that we
are going to get wealthier year by year--not wealthier in terms of inflated
dollars, but wealthier in terms of goods and services. The Rockefeller
report on the U.S. economy pointed out that ‘We may reasonably expect a
continuation of a growth rate of 3 to 4 percent per year over the next decade
and beyond. In fact, a growth rate of 5 percent ls possible if we realize
fully our impressive opportunities for economic expansion.’

"Lf we maintain even the medium growth rate of 4 percent, we will be
able to expand all Government programs, including defense, as well as such
domestic programs as school :construction, hospital construction, research,
health, and road construction. At the same time, this growth rate will
support expanded private investment in better plants and equipment, and
increases in family income after taxes. And this can be done without
inflation.

"Quy real problem is not lack of economic capacity. It is lack of
leadership and of a political philosophy that will capitalize boldly and
affirmatively on the opportunities that are before us. It is not irresponsible
to recommend strengthening good Federal programs.

"Irresponsibility consists of failure to look at problems squarely,
to look at our national capacity to solve them, and to take a considered
line of constructive action. Irresponsibility arises when facts are not
faced."

It is not my belief, Mr. President, that the Federal government
should do everything for everybody. I do feel, however, that there are
selected, high-priority areas of need which we can and must meet in the

National interest. I do not advocate spending for the sake of spending.

I do not recommend increases in all areas. I recognize that Federal
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expenditures must be paid for. Bute-having searched vigilantly for priorities,
and keeping in mind the vigor and growth of our economy--I do urgently

believe that we must enact legislation and provide appropriations to meet

the crisis posed by the threat of a shortage of 15,000 physicians and an

egual number of dentists by 1975, and the resulting impairment of the level,

quality, and distribution of health and medical care services.

I do hope that a way can be found for the Administration to join with
the Congress in a program of action in this matter during this session of

Congress.
With kindest regards,

Sincerely yours,

John B. Fogarty, M.C.