September 24, 1965

CONGRESSIONAL RECORD — HOUSE

‘can Medical Colleges.

& Mr. FOGARTY. Mr. Chairman, last

“ March I introduced in the House a meas-
ure (FLR. 5999) designed to benefit the
health of the American people. Tt was
intended to provide a solid basis for the
great aim of the President’s Commission
on Heart Disease, Cancer, and Stroke: to
match’ medical research potential with
public health achievement by making the
advances of medical science more readily
available to our people.

At that time I reminded all of you that
heart disease, cancer, and stroke together
accounted for 7 out of every 10 deaths in
the United States each year. Ireminded
you that this toll could be sharply re-
duced—if only the medical profession
and medical institutions could make
available to their patients the latest ad-
vances in the diagnosis and treatment of
these diseases.

A lot has happened since March to the
various proposals—introduced into the
Senate by Senator Hitt and into the
Efouse by myself and the gentleman from
Arkansas (Mr. Harris]—to implement a
program for regional centers to combat
these three killer diseases. On June 23
the Senate passed the measure and
earlier this month the House Interstate
Commerce Committee—after extensive
hearings—reported out H.R. 3140, the
Heart isease, Cancer, and Stroke
Amendments of 1965. It is this measure
that I wish to rise to support, today.

It is a tribute to the remarkable un-
derstanding and dedication to matters of
health by the chairman of the House of
Interstate Commerce Committee—that a
measure that was at one time considered
controversial has now gained such ac-
eeptance that it may fairly be said that
a, consensus has been reached regarding
it.

This measure now enjoys the support
of such voluntary agencies as the Ameri-
can Heart Association and the American
Cancer Society. It also enjoys the sup-
port of such respected professional or-
ganizations as the American Hospital As-
sociation and the Association of Ameri-

24137

It enjoys the sup-
port of numerous deans and officers of
medical schools.

In addition, it now enjoys the qualified
support of the American Medical Associ-
ation. In a news release from the AMA
on September 2 that organization re-
ported that an AMA advisory committee
had met with President Johnson to dis-
cuss this measure. AMA President James
Appel said he was gratified that as a re-
sult of these meetings some 20 amend-
saents to the bill were accepted by the
administration and that—and I quote:

Many of the changes are substantial and
will allay many of the fears the medical
profession had about the original bill.

The AMA president was also quoted
as saying:

We.feel that we were successful in getting
@ number of major changes in the bill which
will help preserve the high quality of medical
care and the fréedom of hospitals and phy-
sicians.

Mow, the amendment we are consider-
ing is a complete substitute for the origi-
nal bills and incorporates numerous
changes intended to define the scope of
the program and to guarantee that the
legislation will accomplish its stated pur-
pose without in any way interfering with
the patterns or the methods of financing
of patient care or professional practice
or with the administration of hospitals.

I will not embark upon a section-by-
section analysis of this bill—into which
so much thoughtful compromise has
gone. I will instead point out the signifi-
cant elements of the bill that have
emerged from compromises agreeable to
both proponents and critics of the orig-
inal measure.

One of the changes is in the title of
the bill, We will hear no more of “re-
gional medical complexes,” but rather, of
“regional medical programs.” This is an
important change. It is intended to
make it unmistakably clear that it is not
intended to amount a new construction
program but rather to rely on existing
facilities. Thus we emphasize the local
nature of this program, its limited scope,
and a firm base which includes local hes-
pitals and local medical facilities. The
construction authorized under this bill
will be alternation, major repair or ren-
ovation of existing buildings or replace-
ment of obsolete built-in equipment. No
new construction will be permitted from
any funds provided by this bill. :

Another change undergone by the re-
gional medical program has been to pro-
vide language so that this program will
be concerned with heart disease, cancer,
stroke and “related diseases,” instead
of—as in the original wording—‘other
diseases.” My medica’ friends assure me
that this in ne way impairs the intent of
this bill, but that the present wording
is essential as a practical consideration.
They cite heart disease as an example.
A program of research, training, and
demonstrations relating to heart disease,
which did not include work on diabetes—
when there is an apparent relationship
between diabetes with its complicating
arteriosclerosis and heart disease—would
be incomplete. This seems eminently
sound and above critcism.
24138

A major limiting change made in the
original measure was its reduction in size
and scope from 5 years to-3 and from
what some called.an open-end authoriza-
tion to $340 million authorization.

The emphasis in the bill is now upon
pilot projects and feasibility studies—in
short, upon planning and exploration of
mechanics. Section 903 of this bill au-
thorizes grants to assist In the planning
of regional medical programs. It is the
intent of the bill’s sponsors to take full
advantage of the extensive planning and
organization that have already been car-
ried out in some areas of this country.
Nor is this planning to be a one-time
thing. After regional medical programs
have been funded and some experience
has accumulated, the Surgean General is
required to submit a full report on or
before June 30,1967. In the light of that
report this House will consider extension
or expansion of the present tentative ef-
fort.

Certainly one of the major reasons for
the acceptability of the present bill by
members of the medical profession is the
new and clear-cut emphasis it gives to
the participation of community physici-
ans and health organizations. Borrow~
ing from the experience of the great clin-
ical center at the National Institutes of
Health, all patients who will be treated
under this program must be referred by
practicing physicians. Thus, except in
the case of patients who are referred by
their physicians to a facility to receive
care incident to research, training or
demonstration, this bill will have no ef-
fect on the patterns or the methods of
financing of patient care.

Related to this is a significant change
in the composition of the National Advis-
ery Council which enlarges physician
participation. Of the 12 Council mem-~-
bers 1 must be an authority in heart dis-
ease; 1 in cancer; 1 in stroke—and at
least 2 cther members must be physi-
cians. The Surgeon General may not
make a grant for any program except
upon the recommendation of this Coun-
ell. ,

The establishment of a National Advis-
ery Council on regional medical pro-
grams is based upon the successful ex-
perience of the NIH with this reviewing
mechanism for srants—an experience
that extends over the past 25 years and
more. I am confident that no wiser
course of action could have been taken
by the committee, chaired by my able
colleague, the gentleman from Arkan-
sas [Mr. Harris]. TF am equally confi-
dent that one of the best assurances of
the success of this program is to draw
upon the excellent record of the NIE in
its program administration and to con-
cur in the Senate recommendation in
this matter. There is no doubt in any-
one’s mind but that the NIE shall and
will administer this program as ably as
it has administered its many other pio-
neering research and health programs.

The Members of this House are consid-
ering today a bill which modifies the ad-
ministration proposal as the result of
constructive criticism by many diverse
groups, It is one of the most carefully
reworked measures I have encountered
in the course of my years in Congress. I
believe that this measure is no longer

CONGRESSIONAL RECORD — HOUSE

controversial but acceptable to all rea-
sonable men. -I-urge its passage by this
House, today.

September 24, 1968