(Not printed at Government expense) United States of America PROCEEDINGS AND DEBATES OF THE 89” ] CONGRESS, SECOND SESSION SPEECH OF HON. JOHN E. FOGARTY OF RHODE ISLAND IN THE HOUSE OF REPRESENTATIVES Wednesday, February 23, 1986 Mr. FOGARTY. Mr. Speaker, I rise to introduce H.R. 12976 the. Adult Health Protection Act of 1966. This bill would authorize the Sur- geon General of the Public Health Serv- ice to make grants to medical schools, community hospitals, health depart- ments, and other public nonprofit agen- cies to establish and operate adult health protection centers. It would authorize grants for the establishment and op- eration of these. centers for a period of 5 years: - Mr. Speaker, the system envisioned here will do more for preventive medicine and health protection than anything yet proposed. In addition to many other features, it will bring modern instru- mentation and computer use to bear on a recognized, growing health problem represented by chronic illness and the increasing scarcity of professional health personnel. What this act does is to make way for a healthy mutation in our preventive health care practices in this country. Mr. Speaker, I have often been im- pressed by the fact that—when the time is ripe—innovations occur independently to a number of people. It is rather note- worthy that last fall, after the passage of the Medicare Act, both Senator WiL- LIAMS and I were concerned about the aged who were not going to be helped by the medicare system. And, inde- pendently, we addressed ourselves to the solution—or solutions—of the problem. In September 1965 Mr. WILLIAMS re- minded the Senate that the increasing numbers of our aged and aging popula- _ tion present a growing problem with 210-249—2118 Living Care special significance for chronic diseases. He pointed out that an estimated 74 mil- lion Americans are afflicted by one or more chronic disorders. He went on to cite pertinent statistics on the high in- cidence among the elderly of a host of cripplers—blindness, deafness, epilepsy, arthritis, rheumatism, glaucoma, and others. At about the same time last fall I had an opportunity to speak at the dedication of Hall Manor, Cranston’s first low-rent housing development for the elderly, in my home State of Rhode Island. I took the opportunity to remark be- fore that audience: "I wonder, for instance, how many Ameri- cans realize that there now exist more than 2,500,000 elderly people who will actually not benefit from most of our national programs for the aged. These elderly. cannot secure low-rent hous- ing, cannot participate in recreational pro- grams or. in vocational rehabilitation proj- ects, will hardly, in fact, benefit at all from the new medicare provisions. I said that there is, therefore, an ur- gent need for long-term comprehensive care for the elderly who cannot take care of themselves. I called then for an en- tire program of services to provide for all the needs of life—in short, for what I called living care. Finally, I concluded that we need noth-~ ing less than full Federal responsibility for maintaining the neglected lives of our 18 million elderly population. In the measure that Senator WILLIAMS and I are proposing today, this conviction is spelled out in unmistakable terms. We state that “the Congress hereby finds and declares that the Federal Govern- ment has a duty to assist the adult pop- ulation of the United States, particularly the aged and the aging, in protecting, maintaining, and improving their health.” Mr. Speaker, from this premise we propose for the first time to provide Fed- eral assistance in the establishment and operation of regional and community health protection centers for the detec- tion of disease; to provide assistance for the training of personnel to operate such centers; and to provide assistance in the conduct of certain research related to such centers and their operation. I do not propose to read this bill aloud to you here, but its purpose is to-en- courage and assist, through grants, in the planning, establishment, and opera- tion of regional health and community protection centers, each of which will provide health appraisal and disease de- tection services, on a periodic basis, to any adult who requests such services, if he has attained age 50 and resides with- in the geographic area served by the centers. , These health protection centers would provide a series of basic tests forthe detection of abnormalities in the cardio- vascular, respiratory, gastroizitestinal, genitourinary, and musculoskeletal sys- tems as well as defects in metabolism and organs of special sense. = Specific diseases or conditions to ‘be tested might include hypertension, vari- ous forms of cancer, rheumatoid arthri- tis, respiratory insufficiency, diabetes, kidney disease, obesity, and hearing and vision impairment. The tests would be administered by technicians, nurses, and medical special- ists using automated or semiautomated equipment which has already been proven to give swift, accurate, and re- liable results. The results of these tesis, along with data provided by the person undergoing the health appraisal, would be fed into a computer. It is estimated that the battery of tests could be ad- ministered within 2% hours. The results of the tests, summarized by the computer, would be referred to the private physician of the person taking them. In cases where the persons either 2 did not have a private physician or was medically indigent, the tests would be referred to a physician in accordance with local practice. The adult health protection centers are intended to provide an efficient means for the detection of abnormalities or in+ dications of disease—but not to replace full: examinations. Their purpose ‘is: to place in the hands of the examining physician a summary.of basic data ‘and to place promptly under a physician’s care a person with indications of disease conditions. The health protection centers would conduct training programs in the opera- tion of technical disease detection. pro- cedures and would research and develop new.. disease detection tests and equip- ment.. Additional grants to the centers would be authorized for operational re- search and for the establishment. of. in- ternships to give on-the-job training to physicians, nurses, and technical person- nel. The centers would also: conduct community education programs on. pre- ventive health care. Finally, a 12-man Advisory Council on ‘Adult Health Protection would be estab- lished to advise the Surgeon General of the Public Health Service in the admin- ‘istration of this program. This.Council will. include men who are leaders in the fields of medicine, public health,. public welfare, or representatives of national organizations concerned with the inter- ests of the aging. And it shall include one or more national leaders known for their dedication to the national interest and the welfare of the Nation’s citizens. The basic idea behind the. act,. put simply, is this: to launch a. genuine, nationwide preventive medicine. cam- paign. By making these testing services available to any person age 50 or above, 210-249—2118 CONGRESSIONAL RECORD on a voluntary basis, we will encourage men and women approaching retirement to take regular health examinations and we will facilitate. the giving of full ex- aminations by practicing physicians. Mr. Speaker, the long-range answer to the health problems of the aging is in early identification and control of disease and prevention of illness and dis- ability. Now, ideally, we would achieve this goal by having periodic health examina- tions for everyone. Realistically, of course, we know that there are not enough physicians to accomplish a pro- gram of this seale. Fortunately, a way has been found out of this dilemma. What we are proposing in this act is to take the proven automated testing techniques from an unusual project in California—called Kaiser Permanente— and adapt them for demonstration on a communitywide basis in other areas of the country. _ Assisted by a grant from the Division of Chronic Diseases, Public Health Serv- ice, the Kaiser Foundation health plan in Oakland has developed a multitest laboratory that is immensely accurate and remarkably economical. Some 40,000 Kaiser-Permanente -health plan beneficiaries are participat- ing in this pilot health program. Their experience will now become the basis for this first nationwide preventive medicine effort, so far as the chronic ciseases are ‘concerned——just as, once upon a time, a preventive medicine’ effort had to be ‘launched against the infectious diseases. May this new effort be as successful as that campaign proved to be. Once again I want to repeat what I said at Cranston last fall. I know well that, hearing this pro- posal, many voices will cry out—cry out as they did against medicare, and as they did against the heart disease, can- cer, and stroke program, and. as they cried out against most-of the other far- sighted public health bills passed by the 89th Congress. But I say to them, as I said in this House last year, when asked where “this kind of business” will end: that I, for one, intend to keep going and going until we take adequate care of as many people as we possibly can who so badly need better health services, no matter how long it takes. I promised, in my “Living Care” speech, to introduce legislation to help the elderly. This bill I introduce today is the first ‘piece of such legislation I intend to introduce in this 2d session of the 89th Congress. It is a vital piece of legisla- tion,.for only by preventive care can we hope to reduce the staggering load of suf- fering borne by the elderly in our midst. As most of you know, I have concerned myself with the problems of the aged for the past decade. In 1956 I supported the President in-establishing a Federal Council on Aging, and in 1959 I intro- duced: legislation: calling for the White House - Confererice’ on’ Aging that was held in 1961, , In 1963 I introduced the Older Amer- icans Act which: finally passed in 1965. I am happy to say that the Aging Ad- ministration that it created within the Department of Health, Education, and Welfare is now a going concern. I am proud of this record and of these successes. Yet it is no exaggeration to say that I believe that the Adult Health Protection. Act of 1966 will be the most important single piece of legislation con- cerning the aging and the aged that I have ever introduced into this House. US, GOVERNMENT PRINTING OFFICE:1966