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Department of School Nurses, National Education Association, Annual Convention, Detroit, MI, June 26, 1971
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The original documents are located in Box D31, folder "Department of School Nurses,
National Education Association, Annual Convention, Detroit, MI, June 26, 1971" of the
Ford Congressional Papers: Press Secretary and Speech File at the Gerald R. Ford
Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. The Council donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Digitized from Box D31 of the Ford Congressional Papers: Press Secretary and Speech File at the Gerald R. Ford Presidential Library
KEYNOTE SPEECH AT THE OPENING SESSION OF
THE DEPARTMENT OF SCHOOL NURSES, NATIONAL
EDUCATION ASSOCIATION, ANNUAL CONVENTION,
9.30 A.M. SATURDAY, JUNE 26, 1971, IN
DETROIT, MICHIGAN.
NURSING IS A NOBLE PROFESSION.
TO CARE FOR THE SICK, TO NURSE THE SICK
BACK TO HEALTH, REQUIRES NOT ONLY SKILL BUT
THE FINEST OF HUMAN IMPULSES AND THE
TENDEREST OF EMOTIONS.
IN THAT CONNECTION, I QUOTE
MR. DOOLEY, OTHERWISE KNOWN AS FINLEY PETER
DUNNE. SAID MR. DOOLEY: "I THINK THAT
IF TH' CHRISTIAN SCIENTISTS HAD SOME
SCIENCE AN' TH' DOCT IORS MORE
CHRISTIANITY, IT WUDDEN'T MAKE ANY
DIFF'RENCE WHICH YE CALLED IN -- IF YE HAD
A GOOD NURSE."
NOR DOES IT MATTER WHETHER THE
-2-
NURSE IS GOOD-LOOKING. I ONCE KNEW A
NURSE WHO WAS VERY PRETTY. SHE WAS SO
CONCEITED THAT EVERY TIME SHE TOOK A
MAN'S PULSE SHE SUBTRACTED ABOUT 10 BEATS
TO ALLOW FOR THE IMPACT OF HER PERSONALITY.
BUT THAT HAS NO BEARING ON THE
KEYNOTE OF THIS CONVENTION
AND IT IS A
KEYNOTE I AM SUPPOSED TO BE SOUNDING.
ACTUALLY, THAT KEYNOTE IS CONTAINED IN THE
ADVICE I RECEIVED WHEN I ASKED YOUR
CONVENTION PLANNERS WHAT I SHOULD TALK ABOUT.
TELL US, THEY SAID, WHAT WE CAN
DO TO PROMOTE LEGISLATION THAT WILL BRING
ABOUT BETTER HEALTH SERVICE FOR ALL SCHOOL
CHILDREN AND YOUTH.
FIRST OF ALL, I DON'T THINK WE
SHOULD SEPARATE HEALTH SERVICE TO SCHOOL
CHILDREN FROM HEALTH SERVICE TO ALL
AMERICANS. IT IS BETTER FAMILY HEALTH
-3-
SERVICE THAT WE WANT -- AND THE KEY TO
THAT IS REFORM. NOT A DOUBLING OF THE
DOLLARS GOING INTO HEALTH CARE IN AMERICA,
BUT REFORM IN THE WAY THAT HEALTH CARE IS
DELIVERED.
AT THE RISK OF SOUNDING RADICAL
I HAVE TO TELL YOU THAT OUR HEALTH CARE
DELIVERY SYSTEM ISN'T WORKING RIGHT.
UNL IKE
THE RADICALS
I
AM BACKING A PLAN
A
CONSTRUCTIVE PLAN, WHICH I THINK WILL GIVE
AMERICA GOOD HEALTH CARE FOR ALL. AND WE
CAN DO IT BY BUILDING, NOT BY TEARING
SOMETHING DOWN.
BUT BEFORE WE TALK ABOUT THAT
PLAN, LET'S TALK ABOUT WHAT WE HAVE NOW
AND WHAT'S WRONG WITH IT. YOU KNOW HOW HT
IS WHEN YOURE IN A BIG BUILDING. THEY
HAVE FLOOR MAPS AROUND WITH AN "X" THAT
SAYS, "HERE IS WHERE YOU ARE
YOU HAVE
-4-
TO KNOW WHERE YOU ARE IN ORDER TO GET WHERE
YOU WANT TO GO.
WHERE ARE WE NOW IN TERMS OF
HEALTH CARE? AS HEALTH IS MEASURED, THE
UNITED STATES IS NOT DOING AS WELL AS
OTHER ADVANCED NATIONS. WE RANK 13TH, FOR
INSTANCE, IN INFANT MORALITY. THAT IS
RELATIVELY POOR. THE UNITED STATES SHOULD
HAVE THE LOWEST INFANT DEATH RATE. THERE
IS NO REASON WHY WE SHOULD NOT BE ABLE TO
ACHIEVE THAT RANK.
LET ME NOW IMMEDIATELY ENTER
A DISCLAIMER. WHILE AMERICA IS BEHIND
OTHER WESTERN COUNTRIES IN MANY ASPECTS OF
HEALTH CARE, IT IS FAR AHEAD OF MOST IN
THE OVERALL QUALITY OF ITS MEDICINE. THE
TROUBLE IS THAT THE PERFORMANCE IS SPOTTY
AND UNEVEN.
WE HAVE MADE A NUMBER OF
ADVANCES.
-5-
A CHILD BORN TODAY CAN EXPECT
TO LIVE 30 PER CENT LONGER ON THE AVERAGE
THAN A CHILD BORN IN 1920.
NONWHITE CHILDREN, WHILE LAGGING
BEHIND WHITE CHILDREN IN TOTAL LIFE
EXPECTANCY, HAVE MADE THE GREATEST GAINS --
A THIRD MORE LIFE FOR NONWHITE MEN, AND
MORE THAN A 50 PER CENT INCREASE IN LIFE
SPAN FOR NONWHITE WOMEN.
INFANT DEATHS HAVE BEEN ON THE
DECLINE FOR SOME TIME, AND MATERNAL DEATH
RATES DROPPED BY 66 PER CENT BETWEEN 1950
AND 1967.
SO THE GROSS MEASURES OF HEALTH
STATUS CLEARLY INDICATE THAT OUR HEALTH HAS
BEEN IMPROVING, NOT WORSENING. YET THERE
IS A CRISIS IN HEALTH CARE TODAY. WHAT IS
THE NATURE OF THAT CRISIS? IT IS NOT TO
BE FOUND IN THE GENERAL STATUS OF HEALTH
-6-
BUT IN THE UNEVEN DISTRIBUTION OF HEALTH
CARE THROUGHOUT AMERICA.
I SPEAK OF THE FACT THAT THE POOR
AND THE RACIAL MINORITIES HAVE BEEN
SHORTCHANGED. THEIR LIVES ARE SHORTER.
THEY HAVE MORE CHRONIC AND DEBILITATING
DISEASES. THEIR INFANT AND MATERNAL DEATH
RATES ARE HIGHER. THEIR PROTECTION AGAINST
INFECTIOUS DISEASES, THROUGH IMMUNIZATION,
IS FAR LOWER. THEY HAVE FAR LESS ACCESS
TO HEALTH SERVICES -- AND THIS IS
PARTICULARLY TRUE OF THE CHILDREN AMONG THE
POOR AND NONWHITE MINORITIES. MILLIONS OF
THESE CHILDREN RECEIVE LITTLE OR NO DENTAL
OR PEDIATRIC CARE.
THIS IS PART OF THE HEALTH CRISIS.
ANOTHER PART HAS TO DO WITH OUR
RURAL POPULATION AND OUR GHETTO RESIDENTS.
THE FACT IS THAT THEY ARE POORLY SERVED
WITH MEDICAL CARE.
-7-
THERE ARE FOR EXAMPLE, LARGE
GEOGRAPHIC VARIATIONS IN THE RATIO OF
PHYSICIANS TO POPULATION. , THERE ARE
82 ACTIVE PHYSICIANS PER 100,000 PEOPLE
IN MISSISSIPPI, 141 IN MICHIGAN, AND 228 IN
NEW YORK. A STUDY OF 1,500 CITIES AND
TOWNS IN THE UPPER MIDWEST SHOWED 1,000
OF THEM WITHOUT A PHYSICIAN, AND 200 HAD
ONLY ONE. LARGE METROPOLITAN AREAS
AVERAGE 185 PHYSICIANS PER 100,000 PEOPLE,
WHILE NON-METROPOLITAN AREAS AVERAGE 76.
AND THE CITIES, PARTICULARLY THE GHETTOES
FARE FAR WORSE THAN THE SUBURBS IN THE
RATIO OF PHYSICIANS TO POPULATION.
GEOGRAPHIC LOCATION OF DOCTORS
IS NOT THE ONLY PROBLEM. THE OTHER IS THE
SHORTAGE OF PRIMARY CARE PHYSICIANS --
GENERAL PRACTITIONERS, PEDIATRICIANS, AND
INTERNISTS. THE DEMAND IS FOR PRIMARY CARE LIBRARY
-8-
PHYSICIANS. YET THE RELATIVE RATIO OF
PRIMARY CARE PHYSICIANS TO POPULATION HAS
BEEN DECLINING. IN 1931, ROUGHLY
117,000 PHYSICIANS OUT OF 156,000 WERE
PRIMARY CARE PHYSICIANS -- 75 PER CENT OF
THE TOTAL. IN 1967, THERE WERE ROUGHLY
115,000 PRIMARY CARE PHYSICIANS OUT OF
303,000 PHYSICIANS, OR ONLY 39 PER CENT.
FROM 94 PRIMARY CARE PHYSICIANS PER
100,000 PEOPLE IN 1931 THE RATIO HAS
DROPPED TO 73.
SO WE HAVE THE PROBLEM OF
GEOGRAPHIC LOCATION OF PHYSICIANS AND THE
PROBLEM OF TYPE OF MEDICAL PRACTICE.
STILL ANOTHER PROBLEM IS THE
IMPROPER MANAGEMENT OF OUR HEALTH CARE
RESOURCES.
THE JOINT COUNCIL OF NATIONAL
PEDIATRIC SOCIETIES SAYS THAT 75 PER CENT
-9-
OF THE PEDIATRIC TASKS PERFORMED BY A
PHYSICIAN COULD BE DONE BY A PROPERLY
TRAINED CHILD HEALTH ASSISTANT. A
SIGNIFICANT AMOUNT OF THE WORK DONE BY
OBSTETRICIANS COULD BE PERFORMED BY
NURSE-MIDWIVES. EX-MEDICAL CORPSMEN, OR
COMPARABLY TRAINED INDIVIDUALS, WITH SOME
ADDITIONAL TRAINING COULD ASSUME A LARGE
NUMBER OF THE TASKS NOW PERFORMED BY
GENERAL PRACTITIONERS.
IN EVERY STUDY OF HEALTH CARE
FACILITIES, ONE FINDS VARYING PERCENTAGES
OF PATIENTS WHO SHOULD BE USING MORE
APPROPRIATE FACILITIES.
THE HEALTH-EDUCATION-WELFARE
DEPARTMENT ESTIMATES THAT WITH JUST A
10 PER CENT IMPROVEMENT IN THE EFFICIENCY
WITH WHICH OUR HEALTH RESOURCES ARE USED
WE COULD ACHIEVE A SAVING OF MORE THAN
$5 BILLION.
-10-
IT IS CLEAR THAT THE ORGANIZATION
OF OUR HEALTH CARE DELIVERY SYSTEM NE EDS
REFORMING.
WHAT ABOUT FINANCING?
EXPENDITURES ON PERSONAL HEALTH CARE
AMOUNTED TO $58 BILLION IN FISCAL 1969.
THE LARGEST PART -- ALMOST 63 PER CENT --
CAME FROM PRIVATE SOURCES, AND THE REST
FROM PUBLIC SOURCES.
ABOUT 80 PER CENT OF THE
POPULATION UNDER 65 HAS SOME PRIVATE HEALTH
INSURANCE, MAINLY FOR HOSPITAL AND SURGICAL
COVERAGE.
ABOUT 75 PER CENT OF THE
WORKING POPULATION IS PROTECTED THROUGH
EMPLOYER-EMPLOYE PLANS DEVELOPED UNDER
COLLECTIVE BARGAINING AGREEMENTS.
MEDICARE PROVIDES PROTECTION
FOR MORE THAN 95 PER CENT OF THE ELDERLY.
-11-
AND MEDICAID PROVIDES SOME PROTECTION FOR
15 MILLION OF THE AGED POOR, THE BLIND THE
DISABLED, AND FAMILIES WITH CHILDREN.
YET LARGE NUMBERS OF OUR PEOPLE
ARE EXCLUDED FROM FINANCIAL ACCESS TO
HEALTH CARE. BENEFITS ARE OFTEN INADEQUATE.
AND COSTS ARE UNNECESSARILY HIGH.
STILL ANOTHER PART OF THE HEALTH
CARE CRISIS IS THE FINANCIAL CRISIS WHICH
HAS BESET A LARGE NUMBER OF THE NATION'S
MEDICAL AND DENTAL SCHOOLS puf THE mussing schools
INESCAPABLE FACT IS THAT THE PROFESSIONAL
SCHOOLS ARE IN TROUBLE.
WE'VE TALKED ABOUT THE PROBLEM
NOW LET'S TALK ABOUT THE SOLUTION.
THERE IS LITTLE DOUBT THAT SOME
TYPE OF NATIONAL HEALTH INSURANCE PLAN IS
NEEDED TO BRING BETTER HEALTH CARE TO
AMERICANS AND TO COPE WITH SOARING COSTS
-12-
OF MEDICAL AND HOSPITAL CARE.
THE PROBLEMS OF INCREASING
MEDICAL AND HOSPITAL COSTS ARE NOT LIMITED
TO THE POOR. THE PROBLEM IS NATIONWIDE
UNIVERSAL. IT NEEDS BROAD ATTENTION AND
CORRECTION.
WE MUST RAISE THE HEALTH STANDARDS
OF ALL AMERICANS. WE MUST DEAL WITH THE
DEFECTS IN THE HEALTH CARE DELIVERY SYSTEM
AS IT AFFECTS US ALL. THIS IS A CRISIS
WHICH TOUCHES OUR CONSCIOUSNESS AND OUR
CONSCIENCE. IT IS CENTRAL TO THE QUALITY
OF LIFE IN AMERICA.
MANY PROPOSALS HAVE BEEN
INTRODUCED IN THE CONGRESS.
I
PERSONALLY
BELIEVE THE CHOICE IS PRIMARILY BETWEEN
FEDERAL FINANCING OF A NATIONAL HEALTH
PROGRAM/ AND THE ADMINISTRATION'S PLAN FOR
A NATIONAL HEALTH INSURANCE PARTNERSHIP
-13-
BETWEEN THE FEDERAL GOVERNMENT AND THE HEALTH
INSURANCE INDUSTRY. THE ADMINISTRATION'S
PROPOSED NATIONAL HEALTH STRATEGY, OF
COURSE, GOES FAR BEYOND JUST THE FINANCING
OF HEALTH CARE. IT IS A REFORM PROPOSAL
DIRECTED AT ALL OF THE PROBLEMS I HAVE
OUTLINED.
AS FOR FEDERAL FINANCING OF A
NATIONAL HEALTH PROGRAM, THE COST IS
ESTIMATED AS HIGH AS $77 BILLION A YEAR.
FIRST OF ALL, I DO NOT BELIEVE
JUST DOLLARS ALONE WILL RESOLVE OUR NATIONAL
HEALTH CRISIS.
SECONDLY, IT IS DIFFICULT TO SAY
JUST HOW MUCH MORE GOVERNMENTAL SOLICITUDE
THE TAXPAYING PUBLIC CAN AFFORD. IF THE
COST OF PROVIDING HEALTH CARE FOR EVERY MAN
ORD
WOMAN AND CHILD IN AMERICA WERE TO BE
FEDERALLY FINANCED, THE COST WOULD BE
-14-
STAGGERING AND THE TAX LOAD WOULD BE
VIRTUALLY UNBEARABLE. IF THE COST WERE
TO BE PIGGY-BACKED ONTO OUR SOCIAL
SECURITY TAXES, I THINK PAYROLL LEVIES
WOULD SOON REACH THE BREAKING POINT. EVEN
AT ITS PRESENT LEVELS, SOCIAL SECURITY
TAXATION IS COSTING SOME FAMILIES AS MUCH
AS THEY ARE PAYING IN FEDERAL INCOME TAXES.
I PERSONALLY FEEL FEEL/IT IT WOULD BE
BETTER FOR AMERICA TO PROVIDE BETTER HEALTH
BY TAPPING THE PRIVATE ECONOMY THAN BY DIPPING
INTO THE PUBLIC TILL.
THIS IS ONE REASON ! HAVE
CO-SPONSORED THE ADMINISTRATIONS NATIONAL
HEALTH PARTNERSHIP ACT IN THE HOUSE OF
Furthermore
REPRESENTATIVES. THE OTHER REASON IS THAT
THE ADMINISTRATION PLAN GOES DIRECTLY TO
THE ROOT OF THE PROBLEMS WHICH ARE CAUSING
OUR HEALTH CRISIS TODAY.
-15-
THE ADMINISTRATION PLAN EVOLVED
OVER THE BETTER PART OF A YEAR. IT IS THE
PRODUCT OF DEEP AND DETAILED STUDY -- A
STUDY THAT CENTERED ON VARIOUS ALTERNATIVES.
THE END PRODUCT IS A PACKAGE THAT
WOULD PLACE THE BULK OF THE COST OF BETTER
HEALTH CARE SERVICES ON EMPLOYERS AND FOCUS
ON PREVENTIVE MEDICINE RATHER THAN JUST
GETTING THE SICK WELL.
THE ADMINISTRATION PLAN COVERS
THE ENTIRE HEALTH CARE CRISIS -- FROM
PREVENTION OF ILLNESS AND INJURY TO THE
FINANCING OF HEALTH SERVICES, FROM
INCENTIVES TO ENCOURAGE A BETTER
DISTRIBUTION OF HEALTH SERVICES TO
ASSISTANCE AND INCENTIVES FOR OUR
PROFESSIONAL SCHOOLS.
ONE OF THE KEY PARTS OF THE
ADMINISTRATION PLAN IS THE REQUIREMENT THAT
-16-
EMPLOYERS PAY 65 PER CENT OF THE COST OF
HEALTH INSURANCE PREMIUMS AT THE START
OF THE PROGRAM, JULY 1, 1973, AND 75 PER CENT
AFTER 1976.
THE BENEFITS WOULD VARY, BUT IN
GENERAL THEY WOULD BE FAR HIGHER THAN THOSE
AVAILABLE TODAY. THE PLAN WOULD COVER
MATERNITY CARE WITH NO DEDUCTIBLES.
WELL-CHILD SERVICES, INCLUDING VACCINATIONS
AND PERIODIC CHECKUPS BY A PEDIATRICIAN
WOULD BE COVERED.
ANOTHER KEY FEATURE IS THAT
CATASTROPHIC ILLNESSES WOULD BE COVERED WITH
TOTAL PAYMENTS AS HIGH AS $50,000 -- FAR
ABOVE THOSE OF EXISTING POLICIES.
PREMIUMS WOULD VARY, DEPENDING ON
CIRCUMSTANCES AND THE REGION.
THE PRIVATE HEALTH INSURANCE
SHIELD, IS CENTRAL TO THE PLANx THEY by WOULD
INDUSTRY, INCLUDING BLUE CROSS AND BLUE
-17-
UNDERWRITE BOTH THE INCREASED EMPLOYER
INSURANCE AND THE FAMILY HEALTH INSURANCE
PROGRAM.
FOR PERSONS ON WELFARE -- OR
THOSE WHO EARN LESS THAN $5,000 A YEAR --
THE FEDERAL GOVERNMENT WOULD PAY MOST BASIC
MEDICAL COSTS. RECIPIENTS WOULD PAY SOME
PREMIUMS, HOWEVER, UNLESS THEIR INCOME
WAS LESS THAN $3,000 A YEAR.
AT THE SAME TIME, "PART B" OF THE
MEDICARE PROGRAM, WHICH COVERS PHYSICIANS
FEES, WOULD BE COMBINED WITH THE FREE
MANDATORY "PART A" HOSPITALIZATION WHICH IS
PROVIDED PERSONS OVER 65. THIS WOULD
ELIMINATE THE $5.30-A-MONTH PREMIUM NOW
CHARGED RECIPIENTS FOR THE "PART B" PORTION.
ANOTHER KEY FEATURE OF THE PLAN
IS THAT PRIVATE HEALTH INSURANCE COMPANIES
WOULD BE BROUGHT UNDER FEDERAL REGULATION.
-18-
THIS IS NECESSARY IF EMPLOYERS ARE TO BE
REQUIRED TO BUY POLICIES TO COVER THEIR
EMPLOYES.
TO ME ONE OF THE OUTSTANDING
FEATURES OF THE ADMINISTRATION PLAN IS ITS
EMPHASIS ON HEALTH MAINTENANCE
ORGANIZATIONS. OR HMO'S. HMO'S
SIMULTANEOUSLY ATTACK MANY OF THE PROBLEMS
COMPRISING THE HEALTH CARE CRISIS. THEY
EMPHASIZE PREVENTION AND EARLY CARE. THEY
PROVIDE INCENTIVES FOR HOLDING DOWN COSTS
AND FOR INCREASING THE PRODUCTIVE USE OF
RESOURCES. THEY PROVIDE A MEANS FOR
IMPROVING THE GEOGRAPHIC DISTRIBUTION OF
HEALTH CARE.
HMO'S, AS YOU KNOW, ARE ORGANIZED
SYSTEMS OF HEALTH CARE WHICH PROVIDE
COMPREHENSIVE SERVICES FOR ENROLLED MEMBERS
FOR A FIXED PREPARED ANNUAL FEE. THEY
-19-
PROVIDE A MIX OF OUTPATIENT AND HOSPITAL
SERVICES THROUGH A SINGLE ORGANIZATION AND
A SINGLE PAYMENT MECHANISM. PERHAPS THE
BEST EXAMPLE IS THE KAISER FOUNDATION.
THIS IS ACTUALLY THE MOST
IMPORTANT STEP THE FEDERAL GOVERNMENT CAN
TAKE TO IMPROVE HEALTH CARE THROUGHOUT
AMERICA -- TO ENCOURAGE THE GROWTH OF MORE
EFFICIENT FORMS OF CARE SUCH AS THAT
PROVIDED BY HMO'S. ALL OF THE STUDIES THAT
HAVE BEEN MADE POINT TO THE SAME
CONCLUSION -- THAT HMO'S LOWER THE TOTAL
HEALTH-CARE COSTS OF FAMILIES AND
INDIVIDUALS AND THEIR PREMIUMS COVER A
GREATER PERCENTAGE OF TOTAL COSTS.
THE ADMINISTRATION'S GOAL IS TO
DEVELOP 450 HMO'S BY THE END OF FISCAL YEAR
1973. OF THESE, 100 WOULD SERVE AREAS WITH
A SCARCITY OF HEALTH CARE RESOURCES.
-20-
THE PLAN CALLS FOR 1,700 HMO'S
BY THE END OF 1976. THESE HMO'S WOULD HAVE
A POTENTIAL FOR ENROLLING 40 MILLION
PEOPLE 10 MILLION OF WHOM WOULD BE IN
FAMILIES WITH INCOMES OF UNDER $8,000 A
YEAR. AND THE ULTIMATE GOAL WOULD BE TO
ENROLL 90 PER CENT OF THE POPULATION IN
HMO'S BY THE END OF THE DECADE.
THE ADMINISTRATION WILL USE
VARIOUS EXISTING AUTHORITIES TO STIMULATE
THE DEVELOPMENT OF HMO'S DURING FISCAL
1972 -- PARTNERSHIP FOR HEALTH, REGIONAL
MEDICAL PROGRAMS, HEALTH SERVICES RESEARCH
AND DEVELOPMENT, HILL-BURTON AND POSSIBLY
OTHERS. BUT NEW LEGISLATIVE INITIATIVES WILL
BE NEEDED TO BUILD UP HMO'S TO THE POINT
ENVISIONED BY THE ADMINISTRATION.
THE ADMINISTRATION HAS PROPOSED
A COMPREHENSIVE HEALTH MANPOWER STRATEGY
-21-
DESIGNED TO OVERCOME THE CRUCIAL PROBLEMS
OF TODAY AND TO PREPARE FOR THE FUTURE.
THE PRESIDENT'S FISCAL 1972 BUDGET CALLS
FOR MORE THAN $1.1 BILLION FOR HEALTH
MANPOWER EDUCATION AND TRAINING.
SIGNIFICANTLY, THE BUDGET PROVIDES
$10 MILLION TO SEND DOCTORS, DENTISTS,
NURSES AND OTHER HEALTH WORKERS INTO HEALTH
PERSONNEL SCARCITY AREAS AT THE REQUEST
OF PUBLIC OR NON-PROFIT HEALTH AGENCIES.
THIS PROGRAM INVOLVES AN INITIAL 600 TO
1,000 HEALTH PERSONNEL.
AND TO ENCOURAGE PRIMARY CARE
PHYSICIANS, DENTISTS AND NURSES TO PRACTICE
IN MEDICALLY UNDERSERVED AREAS, THE
ADMINISTRATION PROPOSES TO FORGIVE $5,000 IN
LOANS, PLUS INTEREST, ON FUNDS BORROWED BY
DOCTORS AND DENTISTS AS STUDENTS, AND
25 PER CENT OF NURSES' LOANS, FOR EACH YEAR
-22-
SERVED IN SUCH AREAS.
AS YOU ALL KNOW, WE HAVE A
CRITICAL SHORTAGE OF NURSES IN AMERICA.
THAT IS PART OF THE HEALTH CRISIS, AND THE
ADMINISTRATION AND THE CONGRESS ARE ACTING
TO REMEDY IT.
AT THE PRESENT TIME, THERE ARE
700,000 NURSES IN ACTIVE PRACTICE AT LEAST
150,000 MORE ARE NEEDED NOW. BY 1980,
1,100,000 NURSES WILL BE NEEDED TO HELP
MEET THE INCREASED DEMANDS FOR HEALTH SERVICES
DUE TO THE GROWTH IN POPULATION, THE
EXPANSION IN NURSES' DUTIES AND
RESPONSIBILITIES, AND THE GROWTH IN THE
COMPLEXITY OF HEALTH CARE.
THIS IS WHY THE next HOUSE week OF will pass
REPRESENTATIVES LESS THAN TWO WEEKS AGO
PASSED A THREE-YEAR EXTENSION OF THE NURSE
TRAINING ACT, WITH A NUMBER OF AMENDMENTS
-23-
AND IMPROVEMENTS. THE NURSE TRAINING ACT
OF 1971 CONTINUES NURSING SCHOOL
CONSTRUCTION GRANTS AND ADDS NEW AUTHORITY
FOR CONSTRUCTION LOANS AND INTEREST
SUBSIDIES, OFFERS "START-UP" GRANTS FOR
NEW SCHOOLS OF NURSING, INAUGURATES A
PROGRAM OF CAPITATION GRANTS FOR NURSING
SCHOOLS, INCREASES THE AMOUNT OF NURSING
STUDENT LOANS TO $2,500 A YEAR, INCREASES
NURSING STUDENT SCHOLARSHIPS TO A MAXIMUM
OF $2,000 A YEAR, AND CONTINUES TRAINEESHIPS
FOR PROFESSIONAL NURSES TO BECOME TEACHERS,
SUPERVISORS AND CLINICAL SPECIALISTS.
MY GUESS IS THERE IS SPECIAL
INTEREST AMONG YOU IN ADVANCED TRAINEESHIPS.
THERE ARE ACUTE SHORTAGES OF NURSES
PREPARED AS TEACHERS, EXPERT PRACTITIONERS
AND ADMINISTRATORS.
AT PRESENT THERE ARE NOT ENOUGH
-24-
TEACHERS IN EXISTING SCHOOLS OF NURSING,
NOR FOR THE MANY NEW AND DEVELOPING
SCHOOLS.
IN THE SEVEN YEARS SINCE THE
PASSAGE OF THE FIRST NURSE TRAINING ACT,
THE NUMBER OF INITIAL PROGRAMS OF NURSING
EDUCATION HAS INCREASED FROM 1,158 TO
1,355. THESE NEW PROGRAMS NEED TEACHERS,
AS WILL THE OTHERS IF THEY ARE TO EXPAND
ENROLLMENTS. THIS IS THE MOST CRITICAL
SHORTAGE AREA IN NURSING.
THE PROFESSIONAL NURSE
TRAINEESHIP PROGRAM WHICH IS INCLUDED IN
THE NURSE TRAINING ACT OF 1971, PROVIDES
ADVANCED TRAINING FOR NURSES TO TEACH IN THE
VARIOUS FIELDS OF NURSE TRAINING, INCLUDING
PRACTICAL NURSE TRAINING, OR TO SERVE IN
ADMINISTRATIVE OR SUPERVISORY CAPACITIES, OR
TO PREPARE NURSES TO SERVE IN OTHER
PROFESSIONAL NURSING SPECIALTIES.
-25-
THERE IS A CRITICAL NEED FOR
PREPARED FACULTY TO FILL POSITIONS IN
EXISTING NURSING SCHOOLS AND IN NEW
SCHOOLS NOW BEING ESTABLISHED.
AT THE SAME TIME, RAPID ADVANCES
IN MEDICAL AND NURSING PRACTICE DICTATE
THE NEED FOR EXPERT PRACTITIONERS TO GIVE
HIGHLY SPECIALIZED CARE.
THE TRAINEESHIP PROGRAM
WAS ONE
OF THE REASONS t STRONGLY SUPPORTED THE
NURSE TRAINING ACT OF 1971. H/IS IT VITAL TO
THE RESOLUTION OF OUR HEALTH CARE CRISIS.
THE ADMINISTRATION AND THE CONGRESS
ARE TAKING THESE AND OTHER STEPS TO IMPROVE
HEALTH CARE IN AMERICA.
WHAT THE ADMINISTRATION HAS
OFFERED CONGRESS WITH ITS NATIONAL HEALTH
STRATEGY IS AN AGENDA FOR REFORM.
REFORM
IS CLOSELY AND INGENIOUSLY WOVEN
BRARY
-26-
THROUGHOUT ALL OF THE ADMINISTRATION-S
HEALTH CARE PROPOSALS. WHAT WE NEED NOW
IS FOR THE CONGRESS TO ACT
WHAT CAN YOU DO TO HELP ? YOU
CAN JOIN WITH OTHER AMERICANS IN DEMANDING
FUNDAMENTAL CHANGES IN OUR HEALTH CARE
SYSTEM. YOU CAN URGE THE CONGRESS TO
RAISE OUR NATIONAL HEALTH CARE STANDARDS
TO NEW HIGH LEVELS WHERE ALL OF OUR NEEDS
CAN BE MET. YOU CAN INSIST THAT GOOD HEALTH
CARE BE MADE AVAILABLE TO EVERY AMERICAN,
REGARDLESS OF HIS MEANS.
IF YOU DO THIS WE CAN ALL GO
FORWARD. WE CAN BUILD TOGETHER, BUILD A
TRULY BETTER LIFE FOR ALL AMERICANS.
END : :
Distribution Full
Galleries 12 noon 6/24/71
office Copy
mail p.m 6/24/71
KEYNOTE SPEECH, REMARKS BY REP. GERALD R. FORD
AT THE OPENING SESSION OF THE DEPARTMENT OF SCHOOL
NURSES, NATIONAL EDUCATION ASSOCIATION, ANNUAL CONVENTION,
9:30 a.m. SATURDAY, JUNE 26, 1971, IN DETROIT, MICHIGAN.
Nursing is a noble profession. To care for the sick, to nurse the sick
back to health, requires not only skill butthe finest of human impulses and
the tenderest of emotions.
In that connection, I quote Mr. Dooley, otherwise known as Finley Peter
Dunne. Said Mr. Dooley: "I think that if th' Christian Scientists had some
science an' th' doctors more Christianity, it wudden't make any diff'rence
which ye called in--if ye had a good nurse."
Nor does it matter whether the nurse is good-looking. I once knew a nurse
who was very pretty. She was so conceited that every time she took a man's
pulse she subtracted about 10 beats to allow for the impact of her personality.
But that has no bearing on the keynote of this convention. And it is a
keynote I am supposed to be sounding. Actually, that keynote is contained in
the advice I received when I asked your convention planners what I should talk
about.
Tell us, they said, what we can do to promote legislation that will bring
about better health service for all school children and youth.
First of all, I don't think we should separate health service to school
children from health service to all Americans. It is better family health service
that we want--and the key to that is reform. Not a doubling of the dollars going
into health care in America, but reform in the way that health care is delivered.
At the risk of sounding radical, I have to tell you that our health care
delivery system isn't working right. Unlike the radicals, I am backing a plan,
a constructive plan, which I think will give America good health care for all.
And we can do it by building, not by tearing something down.
But before we talk about that plan, let's talk about what we have now and
what's wrong with it. You know how it is when you're in a big building. They
have floor maps around with an X that says, "Here is where you are." You have
to know where you are in order to get where you want to go.
Where are we now in terms of health care? As health is measured, the United
as
States is not doing/well as other advanced nations. We rank 13th, for instanee,
in infant mortality. That is relatively poor. The United States should have
the lowest infant death rate. There is no reason why we should not be able to
achieve that rank.
(more)
GERALD FORD LIBRARY
-2-
Let me now immediately enter a disclaimer. While America is behind other
western countries in many aspects of health care, it is far ahead of most in the
overall quality of its medicine. The trouble is that the performance is spotty
and uneven.
We have made a number of advances.
A child born today can expect to live 30 per cent longer on the average
than a child born in 1920.
Nonwhite children, while lagging behind white children in total life
expectancy, have made the greatest gains--a third more life for nonwhite men,
and more than a 50 per cent increase in life span for nonwhite women.
Infant deaths have been on the decline for some time, and maternal death
rates dropped by 66 per cent between 1950 and 1967.
So the gross measures of health status clearly indicate that our health has
been improving, not worsening. Yet there is a crisis in health care today. What
is the nature of that crisis? It is not to be found in the general status of
health but in the uneven distribution of health care throughout America.
I speak of the fact that the poor and the racial minorities are being short-
changed. Their lives are shorter. They have more chronic and debilitating
diseases. Their infant and maternal death rates are higher. Their protection
against infectious diseases, through immunization, is far lower. They have far
less access to health services--and this is particularly true of the children
among the poor and nonwhite minorities. Millions of these children receive
little or no dental or pediatric care.
This is part of the health crisis.
Another part has to do with our rural population and our ghetto residents.
The fact is that they are poorly served with medical care.
There are, for example, large geographic variations in the ratio of physicians
to population. There are 82 active physicians per 100,000 people in Mississippi,
141 in Michigan, and 228 in New York. A study of 1,500 cities and towns in the
Upper Midwest showed 1,000 of them without a physician, and 200 had only one.
Large metropolitan areas average 185 physicians per 100,000 people, while non-
metropolitan areas average 76. And the cities, particularly the ghettoes, fare
far worse than the suburbs in the ratio of physicians to population.
Geographic location of doctors is not the only problem. The other is the
shortage of primary care physicians--general practitioners, pediatricians, and
(more)
-3-
internists. The demand is for primary care physicians. Yet the relative ratio
of primary care physicians to population has been declining. In 1931, roughly
117,00 physicians out of 156,000 were primary care physicians--75 per cent of
the total. In 1967, there were roughly 115,000 primary care physicians out of
303,000 physicians, or only 39 per cent. From 94 primary care physicians per
100,000 people in 1931, the ratio has dropped to 73.
So we have the problem of geographic location of physicians and the problem
of type of medical practice.
Still another problem is the improper management of our health care resources.
The Joint Council of National Pediatric Societies says that 75 per cent of
the pediatric tasks performed by a physician could be done by a properly trained
done
child health assistant. A significant amount of the work/by obstetricians could
be performed by nurse-midwives. Ex-Medical corpsmen, or comparabl trained
individuals, with some additional training could assume a large number of the
tasks now performed by general practitioners.
In every study of health care facilities, one finds varying percentages of
patients who should be using more appropriate facilities.
The Health-Education-Welfare Department estimates that with just a 10 per
cent improvement in the efficiency with which our health resources are used we
could achieve a saving of more than $5 billion.
It is clear that the organization of our health care delivery system needs
reforming.
What about financing? Expenditures on personal health care amounted to
$58 billion in fiscal 1969. The largest part-almost 63 per cent--came from
private sources, and the rest from public sources.
About 80 per cent of the population under 65 has some private health
insurance, mainly for hospital and surgical coverage.
About 75 per cent of the working population is protected through employer-
employe plans developed under collective bargaining agreements.
Medicare provides protection for more than 95 per cent of the elderly. And
Medicaid provides some protection for 15 million of the aged poor, the blind,
the disabled, and families with children.
Yet large numbers of our people are excluded from financial access to
health care. Benefits are often inadequate. And costs are unnecessarily high.
(more)
FORD
LIBRARY
-4---
Still another part of the health care crisis is the financial crisis which
has beset a large number of the Nation's medical and dental schools. The
inescapable fact is that the professional schools are in trouble.
We've talked about the problem; now let's talk about the solution.
There is little doubt that some type of national health insurance plan is
needed to bring better health care to Americans and to cope with soaring costs of
medical and hospital care.
The problems of increasing medical and hospital costs are not limited to the
poor. The problem is nationwide, universal. It needs broad attention and
correction.
We must raise the health standards of all Americans. We must deal with the
defects in the health care delivery system as it affects us all. This is a crisis
which touches our consciousness and our conscience. It is central to the quality
of life in America.
Many proposals have been introduced in the Congress. I personally believe the
choice is primarily between Federal financing of a national health program and the
Administration's plan for a National Health Insurance Partnership between the
Federal Government and the health insurance industry. The Administration's
proposed national health strategy, of course, goes far beyond just the financing
of health care. It is a reform proposal directed at all of the problems I have
outlined.
As for Federal financing of a national health program, the cost is estimated
as high as $77 billion a year.
First of all, I do not believe just dollars alone will resolve our national
health crisis.
Secondly, it is difficult to say just how much more governmental solicitude
the taxpaying public can afford. If the cost of providing health care for every
man, woman and child in America were to be Federally financed, the cost would be
staggering and the tax load would be virtually unbearable. If the cost were to
be piggy-backed onto our Social Security taxes, I think payroll levies would soon
reach the breaking point. Even at its present levels, Social Security taxation is
costing some families as much as they are paying in Federal income taxes.
I personally feel it would be better for America to provide better health
by tapping the private economy than by dipping into the public till.
This is one reason I have co-sponsored the Administrations National Health
Partnership Act in the House of Representatives. The other reason is that the
(more)
-5-
Administration plan goes directly to the root of the problems which are causing
our health crisis today.
The Administration plan evolved over the better part of a year. It is the
product of deep and detailed study--a study that centered on various alternatives.
The end product is a package that would place the bulk of the cost of better
health care services on employers and focus on preventive medicine rather than
just getting the sick well.
The Administration plan covers the entire health care crisis--from prevention
of illness and injury to the financing of health services, from incentives to
encourage a better distribution of health services to assistance and incentives
for our professional schools.
One of the key parts of the Administration plan is the requirement that
employers pay 65 per cent of the cost of health insurance premiums at the start
of the program, July 1, 1973, and 75 per cent after 1976.
The benefits would vary, but in general they would be far higher than those
availabe today. The plan would cover maternity care with no deductibles. Well-
child services, including vaccinations and periodic checkups by a pediatrician,
would be covered.
Another key feature is that catastrophic illnesses would be covered with
total payments as high as $50,000- far above those of existing policies.
Premiums would vary, depending on circumstances and the region.
The private health insurance industry, including Blue Cross and Blue Shield,
is central to the plan. They would underwrite both the increased employer
insurance and the family health insurance program.
For persons on welfare--or those who earn less than $5,000 a year----the
Federal government would pay most basic medical costs. Recipients would pay some
premiums, however, unless their income was less than $3,000 a year.
At the same time, "Part B" of the Medicare program, which covers physicians
fees, would be combined with the free mandatory "Part A" hospitalization which is
provided persons over 65. This would eliminate the $5.30-a-month premium now
charged recipients for the "Part B" portion.
Another key feature of the plan is that private health insurance companies
would be brought under Federal regulation. This is necessary if employers are
to be required to buy policies to cover their employes.
To me one of the outstanding features of the Administration plan is its
(more)
-6-
emphasis on Health Maintenance Organizations, or HMO's. HMO's simultaneously
attack many of the problems comprising the health care crisis. They emphasize
prevention and early care. They provide incentives for holding down costs and for
increasing the productive use of resources. They provide a means for improving
the geographic distribution of health care.
HMO's, as you know, are organized systems of health care which provide
comprehensive services for enrolled members for a fixed, prepared annual fee.
a
They provide a mix of outpatient and hospital services through/single organization
and a single payment mechanism. Perhaps the best example is the Kaiser Foundation.
This is actually the most important step the Federal Government can take to
improve health care throughout America--to encourage the growth of more efficient
forms of care such as that provided by HMO's. All of the studies that have been
made point to the same conclusion--that HMO's lower the total health-care costs
of families and individuals, and their premiums cover a greater percentage of
total costs.
The Administration's goal is to develop 450 HMO's by the end of fiscal year
1973. Of these, 100 would serve areas with a scarcity of health care resources.
The plan calls for 1,700 HMO's by the end of 1976. These HMO's would have
a potential for enrolling 40 million people, 10 million of whom to uld be in
families with incomes of under $8,000 a year. And the ultimate goal would be to
enroll 90 per cent of the population in HMO's by the end of the decade.
The Administration will use various existing authorities to stimulate the
development of HMO's during fiscal Partnership for Health, Regional Medical
Programs, Health Services Research and Development, Hill-Burton and possibly
others. But new legislative initiatives will be needed to build up HMO's to the
point envisioned by the Administration.
The Administration has proposed a comprehensive health manpower strategy
designed to overcome the crucial problems of today and to prepare for the future.
The President's fiscal 1972 budget calls for more than $1.1 billion for health
manpower education and training.
Significantly, the budget provides $10 million to send doctors, dentists,
nurses and other health workers into health personnel scarcity areas at the
request of public or non-profit health agencies. This program involves an initial
600 to 1,000 health personnel.
And to encourage primary care physicians, dentists and nurses to practice in
medically underserved areas, the Administration proposes to forgive $5,000 in
LIPREST
(more)
-7-
loans, plus interest, on funds borrowed by doctors and dentists as students,
and 25 per cent of nurses' loans, for each year served in such areas.
As you all know, we have a critical shortage of nurses in America. That
is part of the health crisis, and the Administration and the Congress are acting
to remedy it.
At the present time, there are 700,000 nurses in active practice; at least
150,000 more are needed now. By 1980, 1,100,000 nurses will be needed to help
meet the increased demands for health services due to the growth in population,
the expansion in nurses' duties and responsibilities, and the growth in the
complexity of health care.
This is why the House of Representatives less than two weeks ago passed a
three-year extension of the Nurse Training Act, with a number of amendments and
improvements. The Nurse Training Act of 1971 continues nursing school construc-
tion grants and adds new authority for construction loans and interest subsidies,
offers "start-up" grants for new schools of nursing, inaugurates a program of
capitation grants for nursing schools, increases the amount of nursing student
loans to $2,500 a year, increases nursing student scholarships to a maximum of
$2,000 a year, and continues traineeships for professional nurses to become
teachers, supervisors and clinical specialists.
My guess is there is special interest among you in advanced traineeships.
There are acute shortages of nurses prepared as teachers, expert practitioners
and administrators.
At present there are not enough teachers in existing schools of nursing,
nor for the many new and developing schools.
In the seven years since the passage of the first Nurse Training Act, the
number of initial programs of nursing education has increased from 1,158 to 1,355.
These new programs need teachers, as will the others if they are to expand
enrollments. This is the most critical shortage area in nursing.
The Professional Nurse Traineeship Program which is included in the Nurse
Training Act of 1971, provides advanced training for nurses to teach in the
various fields of nurse training, including practical nurse training, or to
serve in administrative OF supervisory capacities, or to prepare nurses to serve
in other professional nursing specialties.
There is a critical need for prepared faculty to fill positions in existing
nursing schools and in new schools now being established.
(more)
-8-
At the same time, rapid advances in medical and nursing practice dictate
the need for expert practitioners to give highly specialized care.
The traineeship program was one of the reasons I strongly supported the
Nurse Training Act of 1971. It is vital to the resolution of our health care
crisis.
The Administration and the Congress are taking these and other steps to
improve health care in America.
What the Administration has offered Congress with its national health
strategy is an agenda for reform. Reform is closely and ingeniously woven
throughout all of the Administration's health care proposals. What we need now
is for the Congress to act.
What can you do to help? You can join with other Americans in demanding
fundamental changes in our health care system. You can urge the Congress to
raise our national health care standards to new high levels where all of our
needs can be met. You can insist that good health care be made available to
every American, regardless of his means.
If you do this we can all go forward. We can build together, build a
truly better life for all Americans.
#######
LIBRARY
KEYNOTE SPEECH, REMARKS BY REP. GERALD R. FORD
AT THE OPENING SESSION OF THE DEPARTMENT OF SCHOOL
NURSES, NATIONAL EDUCATION ASSOCIATION, ANNUAL CONVENTION,
9:30 a.m. SATURDAY, JUNE 26, 1971, IN DETROIT, MICHIGAN.
Nursing is a noble profession. To care for the sick, to nurse the sick
back to health, requires not only skill butthe finest of human impulses and
the tenderest of emotions.
In that connection, I quote Mr. Dooley, otherwise known as Finley Peter
Dunne. Said Mr. Dooley: "I think that if th' Christian Scientists had some
science an' th' doctors more Christianity, it wudden't make any diff'rence
which ye called in--if ye had a good nurse."
Nor does it matter whether the nurse is good-looking. I once knew a nurse
who was very pretty. She was so conceited that every time she took a man's
pulse she subtracted about 10 beats to allow for the impact of her personality.
But that has no bearing on the keynote of this convention. And it is a
keynote I am supposed to be sounding. Actually, that keynote is contained in
the advice I received when I asked your convention planners what I should talk
about.
Tell us, they said, what we can do to promote legislation that will bring
about better health service for all school children and youth.
First of all, I don't think we should separate health service to school
children from health service to all Americans. It is better family health service
that we want--and the key to that is reform. Not a doubling of the dollars going
into health care in America, but reform in the way that health care is delivered.
At the risk of sounding radical, I have to tell you that our health care
delivery system isn't working right. Unlike the radicals, I am backing a plan,
a constructive plan, which I think will give America good health care for all.
And we can do it by building, not by tearing something down.
But before we talk about that plan, let's talk about what we have now and
what's wrong with it. You know how it is when you're in a big building. They
have floor maps around with an X that says, "Here is where you are." You have
to know where you are in order to get where you want to go.
Where are we now in terms of health care? As health is measured, the United
as
States is not doing/well as other advanced nations. We rank 13th, for instanee,
in infant mortality. That is relatively poor. The United States should have
the lowest infant death rate. There is no reason why we should not be able to
achieve that rank.
(more)
-2-
Let me now immediately enter a disclaimer. While America is behind other
western countries in many aspects of health care, it is far ahead of most in the
overall quality of its medicine. The trouble is that the performance is spotty
and uneven.
We have made a number of advances.
A child born today can expect to live 30 per cent longer on the average
than a child born in 1920.
Nonwhite children, while lagging behind white children in total life
expectancy, have made the greatest gains--a third more life for nonwhite men,
and more than a 50 per cent increase in life span for nonwhite women.
Infant deaths have been on the decline for some time, and maternal death
rates dropped by 66 per cent between 1950 and 1967.
So the gross measures of health status clearly indicate that our health has
been improving, not worsening. Yet there is a crisis in health care today. What
is the nature of that crisis? It is not to be found in the general status of
health but in the uneven distribution of health care throughout America.
I speak of the fact that the poor and the racial minorities are being short-
changed. Their lives are shorter. They have more chronic and debilitating
diseases. Their infant and maternal death rates are higher. Their protection
against infectious diseases, through immunization, is far lower. They have far
less access to health services--and this is particularly true of the children
among the poor and nonwhite minorities. Millions of these children receive
little or no dental or pediatric care.
This is part of the health crisis.
Another part has to do with our rural population and our ghetto residents.
The fact is that they are poorly served with medical care.
There are, for example, large geographic variations in the ratio of physicians
to population. There are 82 active physicians per 100,000 people in Mississippi,
141 in Michigan, and 228 in New York. A study of 1,500 cities and towns in the
Upper Midwest showed 1,000 of them without a physician, and 200 had only one.
Large metropolitan areas average 185 physicians per 100,000 people, while non-
metropolitan areas average 76. And the cities, particularly the ghettoes, fare
far worse than the suburbs in the ratio of physicians to population.
Geographic location of doctors is not the only problem. The other is the
shortage of primary care physicians--general practitioners, pediatricians, and
(more)
-3-
internists. The demand is for primary care physicians. Yet the relative ratio
of primary care physicians to population has been declining. In 1931, roughly
117,00 physicians out of 156,000 were primary care physicians--7 per cent of
the total. In 1967, there were roughly 115,000 primary care physicians out of
303,000 physicians, or only 39 per cent. From 94 primary care physicians per
100,000 people in 1931, the ratio has dropped to 73.
So we have the problem of geographic location of physicians and the problem
of type of medical practice.
Still another problem is the improper management of our health care resources.
The Joint Council of National Pediatric Societies says that 75 per cent of
the pediatric tasks performed by a physician could be done by a properly trained
done
child health assistant. A significant amount of the work/by obstetricians could
be performed by nurse-midwives. Ex-Medical corpsmen, or comparably trained
individuals, with some additional training could assume a large number of the
tasks now performed by general practitioners.
In every study of health care facilities, one finds varying percentages of
patients who should be using more appropriate facilities.
The Health-Education-Welfare Department estimates that with just a 10 per
cent improvement in the efficiency with which our health resources are used we
could achieve a saving of more than $5 billion.
It is clear that the organization of our health care delivery system needs
reforming.
What about financing? Expenditures on personal health care amounted to
$58 billion in fiscal 1969. The largest part-almost 63 per cent--came from
private sources, and the rest from public sources.
About 80 per cent of the population under 65 has some private health
insurance, mainly for hospital and surgical coverage.
About 75 per cent of the working population is protected through employer-
employe plans developed under collective bargaining agreements.
Medicare provides protection for more than 95 per cent of the elderly. And
Medicaid provides some protection for 15 million of the aged poor, the blind,
the disabled, and families with children.
Yet large numbers of our people are excluded from financial access to
health care. Benefits are often inadequate. And costs are unnecessarily high.
(more)
-4---
Still another part of the health care crisis is the financial crisis which
has beset a large number of the Nation's medical and dental schools. The
inescapable fact is that the professional schools are in trouble.
We've talked about the problem; now let's talk about the solution.
There is little doubt that some type of national health insurance plan is
needed to bring better health care to Americans and to cope with soaring costs of
medical and hospital care.
The problems of increasing medical and hospital costs are not limited to the
poor. The problem is nationwide, universal. It needs broad attention and
correction.
We must raise the health standards of all Americans. We must deal with the
defects in the health care delivery system as it affects us all. This is a crisis
which touches our consciousness and our conscience. It is central to the quality
of life in America.
Many proposals have been introduced in the Congress. I personally believe the
choice is primarily between Federal financing of a national health program and the
Administration's plan for a National Health Insurance Partnership between the
Federal Government and the health insurance industry. The Administration's
proposed national health strategy, of course, goes far beyond just the financing
of health care. It is a reform proposal directed at all of the problems I have
outlined.
As for Federal financing of a national health program, the cost is estimated
as high as $77 billion a year.
First of all, I do not believe just dollars alone will resolve our national
health crisis.
Secondly, it is difficult to say just how much more governmental solicitude
the taxpaying public can afford. If the cost of providing health care for every
man, woman and child in America were to be Federally financed, the cost would be
staggering and the tax load would be virtually unbearable. If the cost were to
be piggy-backed onto our Social Security taxes, I think payroll levies would soon
reach'the breaking point. Even at its present levels, Social Security taxation is
costing some families as much as they are paying in Federal income taxes.
I personally feel it would be better for America to provide better health
by tapping the private economy than by dipping into the public till.
This is one reason I have co-sponsored the Administrations National Health
Partnership Act in the House of Representatives. The other reason is that the
(more)
-5-
Administration plan goes directly to the root of the problems which are causing
our health crisis today.
The Administration plan evolved over the better part of a year. It is the
product of deep and detailed study--a study that centered on various alternatives.
The end product is a package that would place the bulk of the cost of better
health care services on employers and focus on preventive medicine rather than
just getting the sick well.
The Administration plan covers the entire health care crisis-- prevention
of illness and injury to the financing of health services, from incentives to
encourage a better distribution of health services to assistance and incentives
for our professional schools.
One of the key parts of the Administration plan is the requirement that
employers pay 65 per cent of the cost of health insurance premiums at the start
of the program, July 1, 1973, and 75 per cent after 1976.
The benefits would vary, but in general they would be far higher than those
availabe today. The plan would cover maternity care with no deductibles. Well-
child services, including vaccinations and periodic checkups by a pediatrician,
would be covered.
Another key feature is that catastrophic illnesses would be covered with
total payments as high as $50,000--far above those of existing policies.
Premiums would vary, depending on circumstances and the region.
The private health insurance industry, including Blue Cross and Blue Shield,
is central to the plan. They would underwrite both the increased employer
insurance and the family health insurance program.
For persons on welfare-- or those who earn less than $5,000 a year----the
Federal government would pay most basic medical costs. Recipients would pay some
premiums, however, unless their income was less than $3,000 a year.
At the same time, "Part B" of the Medicare program, which covers physicians
fees, would be combined with the free mandatory "Part A" hospitalization which is
provided persons over 65. This would eliminate the $5.30-a-month premium now
charged recipients for the "Part B" portion.
Another key feature of the plan is that private health insurance companies
would be brought under Federal regulation. This is necessary if employers are
to be required to buy policies to cover their employes.
To me one of the outstanding features of the Administration plan is its
(more)
-6-
emphasis on Health Maintenance Organizations, or HMO's. HMO's simultaneously
attack many of the problems comprising the health care crisis. They emphasize
prevention and early care. They provide incentives for holding down costs and for
increasing the productive use of resources. They provide a means for improving
the geographic distribution of health care.
HMO's, as you know, are organized systems of health care which provide
comprehensive services for enrolled members for a fixed, prepared annual fee.
a
They provide a mix of outpatient and hospital services through/single organization
and a single payment mechanism. Perhaps the best example is the Kaiser Foundation.
This is actually the most important step the Federal Government can take to
improve health care throughout America--to encourage the growth of more efficient
forms of care such as that provided by HMO's. All of the studies that have been
made point to the same conclusion--that HMO's lower the total health-care costs
of families and individuals, and their premiums cover a greater percentage of
total costs.
The Administration's goal is to develop 450 HMO's by the end of fiscal year
1973. Of these, 100 would serve areas with a scarcity of health care resources.
The plan calls for 1,700 HMO's by the end of 1976. These HMO's would have
a potential for enrolling 40 million people, 10 million of whom to uld be in
families with incomes of under $8,000 a year. And the ultimate goal would be to
enroll 90 per cent of the population in HMO's by the end of the decade.
The Administration will use various existing authorities to stimulate the
development of HMO's during fiscal 1972--Partnership for Health, Regional Medical
Programs, Health Services Research and Development, Hill-Burton and possibly
others. But new legislative initiatives will be needed to build up HMO's to the
point envisioned by the Administration.
The Administration has proposed a comprehensive health manpower strategy
designed to overcome the crucial problems of today and to prepare for the future.
The President's fiscal 1972 budget calls for more than $1.1 billion for health
manpower education and training.
Significantly, the budget provides $10 million to send doctors, dentists,
nurses and other health workers into health personnel scarcity areas at the
request of public or non-profit health agencies. This program involves an initial
600 to 1,000 health personnel.
And to encourage primary care physicians, dentists and nurses to practice in
medically underserved areas, the Administration proposes to forgive $5,000 in
(more)
-7-
loans, plus interest, on funds borrowed by doctors and dentists as students,
and 25 per cent of nurses' loans, for each year served in such areas.
As you all know, we have a critical shortage of nurses in America. That
is part of the health crisis, and the Administration and the Congress are acting
to remedy it.
At the present time, there are 700,000 nurses in active practice; at least
150,000 more are needed now. By 1980, 1,100,000 nurses will be needed to help
meet the increased demands for health services due to the growth in population,
the expansion in nurses' duties and responsibilities, and the growth in the
complexity of health care.
This is why the House of Representatives less than two weeks ago passed a
three-year extension of the Nurse Training Act, with a number of amendments and
improvements. The Nurse Training Act of 1971 continues nursing school construc-
tion grants and adds new authority for construction loans and interest subsidies,
offers "start-up" grants for new schools of nursing, inaugurates a program of
capitation grants for nursing schools, increases the amount of nursing student
loans to $2,500 a year, increases nursing student scholarships to a maximum of
$2,000 a year, and continues traineeships for professional nurses to become
teachers, supervisors and clinical specialists.
My guess is there is special interest among you in advanced traineeships.
There are acute shortages of nurses prepared as teachers, expert practitioners
and administrators.
At present there are not enough teachers in existing schools of nursing,
nor for the many new and developing schools.
In the seven years since the passage of the first Nurse Training Act, the
number of initial programs of nursing education has increased from 1,158 to 1,355.
These new programs need teachers, as will the others if they are to expand
enrollments. This is the most critical shortage area in nursing.
The Professional Nurse Traineeship Program which is included in the Nurse
Training Act of 1971, provides advanced training for nurses to teach in the
various fields of nurse training, including practical nurse training, or to
serve in administrative OF supervisory capacities, or to prepare nurses to serve
in other professional nursing specialties.
There is a critical need for prepared faculty to fill positions in existing
nursing schools and in new schools now being established.
(more)
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At the same time, rapid advances in medical and nursing practice dictate
the need for expert practitioners to give highly specialized care.
The traineeship program was one of the reasons I strongly supported the
Nurse Training Act of 1971. It is vital to the resolution of our health care
crisis.
The Administration and the Congress are taking these and other steps to
improve health care in America.
What the Administration has offered Congress with its national health
strategy is an agenda for reform. Reform is closely and ingeniously woven
throughout all of the Administration's health care proposals. What we need now
is for the Congress to act.
What can you do to help? You can join with other Americans in demanding
fundamental changes in our health care system. You can urge the Congress to
raise our national health care standards to new high levels where all of our
needs can be met. You can insist that good health care be made available to
every American, regardless of his means.
If you do this we can all go forward. We can build together, build a
truly better life for all Americans.
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