Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
1672761
label
President Ford Committee - Input
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
1672761
sourceUrl
contentType
document
title
President Ford Committee - Input
citationUrl
collections
Michael Raoul-Duval Papers
Election Campaign Files
subjects
Youth
Health
thumbnailUrl
largeImageUrl
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
1672761
coverageEndDate
logicalDate
1976-10-31
month
10
year
1976
coverageStartDate
logicalDate
1976-10-01
month
10
year
1976
levelOfDescription
fileUnit
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
2e35885e07a09093
ocrText
The original documents are located in Box 17, folder "President Ford Committee - Input"
of the Michael Raoul-Duval Papers 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. Michael Raoul-Duval 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United States of America his copyrights in all of his unpublished writings in National Archives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.
10/11/76
FILE
MIKE WOULD RATHER NOT RESPOND
FORD & LIBRARY 076870
President Ford Committee
825 New Hampshire Ave., N. W., Suite 105, Washington, D.C. 20037 (202) 337 - 2727
William H. Cooper, M. D., Chairman
William H. G. FitzGerald, Finance Chairman
J. Robert Rittenour, Treasurer
10/4/76
The Honorable Jerris Leonard, Legal Counsel
William M. Bartlett
Henry A. Berliner, Jr.
Berkeley G. Burrell
Robert S. Carter
Richard R. Clark
Fred L. Dixon
Mrs. Cecil G. Grant
huke- Mattel to you lorly
Samuel C. Jackson
Eugene Jewett
Mrs. Philip M. Knox, Jr.
Willie L. Leftwich
Honorable Clark MacGregor
lady, Heles 4 she
Robert McDermott
Honorable Perkins McGuire
Joseph C. McLaughlin
Mrs. J. Willard Marriott
supperted Mail
Mrs. Rodney W. Markley, Jr.
Rev. Jerry A. Moore, Sr.
Mrs. John A. Nevius
Dennis I. Paul
An to you. This
Edmund E. Pendleton, Jr.
Mrs. John Post
E. R. Quesada, Lt. Gen., USAF (ret.)
Henry L. Robinson, Jr., M. D.
Mrs. Thomas F. Shannon
report is supportly
John Lewis Smith, III
Mrs. David P. Waters
William G. Whyte
Confidulal I seews
+ me The President
or smething similar Phrona
he put have This slaw
at him out ? The flue and it's
best that be be forewarned- Sincerely
Bill Coopen
The President Ford Committee, Howard H. Callaway, Chairman, Robert Mosbacher, National Finance Chairman, Robert C. Moot, Treasurer. A copy of our
Report is filed with the Federal Election Commission and is available for purchase from the Federal Election Commission, Washington, D.C. 20463.
SCOTTISH RITE HOSPITAL FOR/CRIPPLED CHILDREN, INC.
1001 JOHNSON PERRY ROAD, N.E.
ATLANTA, CEOROIA 30342
104, 233-3252
CHARTERED 1915
ILL JOHN ZUBER 30'
Severation Frand Impector General in Georgia
August 6, 1976
EXECUTIVE COMMITTEE
JOHN L DIESTMORELAND, R.
Commund
Hospital Attorney
WILDER GLENN
Jack H. Watson, Jr., Director
Via Colluman
Planning Office
WILLIAM THANKEL
Satretary-Trecsurer
Carter-Mondale Campaign
HUGH D. CARTER
GERALD R. FORD LIBRARY
Suite 2500
IRAL COLUNS
H. LEN DROOR
Trust Co. Tower
W. O. DEVALL
THOMAS PERRY
Atlanta, Georgia
WOOD LOVELL, M.D.
Medical Director
Ex One Member
Dear Jack,
JUDSON HAWK, JR., M.O.
Director if Ambulatory Service
: x Member
This position paper is not a compromise of a task
REDDIN
force but the product of a years study by members of
ONE Member
the Advisory Council on the Physical Health Needs
COARD C F TRUSTEES
of Children and Youth to the Department of Human
R.C. BACKE, JR.
Resources. It presents broad recommendations out
MUCH CARTER
EDWIN CLEMENTS
each point can be justified by detailed available
RA COLUNS
data.
SIGNEY C. COLQUITT
R.C. CHOMPER
HAND DOR
Drafts of this document recently have been
V/ 0. DOWALL
WILHAM A. FRANKEL
reviewed, word by word, by key national experts in
JOB - ON
this field. These consultants represent, 00 the
WILSON CLENN
EUGENE GUNBY
national level, The National Institute of Child
JUDSON :. HAWK, JR., M.D.
Health and Development of the National Ins itutes of
JOHN C. KAUFMAN
PAUL MANNERS
Health, the Office of Maternal Child Health of the
THOMAS G. PERRY
Bureau of Community Health Services, the Office
JOHN C. PORTMAN, JR.
of Child Health Affairs of the Office of the Assistant
I.M. SHEPPIELD, JR.
E.S. SWALLUM
Secretary of the Department of Health, Education
TANKERSLEY
and Welfare, representatives of the American Adadem
LOUIS W. TRUMAN
JOHN L WESTMORELAND, JR.
of Pediatrics and American Society of Pediatrics
JAME WILLIAMS
and informal discussion with staff individuals 02
The National Foundation March of Dimes.
ADVISORY COMMITTEE
ROBERT L. DODD
JOBLEAVES
Much of our basic data on Georgia's problem
ROBERT E. EEKEW
CHARGES COBLE
was obtained from interviews with twenty-three
WALLAGE F. KALMBACH
administrators of health programs in our state,
JOHN MEKENNA
the Council on Maternal and Infant Health as well
THOMAS E. ROBERTS
SHIPSON NCHAPOSON
as physicians in the private and the public sector
CHAPLES 2. RUCKER
of medicine in Georgia.
EDWARD J. SCHEMME
SMITH
ROS TISINGLY
We plan to continue our study by on site visits
CUMB WILLCOXON, JR.
POT STATE-YAAPAS TEMPLE
with District Health Officers and the Chic Nurse In
each health district of Georgia.
LIFETATE EMERITUS
THE SLATE
Chairman
It is paramount to say, at the outset. that we
J. HIS WA KITE, M.D.
Chi ...
have been enthusiastically received at every level
A.1 MINSTRONG
and each urgently requests that something be done
Securitary
D.D. D. SUBRMER
for mothers, infunts, children and youth. We sense
VANCE
GEORGE DISTITUTION CARING FOR CRIPPLED CHILDREN FROM Att OVER GEORGIA
(2)
a ground swell of opinion that this hope lies with Jimmy Carter and
his strong leadership.
Jack, your organizational abilities to ultimately untangle
the massive maze of legislative programs will get the job done. As
presently operating, these programs are wasteful, inflationary, not
necting their objectives and are excluding nationally 700.000 pregnant
women and one million children in need.
Our initial plan was to ask several consultants to participate
with us this morning but honestly the number got our of hand. We
decided to disinvite all. But each agreed to be available for a
telephone conference Monday or better that each is willing to
come at your request or ours for a working day or two with your
GERALD FORD LIBRARY
staff.
Without changes on the Federal level our local problem can not
be solved due to the overlapping Federal rules and regulations. We
do not feel this problem is unique only to Georgia.
As advocates for mothers, infants and children we have done a
poor job in the past. We are now ready to assume a more active
leadership role in order that the children get their fair share. We
are now convinced that this group of Concerned Pediatricians is as
knowledgeable as any group in the country. Again we are encouraged
that our ideas for solutions, immediate as well as long range, have
been received with enthusiastic support by each agency and individual
contacted. We believe these recommendations are a reasonable and
affordable place to start on solving this very complicated problem.
Again, we repeat that there is an emerging ground swell that
what this nation needs most is to insure the integrity of the family
unit by providing non-fragmented comprehensive health care for mothers,
infants, children, and youth.
Please do not misunderstand. We do not have all the answers,
and do not believe that all of them will be formed soon. We stand
ready to answer the call to assist further in finding solutions for
problems on the Federal level while we continue to work on our
local problems.
Attached is a copy of the latest draft of the paper which will
be presented and discussed at the meeting on Monday, August 9th.
Sincerely,
Jad
Judson L. Hawk, Jr., M.D.
for The following Concerned Pediatricians
James W. Bennett, M.D.
Richard W. Blumberg, M.D.
JLH/cm
Alton M. Johnson, M.
David L. Morgan, M.D.
Harvey M. Newman, M.D.
Richard L. Schley, Jr., M.D.
Martin H. Smith, M.D.
Oscar S. Spivey, M.D.
Joseph H. Patterson. M.D.
H. Luten Teate. M.D.
Recommendations to Strengthen Federal Health
Programs for the Mothers, Infants, Children
and Youth of America
Respectfully Submitted By
Executive Committee
Georgia Chapter-
American Academy of Pediatrics
James W. Bennett, M.D.
Richard W. Blumberg, M.D.
Alfred J. Green, M.D.
Judson L. Hawk, Jr., M,D.
Alton M. Johnson, M.D.
David L Morgan, M.D.
Harvey M. Newman, M.D.
Alexander Robertson, III, M.D.
FORD : LIBRARY 9ERALD
Richard L. Schley, Jr., M.D.
Martin H. Smith, M.D.
Oscar S. Spivey, M.D.
Joseph H. Patterson, M.D.
H. Luten Teate, M.D.
August, 1976
Georgia Pediatricians, Page 1
As concerned citizens and practicing pediatricians
we appreciate the opportunity of expressing our concerns
regarding the health programs for the children and
youth of America and to offer suggestions for strengthening
them.
The Advisory Council on the Physical Health Needs
of Children and Youth (The Council), was created by T. M.
Jim Parham, Commissioner, Department of Human Resources
(DHR), on August 15, 1975. The membership is composed
of the Executive Committee of the Georgia Chapter -
American Academy of Pediatrics. Its purpose is to
advise DHR on matters pertaining to the establishment,
FORD & GERALD LIBRARY
operation and evaluation of the physical health pro-
grams for children, age one to twenty-one. (The Council
on Maternal and Infant Health relates to the mother
and infant up to one year of age in Georgia).
Our knowledge of the problem relating to child health
comes in large part from our participation on the Council
where for one year we surveyed and studied all tax-supported
health programs providing services to the children and youth
of Georgia.
This paper is being submitted as INDIVIDUALS con-
cerned about, and advocates for, the infants, children
and the youth of this country.
During the course of data gathering and analysis
Georgia Pediatricians, Page 2
numerous individuals were contacted for assistance and
information. Among those contacted were practicing pedia-
tricians in the private and public sector; pediatric
educators; administrators of federal and state agencies
providing services to children and youth; the office of
Child Health Affairs, Office of the Assistant Secretary
for the Department of Health, Education and Welfare; The
National Institute of Child Health and Human Development
FORD & LIBRARY GERALD
(NICHD), National Institutes of Health (NIH); the
Office of Maternal and Child Health, Bureaus of
Community Health Services; American Society of Pediatrics;
Representatives of the American Academy Pediatrics; voluntary
organizations and private citizens.
Without exception every individual contacted iden-
tified as the most critical problem the proliferation,
multiplicity and diffusion of maternal and child health
programs among numerous agencies of the federal govern-
ment in the absence of a strong maternal and child health
administrative unit.
In his presidential address to the American
Pediatric Society on April 28, 1976, Edward Pratt, M.D.,
eloquently described the problem. (A copy of his address
is attached.) This group of physicians supports without
equivocation Dr. Pratt's admonition that:
"Children are the only group who accept
being cheated with equanimity. The record shows
unequivocally that politicians and agency
administrators have accepted this formula and
have acted accordingly. It is easy and politically
Georgia Pediatricians, Page 3
safe to manipulate a powerless, unorganized,
non-voting group such as children, especially
children of the poor. "
A detailed statement of the problems and data
is felt to be unnecessary in view of the profuse amounts
of information available in current publications.
However, data recently published by The National
Foundation - March of Dimes is worthy of mention:
45,000 Americans were killed on highways BUT
53,000 infants died before their first birthday
during the same time period.
1,200,000 children and adults are hospitalized
FORD & LIBRARY GERALD
annually for treatment of birth defects. 11
The recommendations which follow are based upon
the premise that:
1.) The child is a product of, and must be
considered in the context of, a
family unit.
2.) The time has come for America to reorder
its priorities and meet the needs of forty
percent of its population (those under
the age of twenty-one) and provide them
with every opportunity to become healthy,
responsible and productive adults.
3.) The national goal must be that every
child have access to primary health
services from conception to age
twenty-one.
4.) Preventive health programs must have the
Georgia Pediatricians, Page 4
highest priority.
5.) Research into causes of reproductive
wastage, birth defects and acquired
physical and mental conditions and
learning disabilities must be given greater
emphasis.
6.) There is a need to strengthen the existing
federal health care programs, through
strong leadership, and to examine and
modify the basic health legislation and
its administrative structure to meet
the needs of the maternal and child
health population.
FORD is LIBRARY 976870
7.) A single standard of quality for medical
care be established for all children
and pregnant women regardless of family
income.
RECOMMENDATIONS:
I.
Federal Agency for Maternal and Child Health
The single most critical need to resolve
existing maternal and child health problems is
the creation of a strong central agency. This
agency should be headed by an Administrator for
Maternal and Child Health, appointed by the President.
The agency should have authority to:
(a). Direct, coordinate, monitor and
review all maternal and child
health programs.
Georgia Pediatricians, Page 5
(b). Assist and implement the recom-
mendations of the proposed advisory
council,
(c). Make recommendations to assure non-
competitive allocation of funds
for maternal and child health
LIBRARY GERALD R. FORD
programs.
(d). Serve as an advocate for maternal and
child health in the development and
implementation of PL 93-641, (Health
Systems Agency) and other comprehensive
federal health programs.
(e). Develop national heálth programs
for mothers and children responsive
to the national health policy adopted
by the proposed advisory council.
(f). Coordinate its efforts in health
service with the National Institute
of Child Health and Human Development.
II. National Advisory Council for Maternal and
Child Health.
Legal authority is provided to the Secretary
of DHEW to establish specialized councils in Section
1114(f) of the Social Security Act. The Secretary
should be authorized to appoint an advisory council
as soon as possible.
Georgia Pediatricians, Page 6
GERALD R. FORD LIBRARY
The membership should include broad representation
of a) health providers of services to mothers and children,
b) appropriate professional associations, c) consumer repre-
sentation, (1) appropriate representatives of the National
Institute of Child Health. and the National Institute of
Mental Health. Additionally there should be reciprocal
representation between the proposed council and the Domestic
Council of the White House.
The proposed council's responsibilities should include,
but not be limited to:
(a). Development of a national health policy which
recognizes and considers the significance of
lifestyle, nutrition, environment and education
upon the development of healthy mothers and
children.
(b). Development of a single standard of quality
of medical care for all children and
pregnant women regardless of family income.
(c). Specify maternal and child health priorities
including a proposed time table for implementation.
(d). Study existing maternal and child health pro-
grams and projects funded by the federal
government and make recommendations for
maximum consolidation and coordination.
The ultimate objective must be an efficient
non-fragmented delivery system at the
Georgia Pediatricians, Page 7
grass roots level which is responsive
to the needs of mothers and children.
(e). Establish mechanisms to provide for
continuing reviews and evaluations of
operational programs for cost effectiveness,
and impact upon the quality of life.
III. Interim Priorities
While the proposed agency and council are
being established the following programs require
immediate attention and restoration of required
FORD & 938870 LIBRARY
funding levels.
A.
Maternal and Child Health Programs
The programs authorized by Title V of
the Social Security Act, e.g., Maternal and
Child Health, Crippled Children's Services,
project funds for Maternal and Infant Care,
Intensive Infant Care, Children and Youth
Services and Dental Services, as currently
operating are providing a vital service.
There should be an immediate increase in funding
level in order to provide services to the
greatest number of eligible recipients until
this legislation is reviewed in depth by the
proposed council.
B. Nutrition
The WIC Program should be made an entitle-
ment program to assure its maximum utilization
by eligible women, infants and children who
Georgia Pediatricians, Page 8
are now excluded due to budget and geo-
graphical limitations.
C. Immunization
The Center for Disease Control published
data indicates that a large segment of child
population is unprotected from preventable
communicable diseases. Therefore there should
be an immediate restoration of funds to
the program
FORD i QERALD LIBRARY
D. EPSDT (Title XIX), Title XX, Head Start,
Developmental Disabilities, Sickle Cell, Lead
Based Poisoning Acts and Titles I and the
Title 45 Amendment of the Elementary and
Secondary Education Acts.
MP
Our concerns were reinforced by a recently
approved report submitted by an Ad Hoc Committee
to the Executive Board of the American Academy of
Pediatrics relating to Title V Projects. We
quote:
A primary problem shared by all pro-
grams is the fragmentation of effort with
resultant gaps and inefficiency. The afore-
mentioned acts are representative of incom-
pletely developed approaches to meet needs
of mothers and children. Without exception
they either fail to be identified with a
system of health care delivery or they prompt
the development of additional piecemeal
systems. The effect is that they promise
more than they can deliver or act as divisive
efforts in a community by competing for inade-
quate manpower and facility resources.
Georgia Pediatricians, Page 9
The proposed designated federal agency
and its advisory council, as a first priority,
should study the Title V legislation in
relation to other existing programs. The result
should be the consolidation of the best of
these into a single, comprehensive maternal
and child health act responsive to the needs
of today.
E. Research
FORDO & GERALD LIBRARY
Research is the process by which new know
ledge is accumulated which can then be applied
to prevention of disease and advancement of
health. Research into the problems of mothers
and children has the greatest long term implication
of all health research. It can answer questions
which have an effect over the entire life span
and enhance the quality of life. Development
of preventive health programs will be increased
and appropriations for treatment programs
will continue to escalate until the causes
of reproductive wastage, birth defects, and
developmental diseases, including learning and
aberrant behavior are known. Consequently,
it is imperative that there exist within the
Federal government a well funded, central agency
responsible for conducting and evaluating
all research, basic and applied, aimed at the
betterment of health care of mothers and children.
Georgia Pediatricians, Page 10
The NICHD within the National Institutes of Health
is now the major source of any information
concerned with health of mothers and children.
The NICHD:
a.) Should be officially designated
the health agency for the development
of all research activities relative
to mothers and children;
b.) Should remain in the NIH where it
can interrelate to other biomedical
and behavioral research programs, and
thus develop coordinated efforts;
c.) Should receive, incremental
to its official funding, via the NIH,
and additional amount equal to a sur-
charge of 10% of the funds designated
annually for health services to be used
for initiating and innovating new approaches
for research, development, and training
in maternal and child health;
d.) Serve ex officio on the proposed
advisory council to the administration
of maternal and child health.
These steps are made to insure an adequate
national research and training effort aimed
at mothers and children.
Advances made here will prevent disease and
disability in the adult and thus provide the
Georgia Pediatricians, Page 11
greatest cost ratio benefit of any form of re-
search.
F.
Maintaining Existing Preventive Health Services
There has been a consistent reduction in the
level of appropriation which, when considered in
context of the inflationary spiral that exists, has
forced program administrators to provide less
services to fewer people in need.
Programs which have been cut are those providing
maternal and child, family planning, immunization,
dental and nutritional services.
These programs that are available must receive
an adequate continuing level of funding and research
funds must be allocated to identify other effective
preventive health services.
In addition, community leaders should be
encouraged to re-emphasize, promote and restore
the many excellent youth programs sponsored and
supported by private organizations which have
played a vital role for generations in the
development of the youth of America.
G.
Legislative Moratorium
Ideally we would like to see a moratorium
on pending maternal and child health legislation
but we know this is not possible.
The passage of legislation in process,
although well intended
Georgia Pediatricians, Page 12
will add to the existing stockpile of fragmented
programs described.
It is hoped that the next administration
will designate the proposed maternal and child
health agency and advisory council as the res-
ponsible agency for developing a comprehensive
and effective maternal and child health
program.
H.
Pluralistic Approach
Programs and services which must be
delivered in the private and public sectors of
health care must include broad representation of
those at the grass roots level in the planning
process.
This representation must be incorporated
into the entire process beginning with the writing
of the legislation and proceeding through the
development of the regulatory mechanisms.
IV.
Suggestions for Reorganization
Chart 1 visualizes with clarity the current
state of diffusion of maternal and child health
programs with in DHEW.
High priority should be given to initiating
a study to determine which program components re-
lating to mothers and children could and should be
consolidated under the proposed single administrative
unit.
Chart 2 is a partial list of the programs which,
Georgia Pediatricians, Page 13
with limited time for study, have been identified
as inter-related, have similar objectives and lend them-
selves to consolidation.
A decision to consolidate these programs would
eliminate the Office of Child Health Affairs; the
Office of the Assistant Secretary for Human Development;
the office of Maternal and Child Health in the Health
Services Administration and other offices and
agencies will be reduced by that portion which relates
to children.
It would appear that without additional funds,
with perhaps a shift in monies; duplication can be
largely eliminated and intelligent planning for a
system of maternal and child services become a reality.
V.
National Health Insurance
The development of a health insurance system has
begun through Medicare for the elderly and disabled,
Medicaid for the poor, federal and state programs
of categorical service and through employee group
insurance plans. Many barriers exist to high quality
comprehensive health care for a significant segment
of the maternal and child health population. This
high quality care needs to be distinctive, and
preventive services should have the highest priorities.
Mothers and children should have available
some form of payment for health care which meets national
standards. It would seem advisable to establish a spe-
cific annual gross income eligibility level, e.g.
Georgia Pediatricians, Page 14
$20,000.00 in order to avoid the expense entailed
in monitoring complicated eligibility requirements.
It is estimated that the current cost of monitoring
Medicaid eligibility alone is 400-500 million dollars
annually.
The Council is aware of and plans to study,
S 3593 and has reviewed in depth, H 12937 shortly
FORD is LIBRARY 076836
after its initial publication.
VI.
Other Concerns
Mental health services for mothers and children
should be incorporated into the proposed agency
for maternal and child health. This important aspect
of maternal and child health has not been included
in the activities of the Advisory Council on the
Physical Health Needs of Children and Youth and therefore,
has not recieved the attention it deserves.
In administratively restructuring programs for
mothers and children as described it should be noted
that similar recommendations and organizational
realignment is equally applicable to the services
related to aging. Chart 2 places the newly created
agency for aging in the Office of the Assistant
Secretary for Health.
CHART I
DI+EW
OFFICE
Committee on Children
SECRETARY
Social ENT
OFFICE of the
Office of the
Office
Social
habilitation
Ass't SECRETARY
Assit Secretary
OCHA
of
for
for
9
Security
SERVICES
Education
Administration
Human Development
Health
Title
BER
7
SSI
10
EPSDT
OCD
DD
XIX
Voc.R
It
5
-
8
8
Q
National
Center for
Health
Health
Food and
Alcohol. Frug
Institution
Disease
Services
Resources
Drug
Abuse A Mental
Control
Administration
Administration
Administration
Health Admin.
Nat'l Cntr
Other
Hlth.Servs.
Cntr for Studie
MICHD
Insts.
Research
NIMH
of Child and
Family Mental
BCHS
INS
BMS
HMO
NHSC
MH
MCH
FP
NHC
2
/
11 11, 12, 13 Locations Not shown
CHART 2
Assistant Secretary for Health
HRA
NIH
Agency for
Agency for
CDC
FDA
ADAMHA
Maternal
Aging
&
Child Health
Maternal & Child
Portions of:
1. Title X - Family
Planning
2. Title V, Social Security Act
Maternal & Child Health
3. Title XX -
4. Office of Child Develop.
Head Start, etc.
5. Developmental Disabilities
6. Vocational Rehabilitation
7. Title I and Title 45
8. SRS, Title XIX
Medical Assistance
Program
EPSDT
9. Office of Education - PL 94-142
Early Diagnosis of Learning
Disorders
10. Supplementary Income for
Children (SSI)
11. Champus
12. Appalachian Regional Commission
13. WIC
The most important product of this country is a wanted child
who is well born and healthy. Thus, our emphasis, as the advocate
for mothers and their progeny, must begin with conception.
Problem
There are 47 million women of childbearing age and 64 million
children under age 18 in the United States -- a total which is more
than half the population of the United States.
Our country has no national health policy, and existing cir-
cumstances portend none. Federally supported health programs for
mothers and children -- presumed to be directed at important needs --
are scattered throughout HEW and the Departments of Agriculture,
Labor, Defense, State and probably others. Also involved at the
federal level are White House committees, boards, agencies, and
quasi-governmental groups.
Objective
The main objective is to reduce perinatal mortality and
morbidity in the United States to an irreducible minimum. To
accomplish this a national program should:
Focus on important basic and clinical research.
Translate research into improved patient care.
Coordinate federal efforts at improved patient care.
-2-
Essentials of Health Care
One of the essentials to assure a healthy generation is medical
services that are based on one standard of care for all and include
1. Family planning
2. Total obstetric care, including prenatal, intrapartum, and
postpartum care, with special emphasis on the high risk
mother and fetus.
3. Newborn care from the moment of birth.
Other essentials to be addressed are adequate nutrition and
education. The best medical care available cannot overcome the
handicap of inadequate nutrition and educational deprivation.
In any program of national health care, it is important that
the quality of that care not be sacrificed by reason of cost, and
that services should be reviewed by qualified specialists to assure
that services are medically necessary, of high quality, and pro-
vided in the appropriate setting for optimum patient care.
The regionalized concept of perinatal care has the greatest
potential for assuring the highest quality of care to the mother
and newborn, while at the same time may be the most cost effective.
Education/Research
Any national health program must provide for adequate education
and research. Progress in medical care is dependent upon adequate
programs of basic and clinical research. Knowledge obtained by
research programs must be developed into suitable mechanisms for
clinical utilization in the care of patients.
-3-
LISRAST GERALD ? rozo
The funding of education and of research and development
related to health care should be established upon a consistent
basis, with costs distributed equitably among the population as
a whole, and discrete from patient services.
Recommendations:
Strengthen federal coordination and decision-making capability.
Office of Maternal and Child Health in HEW, with appropriate
authority.
Strengthen MCH staff and identification at the national level.
Advisory groups for clinical application of basic and clinical
research.
Support of clinical and applied research, both biomedical and
social.
Data banks on specific entities, but avoidance of categorical
fragmentation by special interest groups.
National guidelines for HSAs as they relate to the provision
of maternal and child health.
Major priorities that are long-term and not changed yearly.
Coordination and cooperation between federal administrative
offices and representative professional organizations in:
1. Regulatory rule-making.
2. Public announcements affecting health care.
3. Program implementation.
4. Evaluation of program accomplishments as related to
legislative intent.
The American College of Obstetricians and Gynecologists
8.24.76
APPENDIX A
M.C.H. PHILOSOPHY
WE EXPERIENCE THE BIRTH PROCESS ONLY ONCE IN OUR LIFETIME
HEALTH AS AN INVESTMENT*
For a long time, economists have been in the business of attaching
dollar figures to human life.** With the great rise in the popularity of
cost-benefit analysis as an aid to government decisionmaking, economists
have applied their experience in valuing life to measuring benefits from
programs that reduce disability and improve health. The concept of valua-
tion of life generally used to estimate the benefits of desease reduction
is the "human capital" concept. This concept views a human being as a
productive asset, one who will generate a stream of earnings through future
years. Capitalizing these future earnings at some appropriate interest
rate allows one to attach a capital value to an individual. By analogy with
the theory of investment in physical capital, any investment which raises
the capital value of a human being by more than the cost of the investment
is worth undertaking.
I. THE PROBLEM
Available evidence confirms that in order for an individual to achieve
optimal potential, mothers and children must be brought into the mainstream
of health care.
The problems of mother and children are unique in that by giving the
highest priority to preventive health care one will greatly reduce the inci-
dence of acute care treatment and possibly lifelong disabling conditions.
*Reference: Vincent Taylor, The Rand Corporation, Santa Monica, California
** For a historical review of efforts to calculate the value of human lives,
see Dublin and Lotka (1).
(1)
8/26/76
The usual indices of health status will not be significantly altered
until preventive health services receive an appreciably higher priority than
they now enjoy.
Many obstacles are thrown into the path of infants, children, youth,
and pregnant women as they seek access to services to meet their needs, es-
pecially those without resources to purchase care (Tables I and II).
The specific barriers to be addressed are those created by federall
mandated health programs.
LIBRARY GERALD ? FORD
These barriers deny mothers and children access to a uniform standard
of quality health care. A brief description of the barriers by sites of oc-
currence follows:
FEDERAL LEVEL
The Executive and Legislative branches of federal government must sup-
port the development of a National Maternal and Child Health Policy directed
toward reducing maternal and infant morbidity and mortality and improving the
quality of life for generations to come.
A fundamental principle within such a policy should be equal access to
appropriate care for all pregnant women, infants, and children. This means
that health resources must be developed to overcome the social, geographic,
and financial barriers to health care which exists in far too many areas.
The proliferation, duplication and diffusion of health legislation has
contributed to the less that expected rate of improvement in health status.
Failure to recognize, utilize, and update the capability inherent in the ori-
ginal intent of Title V of the Social Security Ammendment has resulted in dif-
fusion of programs (fifteen or more DHEW agencies), enactment of categorically
limited legislation (Titles V, X, XIX, XX and Titles I and 45 of the Elementary
and Secondary Education Acts).
STATE LEVEL
Recent national health legislation executive actions has created new
health responsibilities for state governments without commensurate state
funding and without mechanism for participation by state agencies in the for-
mation of these new programs.
As a result, state governments are:
1. Implementors of federal programs with insufficient participation
in their development.
2. Conduits for the disbursement of federal health dollars.
3. Utilizing increasingly higher percentage of available state
funds to meet federal matching requirements.
(2)
4. Initiating fewer state planned health programs.
5. Forced to reduce services to the working poor and medically in-
digent as a result of #3.
6. Places in a position of responding to federal priorities, mandates
programmatic ambiguities, and revisions often with insufficient
time and increasingly more penalties.
7. Compromised by withdrawal of Federal Staff suppor of state mater-
nal and child health programs.
COMMUNITY LEVEL
The major problems of access and availability are most evident as the
individual attempts entry into the health care delivery system.
Barriers include, but are not limited to:
1. Commercial Insurance Deficits
In all but a few states, commercial insurance does not provide
universal comprehensive maternal and newborn health insurance.
Notably absent are provisions for periodic preventive health
maintenance examinations, as well as, coverage for catastrophic
events for the mother, fetus, and infants.
2. Unequal Standards of Health Care.
The working poor and medically indigent are ineligible for
government supported health services.
a. are often provided with individual insurance coverage
while their higher paid co-workers are offered family
coverage by employers.
b. are forced to enter the health care system for care of
acute conditions, e.g. obstetrical patients present
themselves for the first time at a hospital at the time
of delivery; children enter for treatment only for episo-
dic, cricis oriented stuations.
C. this large group of citizens seldom receive dental care,
correction of visual defects, or preventive health care
including family planning.
3. Access Limitations.
a. Those individuals eligible for Medicaid Services have
problems of a different nature, e.g.
(3)
Increasing numbers of physicians, dentists, and other
providers are not renewing their provider contracts,
forcing recipients to travel long distances for treatment
services. Among the reasons given for not renewing
Medicaid contracts are administrative costs, conditional
reimbursement machanisms and frequent revisions in rules
and regulations.
In 27 states, primiparas are not eligible for AFDC benefits
because the fetus is not considered a dependent child.
b. Resource Deficits
Those service agencies at the community level have felt
GERALD FORD LIBRARY
the greatest impact of the proliferation of health programs,
Often these agencies are without sufficient resources,
especially professional and clerical manpower to perform
the tasks mandated by the rules and regulations accompany-
ing each program.
C. Recipient Resistance
Those citizens eligible for government supported services
often lack the understanding and motivation to seek care
for potentially disabling conditions, follow prescribed
treatment regimens and continue care until the health pro-
blem is resolved.
In order to achieve maximum recipient response to seek
needed services various approaches must be initiated
which will raise the recipient's motivational level to
seek help.
II. JUSTIFICATION FOR FEDERAL ACTION
The problems as described are multifocal and occur at the Federal, State,
and Community levels, and therefore require reorganization and development of
a National Maternal and Child Health Policy.
The victims of these bureaucratic barriers are the potential recipients
in need of services. Some examples are:
1. Government Assistance Beneficiaries.
Individuals eligible for assistance from multiple programs often
face delays in entering the system while agencies settle terri-
torial disputes. AFDC recipients frequently face this problem.
(4)
2. Medically Indigent
The working poor are the real victims. At each point of entry
they face rejection when the civil servants or private sector
learns they do not meet rigid program eligibility requirements
even with identical handicapping, catastrophic conditions.
a. The young couple, whose annual income is $15,000, learns
their insurance excludes high risk obstetric and prolonged
neonatal care which could well exceed their total annual
income.
b. A family of four, with an annual income of $8,000 with or
without health insurance, is unable to purchase private
preventive health services and is ineligible for others.
Federal action should seek to convert our present inadequate,
fragmented programs into a comprehensive coordinated approach
aimed at the establishment of a single standard of quality
health care for mothers and children,
The consolidation and coordination of existing legislative pro-
grams under the proposed Maternal and Child Health Administra-
tion could consider the reassignment of the functions of the
following offices of DHEW currently charged with the management
of diverse programs bearing upon Maternal and Child Health.
a. The Committee on Children, Office of the Secretary of DHEW
b. Office of the Assistant Secretary for Health, Office of
Child Health Affairs.
C. Office of Assistant Secretary for Human Development, The
Offices of Child Health and Developmental Disabilities
with realignment of Vocational Pehabilitation.
d. Health Service Administration -
Bureau Community Health Services, The Office of Maternal-
Child Health and Family Planning.
e. Office of Education
Bureau of Education for the Handicapped - PL 94-142 --
Early Diagnosis of Learning Disabilities and Title 45
Amendment.
Consider Reassignment of the maternal and child health portions of
a. Social Rehabilitation Services
That portion of Title XIX, EPSDT and Title XX which estab-
lished service provisions.
b. Social Security Administration - Supplemental Security
Income.
C. Appalachian Regional Commission - Maternal and Child Health
projects.
(5)
d. Alchohol, Drug Abuse, and Mental Health Administration.
It is not inconceivable that other programs and appropriations scattered
throughout the agencies of government would lend themselves to consolidation
and coordination under the proposed Administration.
A period of study of existing program provisions and the development
of a national maternal and child health policy is prerequisite to a cohesive
comprehensive maternal and child health program which will meet the health
needs of half of the total population. These functions can best be achieved
through the establishment of a Maternal and Child Health Administration.
III. PROS AND CONS OF PROPOSED OPTIONS
Three options are offered for consideration:
A. Continue existing organizational structure.
B. Early National Health Insurance (NHI).
C. Maternal and Child Health Administration (MCHA)
FORDS is LIBRARY GERALD
A. Continue Existing Organizational Structure
The adoption of this option would:
require little or no administrative reorganization.
provide children up to 21 years of age and mothers (in theory)
with access to services.
assure recipients and providers of the continued freedom of
choice they now have.
not improve health status.
further reduce quality of care.
preclude a uniform standard of care.
escalate administrative costs.
raise federal, state and local taxes.
perpetuate program underfunding.
continue to exclude a large economically eligible population
from service.
perpetuate ineffective health service programs.
require additional employees at all levels.
(6)
B. Early National Health Insurance Legislation (NHI)
A decision to encourage the early passage of maternal and child
health insurance legislation as the option of preference will in all proba-
bility:
Assure comprehensive health insurance coverage to all children
up to 21 years of age and pregnant women.
Increase the probability that mothers and children are guaran-
teed entry into the health care delivery system.
Vastly increase the demand of all health services immediately.
Create massive delays in gaining entry to the system for treat-
ment of chronic, pre-existing conditions and preventive health
services.
Increase the use of automated systems which could effect the
traditional physician-patient relationship.
Cause unanticipated alterations in the existing systems with
no predictable assurance of improvements.
Provide insufficient time for administrative and provider or-
ganization and planning prior to implementation.
Increase opportunity for additional levels of bureaucracy and
increased response time to recipients and providers.
Require revision, consolidation, reorganization and termination
of direct services.
Alter personnel requirements to administer the program, e.g.,
increase clerical and decrease professional staff except at
provider level.
Eventually may alter an individual's freedom to select a pro-
vider.
Eventually may alter a provider's freedom to select a patient
and area of practice.
C. Maternal and Child Health Administration
This third option has been extensively described in the pre-
viouly submitted position paper and referred to in earlier sections of this
appendix. The establishment of a Maternal and Child Health Administration
should receive the highest priority.
(7)
IV. POTENTIAL OPPOSITION AND SUPPORT
In the form that the proposal is submitted the intent and the effect
should be to provide for elimination of fragmented programs and pooling the
expenditures already being made into more effective programs. Implementation
of a National Health Policy by the Administration may raise costs initially,
however, the long term result should be cost beneficial.
Opposition may be expected from some of those agencies that will be
involved in such a reorganization who would view this proposal as a threat to
their existence. This concern should be real only if those agencies or those
individuals feel that the mothers and children are the secondary reason for
their existence.
Opposition could arise from physicians and other providers which may
not recognize the long term and universal benefits of meeting the needs of
mothers and children.
The support for this proposal might be expected to come from those
professional organizations whos members are already attempting to cope with
these needs of mothers and children on a day-to-day basis.
Additional support should be expected from the many volunteer maternal
and child advocacy organizations such as The National Foundation-March of Dimes,
The Association for Retarded Citizens, The Muscular Dystrophy Foundation, The
Cystic Fibrosis Foundation, The Hemophilia Society, The American Diabetes
Association, and the hundreds of lay citizens' volunteer organizations through-
out the nation.
FORD is LIGNARY
(8)
TABLE I. MATERNAL AND CHILD POPULATION
(1) Children
Age Group
Number
0 to 6
20,000,000
6 to 12
22,000,000
12 to 18
25,000,000
67,000,000
(2) Maternal
3,000,000 births/year (3 million mothers)
(3) Of the 24.3 million persons with income below the poverty line 19.4 million
live in families and 4.9 million are unrelated individuals.
It is estimated that of the 25.6 million persons receiving medical benefits
in 1976, 11.7 million persons will be children under age 21 and 7.2 million
will be adults in AFDC. (Source: Special analysis: Budget of the U.S.
Government, fiscal year 1976, p. 184.)
FGRD LIBRARY is GENALD
TABLE II. NUMBER AND PERCENT OF CHILDREN IN FAMILIES
WITH INCOMES BELOW THE POVERTY LINE, 1974
Related Children
Number of Children
Percent of All Children
by Size of Family
Below Poverty Line
Below Poverty Level
All Children
Under 18
10,196,000
15.5
In 2-Person Families
582,000
38.0
11 3-Person
11
1,310,000
14.3
" 4-Person
"
1,827,000
10.1
" 5-Person
"
1,861,000
11.9
11 6-Person
"
1,565,000
15.9
" 7-Person or more
person families
3,050,000
26.3
Lowest Poverty Incidence: Male head, white, 4-person family = 4.0%
Highest Poverty Incidence: Female head, black, 5-person family = 74.8%
Source: Characteristics of the Population Below the Poverty Level, 1974
Current Population Reports, Consumer, Income, p. 60, No. 102, January, 1976.
U.S. Department of Commerce, Bureau of the Census, Table 22, p. 88.
The University of lowa
TOWA
76
lowa City, lowa 52242
more
100%
FUTURE
MOK
TX
TOWARD
University of lowa Hospitals and Clinics
Department of Pediatrics
(319) 356-2295
If no answer, 356-1616
1847
DATE:
September 3, 1976
TO:
Members of the "Atlanta Committee"
FROM:
John C. MacQueen, M.D.
RE:
Position Paper on Maternal and Child Health
It is my opinion that our "Atlanta Committee" provided Governor Carter's
staff with a helpful background paper and identified people and organiza-
tions that would be available to provide more information.
However, we did not provide his staff with a political statement about the
importance of health services for the mothers and children that could be
used in the campaign. More importantly, we did not provide Governor Carter
with a list of objectives that we would want him to implement during his
administration.
I believe that we should provide Governor Carter's staff with an imagina-
tive charter for mothers and children that includes issues we discussed at
FORD & LIBRARY
the time of our Atlanta meeting. For this reason, I wrote the enclosed
statement that lists most of the ideas that we discussed.
I would have preferred to be able to put it aside for a week and then to
have rewritten it before I sent it to you, but time does not permit. There-
fore, I send this draft copy to you requesting that you edit, add, or delete.
When you return your suggestions, I will combine your ideas and rewrite the
paper.
It would have been far better if I could have "farmed out" each of the
objectives to appropriate members of the committee with the request that
they develop a supporting statement for the objective. Such an arrangement
would certainly have increased the quality of the statement. Time does not
allow us to do this. Furthermore, I believe the supporting material for
the list of objectives was included in the material sent to Mr. Carter's office
before the meeting and from the Committee's paper.
Responsibility of authorship creates a problem.
I am aware that not all members of the "Atlanta Committee" are in agreement
with the list of objectives; therefore, the position paper should not be
credited to any person or organization or to the "Atlanta Committee." It
September 3, 1976
Page 2
can only be a paper put together by recognized experts in the field of
maternal and child health. In effect, it is a list of commonly stated
objectives for maternal and child health from which Mr. Carter and his
associates can select their own list of objectives on the basis of his
basic policies.
The time is very short. I ask that you limit your editing time to three
days and return it to me. If you believe the basic idea is in error and
prefer not to participate, that's fine--there will be no hard feelings.
JCM:ck
Enclosure.
Dear Erv:
This effort puts me on thin ice but I believe that such a statement is
needed if we are to be effective in the political arena.
I would ask that you particularly check the terminology in the objectives
concerned with maternal services.
I enclose a copy of my proposed letter to Mr. Jack Watson to show you how
I propose to handle the matter of responsibility.
The health of this nation's future citizens will be determined by the
health of today's mothers and children.
As the nation provides services to insure the health of these two groups,
it insures the health of the nation's future adult population. Therefore, health
services for mothers and children represent the best investment the nation can
make in health.
The majority of the services required by mothers and children are basic
health services and are relatively inexpensive, but some of the services are
complicated for they are needed to solve complex modern maternal and child
health problems and these will test the determination of the nation.
The following national goal and objectives are proposed-
- The goal of the nation shall be that each mother is healthy, that
each child is wanted, and that each child is healthy and able to
achieve his/her optimal development.
To respond to this goal, the nation must be certain that-
- Each woman will have access to inter-conceptional services that are
needed to insure her health and the health of the fetus.
-- Each woman will have access to modern prenatal, natal, and postnatal
care.
- The cost of obstetrical care must not be a barrier for any child-
bearing mother from receiving complete obstetrical services.
- Any child born at risk will have access to modern specialized care.
- Health care for children up to six years of age will be available with-
out regard to family income.
- Any child born with a disability will have access to an individualized
program of care as needed to result in optimal habilitation.
- All children will have access to approved immunization procedures to
achieve a national objective of eradicating the communicable childhood
diseases that are a major cause of disability.
-2-
- The nation's major and increasing problem of teenage pregnancies must
be met with a total national effort.
At this time of decreasing family size, this nation has a moral respon-
sibility to reaffirm:
- its recognition of the dignity of child-bearing,
- the importance of mothering, and
- its commitment to provide needed child health services for children.
To do this, the nation must develop a contemporary national program of
maternal and child health services.
OR
To do this the President will provide leadership in the development of a
contemporary national program of maternal and child health services.
9/3/76
Mr. Jack Watson, Jr.
King & Spaulding
2500 Trust Company Tower
Atlanta, Georgia 30309
Dear Mr. Watson:
A group of recognized national leaders in the field of maternal and child
health met in Atlanta on August 25 and 26 and provided your office with a
background paper.
In an effort to provide your office with a more concisely stated position
paper about the issues relating to improving maternal and child health, the
enclosed position paper was drawn up.
Power
reluctant to answer our questions by vote. However, the enclosed position, SERIAL
In the field of human services and certainly in the field of health, ther
is complete agreement about almost no issue. As professionals, we are
paper is the consensus of many informed and responsible people concerned
with maternal and child health. It is a statement that would have broad
national support among a number of organizations and groups that are very
concerned with the current low status of services for mothers and children.
There is no implication that the goal or objectives need to be used as
stated, nor is it assumed that all the objectives will be used. The paper
is presented to provide Governor Carter with important ideas written by
people qualified in the field. We are aware that political reality may
require them to be rewritten.
The national leaders in the field of maternal and child health who developed
this position paper sincerely request that Governor Carter give serious con-
sideration to it, not only as an attractive campaign issue but as an issue
of major importance for his administration.
Respectfully,
(Please indicate if you wish to have your name included on the letter to
Mr. Watson as a contributor.)