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The original documents are located in Box 22, folder "Tuesday at the White House
Meeting, March 25, 1975 - Community Health Care (2)" of the Stanley Scott 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. Bettye L. Scott donated to the
United States of America her copyrights in all of her husband's unpublished writings in National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.
w
THE WHITE HOUSE
WASHINGTON
258
March 25,
Claim 1975
MEMORANDUM FOR:
ROLAND ELLIOTT
FROM:
STANLEY SCOTT SP
SUBJECT:
Transcription of
Tapes
Roland, would appreciate it if the attached tapes
could be transcribed and returned to Room 179, EOB.
The agenda of March 25 meeting is attached.
Thank you.
Attachments (3)
per in Coverpolare
3/28/75
FORD A LIBRARY RALD
GE
TUESDAY AT THE WHITE HOUSE
MARCH 25, 1975
AGENDA
1:00 p.m. Coffee
Family Theater
1:15 p.m.
Welcoming Remarks
Stanley S. Scott
Special Assistant to the President
1:25 p.m.
Greetings
William J. Baroody, Jr.
Assistant to the President
1:35 p.m.
Introduction of Speakers
Stanley S. Scott
1:40 p.m.
Neighborhood Health
Dr. Theodore Cooper
Care
Acting Assistant Secretary for Health
HEW
2:00 p.m.
Questions and Answers
2:40 p.m.
Coffee Break & Photographs
2:55 p.m.
Panel Discussion - -
Secretary Caspar Weinberger
Health Care Problems
HEW
and Some Solutions
Dr. Theodore Cooper
Acting Assistant Secretary for Health,
HEW
Dr. Robert van Hoek
Acting Administrator
Health Services Administration,
HEW
RALD GE R. FORD LIBRARY
Dr. Paul Batalden
Director, Bureau of Community
Health Services, HEW
Dr. Louis Hellman
Assistant Director for Population
Affairs, Office of Assistant
Secretary for Health, HEW
3:15 p.m.
Questions and Answers
3:45 p.m. White House Tour
Well for those of you who arrived late in the Family
Theatre over in the East Wing, I'd just like to again -once
again say welcome to the White House and welcome to
Washington those of you who arrived from locations out of
the city. I'd like to get things moving with an introduction
for our Government officials who are with us today. To
my left is Dr. Theodore Cooper, Acting Assistant Secretary
for Health at HEW. Dr. Cooper - would you stand. (Applause)
Dr. Paul Bathalden to the left of Dr. Cooper. Dr. Bathalden
is Director, Bureau of Community Health Services (Applause)
And to my right is Dr. Lewis Hellman, Deputy Assistant
Secretary for Health. Dr. Hellman (applause). We had
RALD of R. FORD UBRART
expected the Secretary of HEW to kick things off for us
today but as is often the case here in Washington in Government
Cap Weinberger was called to the Hill at the last minute. We
do hope to have him with us before we adjourn this session.
for
One other note, after we've completed our dialogue here/those
of you who are able to remain with us will be moving back to
the White House area - the immediate White House area for a
guided tour - a special tour of the White House for those of
you who are able to remain. We expect this session to end
approximately 3:30 - -3:40 as we do have another meeting in here
with the Vice President at four o'clock. I said earlier
we hope that this session if it does anything will provide
us an input - as I said earlier as well we've got our
recording equipment in here and we will be taking down all the
input that you give us today and we hope that you look upon
2
this session as a talking with session as opposed to a
talking too session. Dr. Cooper will make a presentation and
then if you have some questions of him you might want to go
right ahead and ask you to involve all the panelists. They
do not have any major presentations to my knowledge and
we'll let Dr. Cooper kick it off and serve as a point man.
Dr. Cooper.
for
DR. COOPER: Thank you Mr. Scott. Let me say/ko the Secretary
that he will make every effort - he as told me - to drop in
and try to chat with us in between his appearances down on the
Hill. We have told him of the change of room and we expect
that will facilitate his schedule if the Congress turns him
loose. The - we have also the Administrator of the Health
Services Administration Dr. Van Hougk also on the Hill
finishing testimony which we expected to have been finished
A.
FORD
yesterday who will also join us if and when the Congress
GERALD
finishes with him. I think they're all germaine hearings
because as you are well aware these are the programs
that Dr. Van Hougk is testifying on today that are directly
relevant to the - your interests and the interests of our
dialogue today. Now - I'd like to start off by reviewing just
very briefly what you probably know better than I and that is
the purpose of these programs in the community health field.
They are principally concerned with reaching the under served
populations, correcting inadequate distribution of health
services, improving the quality of health care, foster effective
and efficienty health service delivery and providing services
3
to statutorily defined populations. Now these main programs
of interest to you we catorgorize under community health
centers, the migrant health program and the family planning
project. And our proposed budget for this which I know is
very much on your mind is for 1976 is a total of 253,825,000
dollars. We count up a total of 157 community health
centers which represent the combined total of 127 neighborhood
health centers and 30 family health centers. And as I understand
the difference between the two are some special experiments
in pre-payment which identifies the family health centers.
It's our estimate that you serve 1.4 million people and the
main focus of your over-all care is in the area of what is
health
known as ambulatory/services. =And obviously these programs
RALD OF R. FORD JBHART
constitute an important community health resource for
persons living in the medically under served areas in 41 states,
the District of Columbia, Puerto Rico and the Virgin Islands.
states
We have 105 migrant projects serving 355 sites in 37 sakesxand
jurisdictions and we are serving about 400,000 people in that
program. I would distinguish in all of these programs the
difference between numbers of people and patient encounters or
numbers of visits which as you know is a very important distinc-
tion when we get down to our discussions of cost. The family
planning projects are currently providing service to approximately
1.6 million persons who reside in 2,920 counties, that's 95%
of the 3,074 counties in the United States, with a total pro-
posed budget for these programs is of interest to you and concern
4
I know, and I would make at that point then some general 000000
comments about the health budget. We expect to propose to the
Congress , the secretary has already made his initial presenta-
tion, I am planning to make the initial health presentation
on April 7 to the appropriations committees in the Congress.
The initial proposals here will recommend a budget authority of
dollars
about 30.5 billionin health from the Department. Now this
represents aniincrease. Now I'm going to talk to you about
But
some discreases. the first fact I think we have to start from
is that what we're proposing is an increase but a lesser rate
of increase than has taken place in previous years. The largest
part of that 30.5 billion dollars is allocated to Medicare and
Medicaid and we expect that there will be about a 1.2 to 1.5
billion dollar increase in that portion of the budget. The
remaining 6 health agencies with the grant and contract program
including yours will account for somewhat below 5 billion dollars
and in this particular segment of the budget the net recommendation
is for decrease in the Federal participation in the program.
There were about 8 general principles or issues that I think
I should lay on the table as the general criterior which were
followed in determining the budget allocation.
First was that the budget reflects the decision to require
that the states and local governments, private institutions,
and third party payers contribute a greater share of the cost
of the health care programs than they're currently supporting.
That decision affects vertually all the health services programs
whether they be in the Health Services Administration or the
FORD
5
Alcohol Drug Abuse and Mental Health Administration or some
other CDC programs.
The second principle is that we expect the Federal
funding for medical care of our direct Federal beneficiaries
such as the Indians, the Alaskan natives, the Coast Guardsmen,
the American Seamen, XXXXXXXXXXXX will be increased to maintain
or improve the quality of their service. Now this increase is
a very modest one. I'm talking here about 14 million dollars
over a base of about 300.
The third principle is that those programs which are directed
towards bringing about change or improvement in the Nation's
health delivery system, structural changes like the PSRO program
or the HMO program and so on will be maintained at about the
same level. There is some increase in some of them proposed
by the Administration trying to restore some cuts that were
already applied to those programs in previous Congressional
A
FORD
actions.
RALD
Fourth, we will continue to support preventive and
GE
regulatory programs of the Food and Drug Administration and
the Center for Disease Control in order to keep our eye on
the spread of disease and to assure the safety and quality of
foods and drugs, water supplies and so on.
Fifth, there 11 be a new federal policy governing support
for a health manpower development and training of medical
researchers that we have Our authority for programs in
this area has expired. The Congress is debating that at the
current time. Our proposal for that is a reduction in federal
6
share also.
Sixth, we will continue support of bio-medical research,
since the Congress has decided to reject the President's
recommendations on recision for the '75 budget, we will be
recommending an overall reduction in our research efforts
for the coming year in order to bring that budget in line
with the overall strategy of the President for 1975 and 1976.
Seventh, we will continue to honor our commitments in
alcohol, drug abuse and mental health programs but we'll not
propose any extention and the net effect will be a recommendation
for a reduction in budget of the Adam Hoek programs.
And eighth, and importantly, we will be trying to implement
rapidly the recently inacted National Health XXX Planning and
Resource Development Act of 1974 which the President signed on
January 7. This will require additional funds and since the
President did sign that bill we will be seeking a modest amount
of funds within that authorization to implement that program.
Now the total proposed budget as I mention emphasises increased
cost sharing by non-Federal sources thus, while the 1976 level
represents a reduction of approximately of 20% from the 75 level
we hope, and that was the assumption that the President made in
his final decisions about the budget, these were very difficult
ones because they involve people programs was that we would be
able to maintain our service to the same numbers of people
or better if the objectives of increasing the non-federal
a
FORD
sources was successful. And the proposed budget level plus
RALD
this expected increase of the non-federal sources
GE
7
were designed to try to maintain that level of activity along
with some management changes to help project efficiency.
Grantees will be assisted in recovering third party
reimbursements for services that are covered by state
medicade plans, the medicare program or private health
insurance and to facilitate this effort the Department will
propose an amendment to the Social Security Act requiring
that non-hospital affiliated health clinics be included in
each state medicade plan. We hope that this is a help in
achieving self-sufficiency. There are some legislative
which
changes going on **** I would just touch on because as you
are aware the authority for some of the programs that you
are involved with also expired last June. The Health Services
Act or the Health Revenue Sharing Act as it is sometimes
called was passed by the 93rd Congress, was vetoed by the
President at the end of the year. This bill is pending
action in the Senate and in the House there are some differencs
which I would mention. S. 66 is a reintroduction of the
Health Services Act. It's very similar if not identical to the
Bill that was vetoed. It still contains new categorical
A.
FORD
programs, large increases in the authorization levels for
funding and it was on this basis that you will recall tha
GERALD
the President recommended the veto. There's an important
feature that I would mention. Attached to this Bill
is a amendement offered by Mr. Bartlett for himself and Mr.
Helms and Mr. Buckley that would prevent any fund - not only
8
the funds for this program or departmental funds, or
public health service funds but any Federal funds for being
used in any manner to pay for or encourage abortion. Now
this is different than the current situation. It's an important
difference. The amendment may delay passage of the act where
while
at least some time where this is debated you can well understand
the impact that this kind of an amendment would have. In the
House there is a clean bill provided by Mr. Rogers its H.R. 2954.
It's a reintroduction of the Health Services Act but with
certain modifications. The authorization levels are less.
Less of the categorical activities are in it. This bill
has not yet been reported out of Comm ittee and there are
some other suggestions being entertained that when it does
one would be that the Federal project grant and contract
funds be at least 90 per cent of the total operating cost
of the project except when this ratio is already less inan
GE RALD A FORD
on-going projects. This is important to you because it's
obviously different from what the Administration proposal is.
In on-going projects the Federal share could not be reduced
below its present level by that Amendment and as I mentioned
it is opposite to the Administration's proposals for funding
for '76. It is also opposite to the Administration's proposals
for legislative authorization in which we requested consolidation
authorities for all three 14-E programs. The second Amendment
in the Sub-Committee would assure that the public and private
projects at the local level would be able to receive individual
grants and contracts. This proposal if applied to
9
existing grants and contracts would reverse much of the
grant consolidation efforts over the past few years and
it's our belief that this would also cause some delay
in the activities at the present time. So I wanted to highlight
for you what was going on in the department and on the Hill
about these programs. What are basic philosophy has been
and the proposal for 1976. And I would make only one other
comment and it will seem somewhat paradoxical I would admit.
Throughout our rhetoric in the past several months we have
beeen urging that we find ways to reduce hospital utilization
as the primary source of medical care for the community. We
want to get medical care for all the population and the proper
balance for those areas which should have home health services
as well as ambulatory services. And I think you might well
a.
FORD
have some questions about how these two objectives jive with
RALD
the budget proposals we are making. Finally we are making
GE
attempts as you are aware with new guidelines from Dr.
Bathalden office in particular on the operation and management
of these programs. We think this will be a great benefit to you
irrespective of what the eventual funding and authorization
patterns are because I think we are concerned as the country
moves toward a program of national health insurance and as you
know the President has deferred the Administration's submission
of a proposal 'til next January although he has indicated that
this will be the time table on which the Administration
proposal will be submitted since we all seem to be working
toward that end we think it's important that structure
10
elements in the system such as yours be able to compete
with other sectors of our pluralistic health system when
the time comes to be able to retain and attract patients.
So I think a great deal of the management features
guidelines
and the accountability features and the guidiines that are
being developed for the service programs and the community
are directed at that objective. Mr. Scott I think I will
stop at this point and I would just comment that the man
who just came in to my right is our Administrator of the
Health Services Administration at the present time that's
Dr. Robert Van Houck . All four of us would be pleased
to respond to the questions or comments at this point.
SCOTT: All right. Let's start in the rear back there.
QUESTION; I'm a little concerned about the increase and
reduction of federal spending and the increased matching or
hope to match by state and local places. What my concern is
where are they going to get the money from. The economy is
bad and I would think this would be a time for increased
spending -Federal spending rather than reduction.
RALD GE R. FORD JAHART
COOPER: I think that is both a fair question and a not
unexpected one. We - since the submission of the budget I think
this question has been raised at every group by every group that
we discussed the budget proposal with. Now in 1973 if you look
at the trends of state and local government financing, we were
optimistically impressed that they were on un upswing with the
Health Revenue Sharing proposal we saw some light. The overall
trend at that time '73-74 seemed to indicate that on balanced
11
the state and local governments were going to operate in the
black. But we recognize they have not been immune from the
economic crises that the rest of the country has and I am
aware that our current estimates is that they will be
substantially in the red. And where we find ourselves
is in a relative position. Who's more in the red. The
local jurisdictions and states or the Federal government?
Now when we prepared this budget the Federal deficit
was estimated for '76 to run about 52 billion dollars. Since
the the budget recessions were rejected generally that adds
on another 17 since there have been changes in unemployment
insurance required by the change in the employment status
of the country large amounts of money have also been required
and as you probably heard in the news from Secretary Simon
A.
FORD
recently and from the President himself and other spokesmen
RALD
for the Government it is not unrealistic to expect that
1mg
deficit to be 75 or 80 billion dollars. Now that's alarming.
So it's not that we do not recognize that the states will have
serious problems in trying to find some of this additional
resources for new programs or new responsibilities the question
is who can afford it more and what's more important. We have
found in our program that we've had to realign some of our
priorities. And perhaps the states and other programs
will have to look at the same choices. Of course it's always
a possibility that the Congress will not see the '76 proposals
as we see it either.
QUESTION: We have a cross section of individuals represented
12
here from all phases of health care - hospital administrators,
individuals from neighborhood health centers and we also have
representatives from the communities that we serve that
are concerned about the continuation of health services in
these various communities. I'm quite sure they have say something
they want to say about that. One of my concerns and I think
this is a concern of all of the individuals who are here is
that we agreed that at this time we are in an economic crises
and we've got to use good common sense about this and we
see that this Administration is concerned about the rise in
unemployment and seemingly is in the process of trying to do
something about this unemployment through appropriating funds
to provide new jobs. I'm from Atlanta, Georgia and I know
we have recently had some 5 million or more dollars to come
into Atlanta to provide jobs. However, this money is coming
thore to provide nonexistent jobs that we do not presently have
jobs that we will have to make up jobs that we will have to
put together in order to provide services to individuals in order
to cut down on the unemployment. Now as we read the budget
for 1975 and 1976 and see the cut that is proposed there in
a country where there is an admitted health crises in a country
where we have already admitted that health care is the right
of an indivdual to have this and we do have neighborhood health
centers, hospital outlets and other services throughout these
United States who are in the process of trying to render the
needed health services for the people all over this country.
As we cut back on the budget in these various categories
RALD GEL R. FORD
it's going to affect us two or three different ways.
13
Number one it's going to affect the services that we willbe
able to render to people and it's going to put a hardship
on the hospitals because the hospitals in these various
cities cannot assume carrying out the services that are now
being rendered by neighborhood health centers. And number
two it's going to affect jobs. Individuals who are now
rendering legitimate services. Individuals who are doing
a job will be cut out some five to ten thousand jobs will be
cut back. Now my problem and maybe you can help me because
I can't see it. I don't understand how we can appropriate
funds to cut back on unemployment and at the same time cut
back on needed services which will put five to ten thousand
people out of jobs. Now here are jobs where people have
been trained to render a service that you and I say is
a needed service. A necessary service. We're going to cut
back on these services, cut out these jobs and at the same
time we're going to appropriate funds to provide non-existent
jobs some of them will be paper jobs. Now I'd like for someone
for give me an answer in plain old common sense as to how we
can put pux the two together.
SCOTT: Even though Dr. Cooper lead it off I would like for all
the panelists to join in and we'd like for you to direct your
questions to all the panelists and get everyone involved in this
dialogue.
FORD A LIBRARY RALO 30
14
COOPER: Since it's on that kind of a policy question let me
tackle that one for you Mr. Scott and see if we can get some
resolution to that paradox. First off it is not the over-all
proposal that we cut services. I know that your conclusion
already taken was that if the Federal share is reduced
it cannot be made up from any other source and therefore you
automatically reduce services. But I think you have to listen
carefully what the actual Presidential proposal was which was
not to reduce the level of service but to try to maintain the
total funding from different sources. The Federal share would
be different. I acknowledge that it might be quite impossible
under the current economic sitaution to achieve that goal
but I think that the strategy by design was not to reduce
the service level. I think that if we can hold that one
fact on one side. Therefore the strategy to provide more
jobs is not paradoxical from push pull mechanisms. The second
point on the job provision which I think is important. We feel
and I know the Secretary feels this way because he recently
testified about health insurance for the unemployed on this
regard. We feel that the best defense for health which is
A.
FORD
the final objective of all these programs is to have people
RALD
at work because the health of the people suffers during
GE
unemployment, during economic recession from three factors.
Not only from the loss of insurance or indeed the loss of
services from specialized projects in communitiessuch as your
own but when unemployment goes up we do know that the health
of the people tends to go down. But the things that go down
15
But the things that go down are usually things that are
dependent on nutrition and that means making sure that
money is in the hands of the people to buy food. Secondly,
the kinds of diseases beside those of malnutrition, fetal dealth
and the things that are related directly to nutrition are
those items which result from people not having jobs. Alcholism,
automobile accidents, crime related injuries and so on. It's
do
only after a lag of three to five years XX/ you begin
to see an impact on several of the other disease categories.
That means that the primary object would also be served by
making more jobs. The third area is access to health services.
And it is an important area. So my point is that basically
it is not incompatible for the President to be suggesting
at in the first level of economic crises that putting people to
work is the best for them, the best for the humanity and indeed
the best for their health.
QUESTION: I would like to introduce myself. My name is
Curtis Allmond. I'm the Project Director at Temple University
Comprehensive Health Service Program. I direct two neighborhood
health centers and also represent the National Association of
Neighborhood Health Centers as the President. I understand
the answer that you just shared with Dr. Powell. However there
are two other areas that concern me in terms of establishing
priorities. The area of research and the area of planning.
A.
FORL
How in the world can we establish priorities in terms of
RALD
generating enough money to continue research and planning
GE
and for you to share with us the fact that more money is put
into those pots and yet there is not available money
16
to perform health services. How was that priority established?
COOPER: Again, I'll prempt my colleagues here because I
have to bear the responsibility for that allocation. As I
think I said I guess I didn't make it clear the research budget
will be recommended for decrease. It will be. It will be
recommended for decrease. Now in the original combined budgets
of '75, '76 - '76 showed an increase of 36 million for cancer,
7 million for heart disease and 29 million for others. This
was proposed on the suggestion that the Congress rescind in
1975 358 million dollars from the research program. That has
been rejected by the Congress therefore we will be testifying on
behalf of the President for a reduction of about 3 million or
more in the research budget so I think we can bring that into
line that we are not the over all strategy was to make every
program participate in the constraints put on by the guidelines
of the President. The planning activity is recommended for some
money because three other agencies are being recommended for
phase-out as you are probably aware. RNP, CHP and Hillburten
and there's a new Health Planning Act. We will be seeking a
supplemental as you are aware of 75 million dollars to get
that program started in order to consolidate those programs.
Our strategy here is not to try to make those dollars more than
what has been previously been spent in those programs. It
probably will show some increase because of the Congressional
instruction to implement this program promptly and as you know
RALD En R. FORD JBRAN)
17
in that Bill it's a very tightly worded bill with specific
deadlines in which we will be accountable to the Congress
on those specific timetables.
QUESTION: My name it T. Roosevelt Butler and I'm the
Administrator of Doggetts Hospital in Kansas City, Kansas.
The question I have may not be proper at all but did I understand
you sir to say that there is an amendment to the health program
that will exclude any money for the payment of abortions.
COOPER: I think Dr. Hellman might want to comment on that and
clarify what the status of that is - what the specific
amendment is and I make it clear that it's not the Administration's
proposal.
HELLMAN: There are two amendments. There's S. 318 and S 66
both proposed by Bartlett. They are both amendments to the Health
Revenue Sharing Act - S. 86. They are both Amendments to
S 66 and they both read approximately the same. I'll read the
86 one to you. Sec. 108 is amended to read as follows: "No
funds authorized under this act or any other act may be used in
any manner directly or indirectly to pay for or encourage the
performance of abortion except in cases where such abortion is
necessary to preserve the life of the mother."
Now 318 reads exactly the same except it applies only to
Department of Health, Education and Welfare funds. This applies
to all funds.
QUESTION: That I'm sure has been weighed against
HELLMAN: Yes. But we don't support -
FORD A. LIBRARY QERALD RALD
QUESTION. You don't support - all right then.
QUESTION: Sir, two most important questions have been asked
18
of the panel and unfortunately I did not quite understand
the answer to the questions. The questions were Why
are we creating jobs for non-existing why are we cutting the
services in the health field and creating jobs which are
non-existent. That answer that the President feels it's
parallel I don't think is sufficient. Number one. Number
two we know for a fact - you take the case in New York for
instance where the state right now has a 585 million dollar
deficit, the city of New York this week must borrow 1 billion
dollars if that banks don't hold them up that is, in order to
make their payroll and you want them to put in a 20 per cent.
Can you explain to me what is the thinking behind this because
I really don't understand it in terms of economics.
di
FOR
COOPER:: Let me reiterate to make it simpler. The proposal
RALD
of the Administration was not to reduce the level of service
GE
and put the people out of work. The assumption would be that
the objective of the increased non-federal share would occur.
Now your point is that in the second part of your question there
is that New York State for example is having difficulty meeting
their payroll and that the likelihood of New York State being
able to assume an additional burden is unrealistic. I understand
what you are saying. I explained in my initial comments what the
situation was when that plan was made. The purpose of this
dialogue as will be the purpose of the dialogue with the Congress
will be to see where this falls out and perhaps as it's discussed
some other solution will have to be found. Maybe 20 percent
cannot be achieved. I think the point you make is well taken
19
QUESTION: Even though it's assumed that we do cut 20 per cent
assuming that the Congress will abide by that and the Administration
certainly would like that what happens to the 15 per cent of
inflation that took place last year, the 15 percent that has
taken place this year, the 15 per cent that has taken place
this year which is two that's already 30. The 15 percent
that we took which is 45 and certainly here in the neighborhood
health centers I for one can attest to the fact that I had
to let 30, 45 people go last week, because of the inflation.
Now how do we deal with that And on top of that how do we
deal with the fact are assenters are increasing anywhere from
10 to 15 percent almost weekly because of the unemployment
situation. How do we deal with the fact that that 10 or 15
per cent anywhere from 10 to 12 percent of those individuals
do not have third party reimbursement and can only afford to
a.
FORD
pay xxxx maybe three or five dollars from their unemployment
insurance. How do you resolve these problems, sir with all
RALD GE
due respects sir?
COOPER: With all due candor I can't. I wouldn't try to snow
you for a minute. And I appreciate your comments. That's what
I say I think as Mr. Scott says we're putting it on the record
so that your concerns can be heard. I might say it's not the
first time I've heard it but the - and I am not unsympathic
to what the problem is you have to keep in mind however that if
we take all our programs to the index of inflation what that
Federal deficit would be and I think you find that you Federal
dollar and the stability of the republic would make for
20
perhaps the neighborhood health center programs and others
no more solvent from the standpoint that you're talking.
Now I'm not an economist but I think that it is quite clear
that we cannot pay all of our programs to the inflationary
index. I do recognize that several of the other programs
that have visted me personally have made clear to me the
impact of inflation even at current stable budget levels if
they had it, is on their employment. Most of them have reported
to me and I was delighted to hear that dispite that with the
improvements that they've made since the inception of the
programs in the mid 60's that they have not had to cut down
services to the same percentage that they are still trying to
provide the same level of coverage for these people. We don't
have an easy answer for that question.
QUESTION: I've heard you say several times that the
Administration anticipated no cut backs in the number of people
to be served yet in the budget itself it indicates that in
fiscal '76 the health programs would serve only 306,600 people
down from almost 400,000 for the previous year. Would you
explain that.
GERALD R. FORD
COOPER: In our analyses if it were totally dependant on
that and didn't achieve it that would be the level that would
have to be justified.
QUESTION Are you saying then that 67 per cent of the population
that we deal with is not elegible for any kind of third party
where
coverage whyxwas it anticipated that we would make up the difference?
21
COOPER: State and local jurisdictions.
SOMEONE: That's nonesense. (Laughter)
SCOTT: Said for the record (More laughter)
SOMEONE: That's nonesense.
QUESTION: -- of the Administrative Health Center in
Oklahoma City and I would like to address a series of comments
and questions to Dr. Bathalden and Dr. Van Hought and finally
Dr. Cooper. Dr. Bathalden it's been my assumption after reading
42 CFR, Subpart 50 that the regulation for health services
funding were in part designed for purpose of streamlining
both fiscally and manangerially the topics of neighborhood
center programs. Now my statement and question to you first
is that true?
BATHALDEN: The Health Services funding regulations
were to develop a clear relationship between forward financial
di
FORD
planning and current center management.
QUESTION: All right that being true then it must have been
GERALD
RALD
140
assumed that the effect of this regulation would be to have
some sort of streamling effect financially or fiscally on the
program and result in some capturing of funds due to cost
saving by lowering - increasing the managerial potential of
the health centers.
BATHALDEN: I think the evolution of that policy was one that
eventually concluded that those monies that were being used
in centers and were a part of the health services funding
policy that those monies would be used to expand the number
of people who were served and the emphasis was on expanding the
service rather than on taking the funds away from either
22
the appropriation or the program. The emphasis was on
expanding services and expanding the manangerial capabilities
of the centers to provide those services.
DR. VAN HOUCH: I maybe have the wrong department but I think
in the administrative area XXXX may be dealing with the
efficiency of such a regulation and back its implementation
if its to become to work in terms of meeting the objectives
of the Administration. Many, many objectives were set
concerning proper health centers but the three basic ones
thatx they would in fact reduce utilization of high
cost hospital care. The report released by the Department
of Community Health Services in fact in 1973-74 U.S. average
A.
FORD
was 1,160 hospital days per thousand and CHS' 762 for a 34
RALD
per cent decrease in terms of the higher cost of health
GE
care being delivered by the hospital. In terms of physician
productivity. A light statistic - national average 2.8, CHS
medium 2.1. Of course OMB came up - GAO came up with some
statistic of 1.97. My theory is that they left something out.
Cost of services-essential quality. Physicians offices
approximately 13 dollars for a physician encounter at his office.
But at CHS where we all know that several volumes of different
services are delivered vis a vis all the support services
physician and the supporting services only 24 dollars.
(inaudible) being in business for over 30 years (inaudible)
There is only a two dollar difference between a pre-paid
practice that's been established for all this time and
a
in terms of a physician visit our value of service is
23
probably lower than a physician's office. Now in terms of
over all statistics that means that the CHS medium in '73
was 167 dollars per capita for year. Gentlemen, I'd
like to suggest that these indeices number 1 prove a point
that CHS is a viable means of controlling your budget.
In terms of cost allocation. If that's true than it becomes a-
I think we would be remiss without making some sort of suggestion
here. Number 1 being that the Administration before it
drastically cuts out programs do a shifting (inaudible)
terminology of responsibility for sharing they allow these
regulations to work because if these regulations are put
in and enforced vigorously and CH's are able to comply with
them to save not 50 million dollars but almost a hundred million
dollars which in essence would be money returned to the pot to
IA
FORD
share back either in a revenue sharing concept or through an
RALD
ABRAR
expanded services program. So in terms of that I would like
OF
to have a response from Dr. Cooper in terms of your feeling
about the analysis I just made in terms of the (inaudible).
COOPER: You initally addressed some comment to Dr. Van Hough and
he
maybe you could reply.
VAN HOUGH: Well, there's no question based on CHS data and other
data as well the comprehensive ambulatory health services
can be performed in an economic fashion competitve with other
ways of delivering services and in fact can significantly
reduce hospitalization and the total cost either to the
individual or to society for the care of that individual. There's
no question about that. And we're getting more and more data
24
to substantiate that. It's also clear that from a number
of studies that a comprehensive program in a well-organized
setting can significantkyincrease the productivity of
physicians by the use of paramedical personnel, and so forth
and thereby hopefully in the long range help with man power,
health man power and physician distribution problem to some
extent. The question of the health services funding
regulations is one in which we have to the present time
through Dr. Bathalden's staff worked very intensly with the
projects to try and prove the capibilities for developing
better cost information. To develop eligibility and billing
procedure so that maximum third party reimbursement can be
A.
FORD
achieved and the centers can use **** these funds to
RALD
increase services to the area of poplulation and presumably
OF
this would then lead to further reduction in hospitilization
XN for that beneficiary group. We are however, as you well
know better than we do as you're at the scene we still have
the problems of other health regulation legislation being
incompatible with that 08 objective. The services are not covered
in many instances by third party paying programs including medicare
and medicade and also the individuals state elgibility determination
and certification of providers and so forth need to be resolved.
I think we've made progress in that not to the extent that
we wanted to and also we have in essence been forced into
some delay in the further accomplishment because I think the
data that we have developed with the centers and with other
projects has led to a much more advanced look at terms of national
25
health insurance proposals. The fact that the National Health
Insurance proposals do not model the medicare benefit package
for some of the state medicade benefit packages or Blue Cross
Blue Shield is an indication that some of this information is
sinking in and that the many of the national health insurance
proposals are - will cover when passed - would cover if passed
a comprehensive program of services focused particularly on
ambulatory care so that I think that both in the short term and
the longer term we've made progress. Not as much as we'd like
but I think we have made some progress.
BATHALDEN: I think one of the other things that is so
frustrating for us and frustrating for you is *hat as Dr.
Van Houch alluded to we have other laws that govern our operations.
I think that the statutes of the medicade, medicare statutes
that we have been trying to work with and garnering third
party support and trying to effectively move the delivery of
services and the support for the delivery of those services from
a project grant support base to a stable more stable insurance
type or third party payment type of financing is exactly the
problem we face today where we have in essence the project
A.
FORD
grant supported activities on the "controlable" side of the
RALD
budget and mathe third parties the ones that continue to
GE
eat a greater percentage of the Federal health dollar on the
so-called uncontrollable side of the Federal budget and it's
that struggle that I think we are joining in the national
health insurance initiative. We are joining in the national
health insurance initiative. The data that we are gathering from
our projects with respect to total health cost, with respect to
26
total health services is the data that in fact is being fed
into the national health insurance formulation activity.
I"11 stop there.
SOMEONE:
Just let me say - I'd like to have your analysis
because - I invite you to send it to me because I recently read
a report where the average visit in the centers on several of
the programs were not in the range of 25 dollars or 20-25 dollars.
sion
But were closer to 80 to dollars And this might be including
of
your social services a lot of other things in it besides
medical services but I'd like to have - just quote for me from
A.
FORD
BATHALDEN: You mean from the Comprehensive Health Services
data based project report.
RALD
OF
SOMEONE: Yes.
BATHALDEN: And it was a report on the management and program
status of Community Health Services July 1974 3 your office,
SOMEONE I think part of what I'm saying that in that analysis
not all of the programs involved as Dr. Van Hoke said are included
but in this particular project grant program those might be the
ones that we need to work with. On the others, when they're
lumped together, for other objectives, it comes out, at least
in a recent report crossing my desk, a much higher number.
I'm JENNY L
from
I think that we are all trying
to say in one way or another that the Administration's position
is either unrealistic and should be reexamined, or the Adminis-
tration in a way knew exactly what it was doing but I think we
really have to face this because the facts are fairly simple.
What we are being asked to do is to cut back on the Federal
support direct from the Federal Government and go to sources
27
such as other States and localities for funds when the very
reason that it is a Federal program is because that source
really the west
I've never seen very much to invest in the way of health
services and preventive services. So we are being asked at
a time of economic hardship to go to the least
of the
possible sources of funds so I think this is realistic on that
ground. The other sources which are fair party payment, are,
even if they were maximized even if all the laws and regulations
which would be
changed, would really not have
that much possible yield very simply because most of the
people who are on medicare are people who are on welfare.
SOMEBODY: That's right.
JENNY L
:
And that there are many poor people who are
not on welfare, they are the non
working pool and families
with husbands in the home. So that even if we did things right
in terms of medicaid, it is still a low-yield source. When it
comes to
care insurance programs, I mean private insurance
programs usually provide very little coverage , and assuming
that the population that we are caring for
had insurance
they probably would not have the kind of insurance that would
cover preventive care. point Lastly, patient fees, we find in some
at
of our operation that people are defaulting on their bills simply
because they are unemployed and they can't pay the bills. So,
none of these sources are likely, and if they are not likely
then the only thing that can happen is we cut back on programs.
FORD A LIBRAR HALD
28
I think we could keep saying, "No, no we are not going to cut
back on programs" but we are going to do all these marvelous
things I think we are deluding the American public and the
Congress, cause they think everything is in hand, when it's not.
I'd like you to comment on this.
: Well, I think that is a very nice
comprehensive analysis that I can take very little issue with
it, except for the first part where you think we approach this
by design. I think that -- I'd rather be ignorant, than stupid,
you know, in that sense. To be candid with you, in our original
projections of how we thought these things could be done, in-
cluding beginning to get the system ready for National Health
insurance, we were cognizant of all the points you made. And in
our original proposals of how we could begin to get the system
ready to be self-sufficient which is the objective, we did not
take into account the financial crisis that is now upon us. As
you're probably aware, our cycle of designing these budgets
it goes about 18 months in front of presentation of the end
product. I would think that the decisions to lay on restraints
and to seek even unattractive alternatives, is the result of
A.
FORD
seeking the fine ways which we could at least explore in a
RALD
dialogue and maintain at least the forward thrust of some
OF
of the things we are trying to do. As it has been pointed out
many times this afternoon, this and before, several settings,
that this is probably, totally unrealistic from several of the
standpoints unless we get to the point of saying we are willing
to accept lesser levels of service. And that may be one point
29
that we'll come to if that's the Nation's priorities, and
as you know, from what is going on
the Hill right now,
that dialogue is far from over, but I do think your comments
were well taken. We were cognizant of them in our original
design of self-sufficiency, and perhaps our strategy there
ought to be re-looked at from the point of the fiscal situation
at the time.
: Gentlemen, I thought at one time that I'd
been a woman whose taken some of these sentences that we have
in discussion and not knowing so much about the sociology,
kind
and theology and all those little "ologies" that the
have been bringing to your attention. But, coming from a
consumer's side of a person who have worked with the community
health centers from the
section of health centers,
who met here with Wilson long years ago in the 60's, who we
were talking about trying to organize, and which to me which
was a very beautiful job done. And as I stand here today,
I get amazed and sometimes my heart takes two or three beats
that millions of dollars that we have spent to try to educate
people from the low economical communities is about the health
condition of people in that communities. And highly important
that the government wants you to have better health. And some-
times I read great big letters and notices, you know, about
how beautiful it is, even in the schools, I would surely not
talk about the beautiful part of what health means to us, and yet,
yet, when we get that service, somebody up here with the
confusion who always confuse the confuser, cause we already was
FORD
30
confused. So the confuser up here in Washington who confuse
us who was already confused in the beginning. When black
people, minority people, and I just don't have to say just
chicanos and black people filipinos, and chinese and all the
other low ethnic groups who had not been orientated of going
to doctors. Some were alien, some were afraid, some were
afraid that they had to see the assistanceshipe would be taken
and that they would find that they was here, you know, illegal
and some of the black people who had five dollars and their
bodies were sick xxxxxxx or something was wrong and they
had 5 or 6 children, they suddenly would go buy some beans
and bread before they would go to the doctor and I feel we
are going backwards and backwards and backwards. Then, our
beautiful government came up with something, health communities,
health centers in every city that comprise of so many people.
And by gollys we thought that was the most beautiful thing that
ever happened. We did more than that, if you could remember --
YOU, the government, furnished us money to train the people and
take them off welfare so that they may be able to be the
A
FORD
technicians and all the clerks and knowing how to talk about
RALD
the doctor and all the miracle things that the patients were
30
going to come in there, YOU did that! You allowed us that
money to do that. And then you allowed us to be on the Boards
and you gave us little
tipends
of 5 and 10 dollars a month
when we made 25 and 30 dollars and gave them to the sinners and
didn't even get paid for our gas and it was so bad, so bad,
t
31
that we had to
that we didn't have to go to
and remember now, I'm the chairman of the
outpatient department at San Francisco General so I'm going to
talk about San Francisco General where my people would go there
in the morning at 8 o'clock in the morning and sometimes
stay until 5 and 6 in the afternoon and still wouldn't get
waited on. STILL WOULDN'T GET WAITED ON! But one day, YOU
not me, cause I didn't have the power, to sign my name to
no bill and I don't know anything about SBCD ED AND ANY THEX
OTHER D's and don't give us that. But I do now that somewhere
on top of this hill you provided service for my people and you
gave us opportunity and I'm not getting emotional!
SCOTT
: Let's not
try to get emotional.
: Let me tell you something you gave us that
opportunity that we could stand proud and we could walk down
the streets and have all the childred
and feed correctly
and then I heard this man say a few minutes ago that you wasn't
going to pay for no more abortion. We don't care about abortion!
Danny've
got 19 grandchildren so you know we don't believe in the
pills. But you did, your'e the one who said
SCOTT : Kindly keep your voice down, please.
: I can't
GERALD RALD GE A. FORD JBRARY
You know this is from my heart and I must talk about it.
SCOTT : I know, we have quite a few people here and
we want to give everyone a chance to
: I'm going to be through, brother, I don't
think my brothers today could be the ones who serves me. You know,
poor people.
32
SCOTT
: Well, we certainly want you to have your
say but
: Let me get through, Mr. , what's your name?
SCOTT: Stanley Scott
: Mr. Scott, you know, that's my problem
now. You know, every time we want to talk to the high officials
that we are always shutup,
SCOTT: No, we don't want to shut you up, We don't want to
shut you up.
: But let me say this -- Gentlemens, if ever there
was a time, that we need our health service, it is NOW. If ever
there was a time that you cannot close the doors, it is NOW.
a
FORD
I heard somebody say a few minutes ago that about 8% of the
RALD
whole Nation was unemployed. By gollys, in the black and
GE
chicanos it always has been 8 and 15% that was unemployed. It
always have been that. What I want to
upon you today
is the millions of dollars that you have spent, the millions
of dollars that you have erected these beautiful buildings
and educated to go in there to serve the low and moderate income
and I want to tell you one more thing, Mr. Scott
SCOTT: Right, would you please give us a question, No, I'm
not nervous, I want to give everyone a chance to have his say. tho.
: OK! I'm going to say one more thing. I am very
full and I'm going to say this
I do hope that this
Administration won't let this happen. To cut our facilities
that we are so hurt for and I hope that the next time that I
ever put my foot in Washington -- I hope that -- that I will be
able to talk to somebody who has some sympathy toward the
33
Today
problem that we are trying to talk about And that you will
have the time and the energy to listen and thank you, Mr. Scott
for the little time that you have given me.
LOUD APPLAUSE
SCOTT: I would just like to add here a little footnote
that we are appreciative of all the input that we received
today and my only concern was that we have the chance for
as many people as possible to have their say.
I have a speech that I'm going to give you
RALD GE R. FORD JBRARY
and I m going to read cause my heart's too heavy.
SCOTT: OK, I'll be more than happy to accept it. Yes, sir--
: I'm Jeff Marilyn from the American Public Health
Association. I think that you're dealing with a group here
who is not niave enough to be frightened by such terms as
inflation and deficit spending. I think we all know what the
great economic experts in this country have led us into, and
I'm not sure that the alternatives are so devestatingly terrible.
I make a plea that we get away from those terms because they
have two dangers. We're all familiar with the dangers of
inflation and deficit spending. But I think the second danger
involved is to use them as a smoke screen to justify certain
actions. We're not talking here about multi-billion dollar
increases. If all these programs we're discussing about the
increases people here would want, the maximum increases we're
probably not even talking about a billion dollars. So, the
spectre of inflation and the spectre of deficit spending in
the light of a 58 or 59 billion dollar deficit doesn't seem
so great. We realize there are other agencies and there are
34
other people demanding programs. But these are people in-
volved in the health field. And I think that they have a
right to have what they need. We'll let the other people
worry about their problems
Now there is a certain illogic
in what I've heard, and I'm sorry for that little introduction.
The budget makes it very clear that it wants to control costs,
and it talks very grandiosly throughout the budget about means
of doing this. Yet, it makes it very clear that there is no
intention of doing that because the programs that their costs
are uncontrollable like medicare are going to show a 15.4 increase.
Assuming that the budget figures are correct that the Admin-
istration
Q: 15.4 what?
(continues) A 15.4 increase
in the total outlay as under Title XVIII in fiscal 1976. I'm
sorry, 15.4 percent. On the other hand, as this gentleman here
very elloquently stated, and I think other people could elloquent-
ly state for other programs, there are great potentials in
saving great amounts of money -- maybe more than the 800 or
900 million dollars total increase we're talking about. The
health center program, the family planning program, the HMO
program, the PSRO program, all of these programs have either
been decreased or have had small increases not commensurate
with the needs of the program. And I think that in the sense
of the Administration, you seem very penny-wise and pound-foolish
in this way in not trying to develop those kinds of programs.
FORD is IBRAR ALL
35
:Okay, we'll go right ahead and let the
secretary
Go right ahead.
(Jeff Marilyn (?) continues)
What I was saying, I feel the
justification to control costs, I mean, I don't think any of
us is not enough bothered to believe that the funds are going
to be absorbed for other programs. The budget makes that
clear. For family planning, under Title 19, there is a 4 million
dollar increase projected, while there is a 21 million dollar
decrease in the funds available under Title 10 in family
planning. And I think that kind of information could be applied
to any program. We're not naive about that. We're talking
about a decrease in services. We're talking about a decrease
in services for those programs that are/intensive labor and would
help the employment situation and that are means of either this
year or in the future radically changing the delivery system
and controlling costs. And I feel that to justify this on
the basis of inflation or deficit spending is ridiculous,
because what we're doing really by encouraging expenditures
under medicare, by placing more reliance on Medicaid,
which is really an uncontrolled program, were really then
talking about deficit spending, then we're talking about
inflation. They're not programs designed to do what I assume
the budget intends to do.
MR. SCOTT: Thank you, Dr. Cooper would you want to respond
to that?
FORD A LIBRARY RALO
GE
36
DR. COOPER: Well, I think the point that is being made is
one that we, that some of the ground we covered only from a
little different vantage point. I was just briefing the
secretary here on what has been discussed before and the
speaker presently pretty much reviewed that. I think in his
comments he raised the question of whether a relatively small
amount of money in his terms that we're talking about to
stabilize and expand these programs is the right priority that
we selected to deal with the apportionment of federal moneys,
and perhaps the man to my right is best qualified in the
room to speak to the overall questions of national priority
on this regard, because that's essentially the question we're
asking, of where are we putting our priorities? And these
programs are some of the other agency programs.
(Mr. Marilyn again, interrupts:) Well that's not right. I'm
not trying to prioritize programs. I realize every individual
has their interest, their program being a priority. I'm trying
to say that we're all trying to control costs in the Health
Programs, not prioritizing in comparison to labor programs, and
other programs within HEW. They've got a place in those areas
within the health area that are going to assure for the present
and future costs are controlled.
DR. COOPER: I think the secretary will be delighted, I would
expect to comment on his concerns of whether Medicare or Medicaid-
were properly structured to contain costs, in the same sense
R. FORD LIBRA
37
that you are saying before. So that I think this is the
general area that perhaps
: Let's just take a second to welcome the
Secretary for escaping the Hill and being here with us.
(Applause.)
berger
The Secretary : That's a nice hopeful introduction, but not
quite true, because we never escape unscathed and I haven't
really escaped at all. But I'm delighted to be here briefly
and have an opportunity to talk with you about some of these
extremely important problems. Not having heard, had the benefit
of hearing, what you were talking about before, I can do what
Robert Benchly used to do with examinations: He didn't like
the questions, so he wrote things that he liked to write about.
I will talk about some of the things that perhaps seem to me
to be important, even if they may not tie directly to what you've
been talking about. But I kind of think they will, from the
very little bit that I have heard already. And the problem
here on health care costs is a very severe one, there is no
question about it. And I do feel that Medicare and Medicaid
were improperly structured when they were adopted 10 years ago.
I don't think there was a sufficient realization that injecting
that amount of new demand with guarantee re-payment in
virtually any amount the provider wished to submit, was going
to be inflationary as it was. But obviously, it was inflation-
ary, it had all the classic ingredients for inflation. And
health
when you mixed with that the shortage as it was then of care
FORD A ALD BRA
38
providers in a number of situations, even at that time we
didn't have any where near the surplus of hospital beds that
we have now. With all of these things combining, you had a
tremendously inflationary effect on health care costs, and
we're still feeling the effects of that, and a matter of fact,
I'm afraid we will for some time to come. And that's one of
the reasons I have felt, though I don't like cost controls,
wage or price controls, and I don't think ultimately they're
very effective, but it's one of the reasons I think that in
the health care field you pretty much have to go to that route.
Because we don't have a free market in health care costs, we
have the government that has injected itself now in one way
or the other, rightly or wrongly, to a very considerable extent,
and so I do think we have to have something that does contain
costs in one way or the other. That is one of the reasons that
our National Health Insurance Program contained a health care
cost control, because that would complete the cycle and inject
another additional demand into the system, not just for people
of low income but for everybody, because everybody would be
covered by the health care insurance plan. And so I do think
that we do need to have some kind of restraints and perhaps,
not surprisingly, I believe that the states and local governments
are the best areas in which to administer these. Having seen
and participated in attempts to control prices nationally and
realizing that you can do that for a very short time, but not
nearly as effectively as it can be done on the local level. So
FORD in HALD ABRAR
39
I think you're cost control problem is a very real one, I
think its essential that we do do something about it. We've
been pleased that health care costs increases have slowed a bit,
and are now about at the level at the cost of living index.
But that's much too high too, so we don't really feel that we
have in any sense finished with this problem, nor that its
in any sense been solved. I think ultimately, not only for
cost controls, but for a lot of the things I know you've been
talking about, and in the neighborhood health centers and
community family health centers, and in migrant health and things
of that kind, that ultimately the answer to that is comprehensive
national insurance. Not to the exclusion of a great many pro-
grams, but as a supplement to it. And I think that that would
fill out the health care picture a great deal more effectively.
The long-range answer, the one that I am convinced is the one
that will do the greatest amount of good, and its one in which
we have the very highest priority now, is the early periodic
screening detection and treatment program for children of
medicaid families and low-income families. That, I think, has
the greatest potential for improving the public health of any
of the programs in which we are working because it involves for
the first time getting children of families that have not had
any kind of exposure to medical examination or health care a
rather full examination rather early, and the treatment. And
we're up to about 3 million children now who we believe will be
screened this year, we hope to reach 5 million next year. We
FORD A. RALD BRAR 3
40
are perfectly willing to agree that we've been much too slow
about this. The program was adopted in 1968 and it wasn't
really until 2 years ago, 1973, when we started working on it
actively, and it wasn't until last year that Congress gave us
the ultimate weapon to withhold funds that may produce the
kind of cooperation we have to have from the states. So I
have great hopes for this program, and I think that that can
do a tremendous amount of good, but I realize its very long-
range and we have to do a great many things in the meantime.
DR. SMITH: Mr. Secretary, we're happy to know that you've
arrived. We've been discussing a lot of issues today that
really relate to the preservation of a system that we have,
centers &
neighborhood health centers and all of the other/programs that
are eminating therefrom. And I guess we're here to sort of
ask the question whether or not you and the administration
are indeed committed to the preservation of these systems.
Some of the dialogue that we hear suggests that programming has
gone on in order to make sure that we would be ready for the
National Health Insurance when it comes along, that part of
the program has been to deal with the issues of self-sufficiency
etc., I guess our concern is that from what we hear relating to
the budget cuts, etc., many of these centers may very well be
killed off before national health insurance comes along, which
everyone considers to be the panacea. We may not be here, and
that's our concern. When we look at the fact that the health
care portion of that total administrative budget is less than
FORD in RALD BRA
41
10 per cent now; I thought it was roughly around 10.8 per cent,
but Dr. Cooper tells me is about 30 billion dollars. I assume
the President's budget is still at the range of 329.4 billion,
and climbing, less than 4 per cent is for health services, for
human services, really. Less than 10 per cent of that budget.
That gives us great concern. Now when you speak of self-sufficiency
of neighborhood health service, I would like to raise a question:
How can you assume that we're going to survive, if indeed there
is a proposal wherein the federal matching percentages to the
states would be increased on a 60-40, rather than a 50-50 as
it currently operates. If indeed we are relying upon those
third party reimbursements from within the states from which
we reside, either on a capitation/?basis or whatever, from the
states and the moneys are not there, the states can't pump the
money in to support the medicaid states' program, then we
certainly cannot be reimbursed those funds. And if indeed we
cannot enroll our patients , and many of these medicaid patients
cannot be enrolled, we simply register them. And we have no
control over that process in terms of dollars and cents. And
if indeed as one lady has pointed out here the patients whom we
serve do not have private health insurance, and the foundation's
moneys are drying up all the time all over the place, from what
source would we obtain third-party payment sources in order to
survive? The federal dollars are being taken away and yet we're
saying that we become more sufficient. We agree with that that
we indeed would love to become more sufficient, efficient, etc.
FORD A LIBRA RALD
42
Would love to carry the total ball ourselves. But how can
it be accomplished? We don't see that. We would like to have
your analysis and how it was programed that this really could
take place?
SECRETARY WEINBERGER: Well, Dr. Smith, you've got an awful
lot of points there, in that statement. And there are good
points, valid points.
DR. SMITH:
SECRETARY WEINBERGER: Well, I'm delighted to hear it. Welcome
to the club. It's a small group but we like it very much.
We hope to make it larger. Those are very valid points, but
let me say two or three things right at the outset. You asked
if I was dedicated or committed to the maintenance of a
particular institution. I am not dedicated to the maintenance
of any kind of institution at all including the Department
of Health, Education, and Welfare. I am dedicated to the
maintenance of the service and the kinds of activities that
are absolutely necessary and that should be done. But how
they are delivered, I think is a matter of what's the best
way to do it. I happen to think that neighborhood and family
health centers is one of the very best ways to do it but I am
not committed to the maintenance of any particular institution
as such. I am strongly committed to the maintenance of the
delivery of the services and I do think that neighborhood and
family health centers are one of the best ways we have of
delivering that. Secondly, you spoke about self-sufficiency
&
ERALD
43
as if you may suffer from the same misunderstanding that some
other people that I have talked to in Washington have suffered
and that was the idea that by trying to move toward greater
third-party contributions for all of these activities including
many others besides neighborhood and family health centers
there is some policy to rely completely on that and to require
complete 100% self-sufficiency and that was never the answer.
I had starting with a government institution, I called the
clinical center at the National Institute of Health. I had the
idea that we should, to the greatest estent that it is available,
rely upon and draw any third-party contributions that might
be there. I personally think that it is pretty silly to leave
some money in insurance companies when people who have it
available and could have it applied if any kind of reasonable
activity were undertaken by people in various levels including
the Federal government to get the benefit of that. Now if it
isn't there, if the people, if an individual patient doesn't
have insurance, if the insurance doesn't apply in that situation,
why fair enough. If it does apply and it is there and the
person's covered with it, why not lets try and get it. And that
has been a point that I have had some difficulty in conveying
because everytime I make it some people say well you are just
going to close this institution if the insurance doesn't cover
all of the cost and a lot of people don't have insurance. That's
right, they don't have. But on the other hand, if you can get
five, ten, fifteen, twenty percent, which we know we can, and
IALO R. FORD LIBE
44
which otherwise would simple lie in the
of insurance
company, why not get it. And so that's where all of that
came from and I think that's essential. Now as far as
national health insurance is concerned I think it will perhaps
be a
I am getting a little skeptical of
in my old age but I think it will improve things substantially
for a large number of people just as I think that this EPSTD
Program will improve things for a large number of people.
But I do think that we should use to the greatest extent
that is possible and available third-party reimbursement and
I think to the greatest estent that it is possible we should
move toward a higher degree of self-sufficiency and it's in
your own interest, because to the greatest extent that you
can be free of outside sources or funding, and I know you can't
be completely or maybe even fifty percent or any number but
to the greatest extent that you can be it's infinitely better
because you can make your own rules, you don't have to worry
about regulations coming out of the department, you don't have
to deal with other people, you can run and manage your own
shop and that's a much better thing. Nobody is saying here,
nobody believes here, that that can be accomplished 100% or
the third-party reimbursement can run you, run all the funds
or anything of that kind, but let's try and get the most that
we can because the more you can get the better. Now one more
RALD OF R. FORD UBRART
45
point and then we'll get a couple others. The point has been
made frequently, very well by you and I am sure before I got
here, to the effect that states can't afford a larger contri-
bution rate and that Federal government will have to continue
doing it or there will automatically be a reduction in funds
and so on. And you've made the point about the percentage
of the total budget going to these matters. Again, I don't
think the numbers or the percentage is particularly important.
If you do that you get into a lot of dangerous ground where
you have to allow a certain percentage for each activity
including Defense. Because all of our new friends and former
enemies are allowing certain percentages of their budgets
for defense so we should do it. I don't believe in that at
all. I never did when I was here in this building running the
budget. I think you ought to look at needs and try your best
to get the amounts that match the needs and if it happens to
be five percent, or if it happens to be twenty percent I don't
care about that, but what I would like to do is get the maximum
amount that we can to satisfy those needs. On the point about
the States not being able to do so. That's a very interesting
point. There is no doubt that any level of government and
indeed a great many private activities, foundations as you
correctly identified, are all having financial problems. In
fact I can't think, looking back over some fifteen or twenty
FORD OF RALD LIBRAR
46
years or I'm afraid more than that, in both the public
and private sector in this sort of thing, I can't ever
think of any organization or any activity that had enough
or that could take care of all of its needs. There may
be one or two but not very many organizations like that so
everybody has got to select something. And my point on the
States is that the States are relatively somewhat better of
than the federal government on a proportionate basis though
obviously they are not in fine shape and they do now have
apparent deficits, though just last June they were in surplus
to the extent of about two billion dollars whereas we've been
in deficit for far to long. They are at least about as well
off or a little better off on a proportionate basis than the
federal government even though it may not be all that good.
The point I'm making is that with the six billion that we
are sending out for general revenue sharing and with the, the
I've forgotten the exact amount now, but it's higher, I think
it's fifty three billion, higher than it's ever been before
for federal aid to state and local government. It is time for
State and local governments to do some of the things we have
had to do and that is make a selection and decide what are
relative importance and I think neighborhood health centers,
family health individual help is a very high priority and I
think that we should ask the States to do some of the things
FORD & RALD LIBRARY
47
we're trying to do ourselves and that is to cut back and
stop some of the things we are doing in order to assign
more of the funds they have to these purposes. And so I
think your efforts, quite properly are directed here but
also ought to be directed to State and local government.
To say you've got some money, you've got some new federal
money, let's have some of that for our neighborhood health
centers. So I think it's a matter of all having to try
to contribute.
DR. SMITH: Yes, Mr. Secretary, I am impressed by actually
the amount of agreement that we have all had this afternoon.
We have heard that the administration was very upset at having
to veto a bill that dealt in human services and we can
agree to that. We have heard you state that you feel neighbor-
hood and family health centers are a very viable vehicle to
deliver health services and we can certainly agree to that.
We've, I think agree, prior to your coming in and perhaps
to some extent since that twenty percent cut is no longer
viable in view of the present economy as an across the board
sort of thing especially in view of the fact that in 1973
GAO did a study and they proved in that study, I think beyond
that neighborhood health centers could never
be under the present reimbursement systems more than twenty
GE LIRARY RALD A. FORD
48
percent
on a nationwide basis at best and that
was in a very healthy economy.
SECRETARY WEINBERGER: Yes, but don't let me interrupt you, but
just a quick point at that point. At that time a lot of the
contributions from a lot of the centers a lot of the attempts
to get third-party reimbursements were zero. And if they
can go from zero to twenty percent I think we will agree that
that's worth some effort.
DR. SMITH: And now that we have succeeded in going from
zero to twenty percent can we maximize. And I don't believe
that many neighborhood health centers one can maximize any
more. I know that it is true in New York, I know that it is
true in many California centers and I have a feeling it's
true in most of the centers accross the country. We've already
had enough TA and enough emphasis placed on self support so that
we have maximized our third party reimbursement. And we are
at the twenty, thirty, forty, fifty and sixty percent in some
cases. And I know of one case where it's higher than that.
We are at those levels, if we receive a twenty percent cut now
there's nowhere to go. If we still have that room perhaps
R.
FOR
we would be able.
GERALD
SECRETARY WEINBERGER: Now I think you are making the point
that I was trying to and perhaps a little better than I was
able to make it. You speak of this as a twenty percent cut
and it is true that we are suggesting that there should be
twenty percent less federal funding, but we are not thereby
49
saying that the activity is less important or that the
amount shouldn't be the same or higher than it was last
year. What we are saying is that the Federal government
is this year less well able to make that kind of a continued
contribution at that level than a combination of some other
factors particularly State governments. And so everybody is
saying why are you cutting the neighborhood health centers
if you think they are so good and so on. We do think they
are good, we do think they are very good. We don't look at
it as cutting them. What we are saying is we aren't as
well abled as some levels of government are to assist this
particular year. Now I know there are a lot of hands up and
each of you I'm sure are going to tell me that in your
particular city things are horrible and I can't argue with
that because you know about that than we do and that's exactly
why I think there should be local control of these things,
because you do know more about it. All we can look at is
overall and also all we can look at is the problems that we
have as a Federal government and they are massive and as you
have seen are what we talked about was a 52 billion dollar
deficit what is now getting very close to realization is a
hundred billion dollar deficit and when you have it that high
then you don't have just a lot of minus figures and a lot of
people in the budget office worried, what you have is the
necessary private capital to produce jobs is being dried up
and diverted to non-job producing activity and that is
ALD R. FORD LIBRAN
50
the worse thing that we can get into from a point of view
of
or the national economy or anything else.
So these are some of the considerations I think you have to
have in mind to.
SPEAKER (?) : Just to finish up, Mr. Secretary. I am impressed
because from the time the conference started until you just
quoted it, the projected deficit is about 25 billion dollars.
SECRETARY WEINBERGER: Well, nobody knows, you see I just
came from the Hill, I'm very worried about letting them alone
five minutes up there.
SPEAKER (?) : Could we make the point that the states are in
to show a deficit
many cases
by legislation/ and in other cases
they are actually in the process of bankruptcy and I don't
think that they can with stand the 20 per cent. It's been
agreed that we're anti-inflationary in the sense that we are
probably one of the few services that cost less per visit today
than it did per visit a couple of years ago. We are anti-
recessionary in the sense that we employ people who were formally
on welfare roles and who will be back on those welfare roles
if we have to cut, and we have no choice.
SECRETARY WEINBERGER: You have know argument with me at all
about the effectiveness or the necessity, what I'm arguing is
that you don't have to assume that the states can't afford
it because it might be a new or additional expenditure for them.
10 R. FORD
51
What I am saying is you should be just as persuasive with them
as you are with us. That they should increase the priority
they attach to this and perhaps go the unthinkable and diminish
enough
some other things in order to free/funds for this purpose.
That's what we are continually arguing with our own people
about on high priority projects.
QUESTION:
Can I simply ask is it possible in the way of
compromise in the way of conciliation, the administration and
Congress and we're caught in the middle, do you think it would
be possible if the House bill which as was previously stated,
has already been pared down quite a bit, from it's original,
authorization level . If that bill were presented at an
authorization level that is reasonable within the realm of
survival for us, would it still than, if the Administration
agrees, and if you agree, Mr. Secretary, would we still than
have to look forward to a veto of that bill, of the authorization
bill rather then the appropriations? The appropriations
can be fought later when it probably will be a better battle.
What we really need now is to authorize the legislation
(authorization).
SECRETARY WEINBERGER: You've given me a very good out because
you asked, made the assumption that the authorization level
is reasonable and I've never turned down anything that's
reasonable in my life. But I really don't know, I, it depends
entirely of course on how the President views it at that time.
And we do have to bear in mind that authorization levels tend
to force appropration levels. I strongly believe myself that
FORD LIB
52
we should get away from the difference between authorization
and appropriation. In California when I was in the legislature
and still I think we did very nicely by simply having a
single level you appropriate funds as necessary and I think
that's much better. I think an authorization level arouses
a lot of expectations that frequently can't be met. But, I know
the President shares the feeling that we have as to the
importance and the necessity of this particular activity.
I know that he's worried about very high, unreasonably
high, authorization level and, because of this fact that they
can't be carried out or sustained, sometime by appropriations
but I know that he would be very anxious to try to get a
bill continuing this activity that is within what he thinks
is economically possible for the government as a whole.
QUESTION: Mr. Secretary as a fellow Californian, I would like
to just get back to California . The situation in Los Angeles
with pre-paid health plans and that whole bit, to date there
are about 2 or three community health centers that are now
kind of getting into the pre-paid health situation. Prior
to that there was something like maybe 13 or 14 private
organizations that were in it for the profit
I think based upon testimony that's come to Congress
and the experience high cost of everything, I think that whole
program is failed to an extent. But I'm interested in knowing
is what the government is doing as far as mechanisms to make
sure that once this money, the revenue sharing money or whatever
money goes to the states that in fact organizations might
FORD
,ALD
53
help so as they don't have a profit motive in mind
.
What is the guarantee that some of that money will get
there and probably get there before some of the centers close?
SECRETARY WEINBERGER: Well, as far as general revenue sharing
funds are concerned, the idea there is that because people
are closer to there state and local governments, they should
be forced to come to Washington to make there pleas or to
look for their protections of the kind you described which
are entirely proper protections, but they should go to the
state and local governments so generally the general revenue
sharing funds would go to the state and local governments
with the their ability to re-spend them very freely. And
guided only by the general decisions of state and local
government. With a few overall federal restrictions, for
example, none of the general revenue sharing funds of course
can be used in any way to [End of tape 1.]
Overall federal restrictions for example, none of the general
revenue sharing funds can be use in anyway to violate any
civil rights laws. It's one of the very few restrictions on
general revenue sharing funds. Within that kind of protection
than generally the revenue sharing funds go to state and local
governments to spend as they saw fit. Controlled, I hope by
RALD GE A. FORD VIBRARY
54
public opinion and people close to those governments so
in your question you would not have to come to Washington.
You would go to Sacramento or to Los Angeles to try to get
better rules for the distribution of those funds to neighborhood
health centers that are truly non-profit. And I know that
non-profit in quotes organizations and you described a couple
of them and I understand there very real problems with those.
Aren't really non-profit at all. Because when you add in the
salaries and the expenses and all they get to be pretty
profitable ventures for some people. But I don't see any
reason why the stateand local government cannot require that
in the funds that we give them in general revenue or their
own that they distribute these to neighbor hoood health centers
and let the neighborhood health centers establish their own
pre-paid health care systems which I think in many cases,
would be far better managed and do a better job.
The purpose of general revenue sharing is to eliminate the
need to come to Washington to argue these matters , it's to
be able to go closer to your home and get the decisions made
there. That's the whole theory of it.
QUESTION:
Mr. Secretary, I have looked back
as we all do in programs that are in the past, but I would
like to take a look at the future and to hear what you have to
say with reference to the impending national health legislation
although the time table would suggest it won't come until next
January.
FORD A. LIBRA
55
SECRETARY WEINBERGER: Right.
QUESTION: I would certainly recognize the need for continuing
programs such as the ones represented by the people here by
whatever means possible because they do represent some major
steps forward. But I would also like to look into the future,
try to make sure we don't make some of the mistakes that have
been made particularly when we make very significant concessions
to rather strong lobbying interests, rather strong vested
interests who sing the siren song and who insist that the
legislation contain such phrases as without disturbing the
traditional methods of medical practice and other such restricted
phrases that prevent us from really picking the
sources
that we have and distributing them in such a fashion that instead
of being concerned with us as providers, physicians, administrators
and what have you, that we would be concerned with what ultimately
gets to every patient so that when the national legislation
come about we will have a basic form that is without faults,
that is for real, that has the patient concerns and that has
the consideration for those who are least able to afford.
These are things that are perhaps not always a part when we look
at it from a budgetary point of view, although some of the finest
people I know of are budgeteers, Mr. Beam and Mr.
happen to have a very strong budgeter influence on their program,
but I do want to make sure that the programs that are designed
RALD GE R. FORD UBRAST
56
are programs that can have the ultimate effect that will translate
the rhetoric of health care as a right into reality.
SECRETARY WEINBERGER: Those are very, very good points, Dr.
Holoman, I have a great deal of trouble arguing with any of them.
Let me tell what I see as some of the necessities for national
health insurance. And I don't think the President's decision
not to sponsor, to sponsor no new spending programs this year
anyway is going to slow that down because I think that for one
thing, the Ways and Means Committee to speak very practically
indicated they can't begin hearings on the subject until
October and our bill is all finished and is had hearings and
put that in in January I don't think any time is going to be
lost I'd like to see national health insurance take the form
of a provision of health services and health providers
on the freest kind of choice bases for people without regard
to their financial resources and with only regard to their
needs and I want to see that done because I have great prejudices
on this subject and you should know that ahead of time I want to
see this done without the federal government trying to administer
or deliver it because my experience while we worked very hard
and continue to work very hard to make the federal government
as responsive and as effective as we can, I just think in the
nature of the beast it is done much better if it is done without
that kind of governmental operation and control and direction
is
so what I would like to see/essentially contained in the
RALO GE FORD
Administration health insurance bill is a bill in which for
people who are employed they joined together in getting, in
payin
57
paying the premiums for the kind of policy described by
the government which is very complete, very comprehensive,
and which covers all physicians visits, hospital visits,
out-patient care, prescription drugs, alcoholism, mental
illness, things that are frequently not covered and which
under which people of lower income would have government
subsidy for their premium down to the point they would all
be taken care of. And the Medicare Program would continue
but would have these benefits extended so that everyone would
have the same access to comprehensive health care delivery.
The things that I think in that bill that are important from
the points of view that you mentioned are two: one is that there
is a very high degree of flexibility with respect to the
form in which the health services called for by that insurance
would be delivered, in other words an employee could say I
don't want you to help me pay insurance premiums, I want
you to pay my dues or help pay my dues in an HMO , of my own
choosing. And that flexibility is there. The other thing that
is there is the fact that the government is not running it or
going to deliver it or going to be paying all the providers
directly or anything of the kind, and therefore you don't have
to have that full scale governmental substitution of all
of the very elements in the community that are now delivering
health service, thirdly, as I mentioned a moment ago, there are
substantial cost controls and that which I think are essential,
FORD a. RALO LIBRARY 3r
58
so that given all of this, given the fact that it is based on
a sliding scale that, if your income is such, that you can
afford it , than we'll always argue I suppose as to what that
level is, you and your employer or you and your employee would
share the cost. As your income fell or you didn't have any,
then the government would pick that up so that you would have
this kind of insurance coverage, you would be able to go where
you wanted for your health care, if you wanted to go to a
your
neighborhood health center/reimbursement there would come through
these policies and so that you would have I think the maximum
degree of coverage, the maximum degree of flexibility, and the
minimum degree of government control and direction. That's
the kind of health care program that I would like to see.
number
With that kind of a flexible framework anyone of a/variations
could be developed for the actual delivery and if you wanted
a pre-paid system run by a neighborhood health center it would
be qualified, if you wanted a HMO organization or run by a
group of neighbors or by the health center itself that could
qualify. This allows a degree of flexibility. The way I would
not want to go would be to add 4 or 5 per cent to the payroll
tax have the government sponsor the whole thing, pay for the
whole. thing, it would (quote) all be free (close quote) we would
have a horrendous additional of governmental envolvement and there
are the rule books that tell you and everybody else how to practice
medicine would be so thick that we would probably would not even
FORD & RALD LIBRARY 30
59
get them delivered and this is the kind of thing I don't
want and on the other hand it's the kind of thing I've
described I think would be the best kind of improvement
and allow for the change of direction of delivery of health
services anyway that seemed best to individual people to want
to move it. That's the kind of framework I would like to
see us establish. I hope it can be done next year.
SPEAKER: The Secretary had told me he had to get out at
3:30, I think it's about 3:40. Mr. Secretary do you have a
chance for one more?
QUESTION: Mr. Secretary, I'm Dr. Harvey Webb, Vice President
of the National Dental Association and Director of the
Health Center in Baltimore. I would
like to give a slight analogy
and ask the feasibility
question. I don't totally agree with the approach that's been
taken here, I think we've taken too much of a negative approach.
We've been talking about cuts and so forth but let me give this
analogy. Mr. Kissinger and we assume you'd like to give him
credit for the effort he has made, has not been able to pull
off the arrangement in the Middle East has he had liked.
WEINBERGER: Not yet, but we're hoping.
RALDO GE R. FORD TIBRAY
QUESTION: With the death of the King of Saudia Arabia this
morning also made the stock market quiver or gain since yesterday.
The collapse of the government in Southeast Asia has caused
considerable concern and the economy here of the ******** REMMEMX
hexex
national companies
& P cutting out a third of its stores and the
metro utilities on the border of somekind of bankruptcy make
60
the stake as I understand Mr. Kissinger is suggesting that we
re-evaluate the entire situation and take a different prespective
I would like for us to consider and to get your reaction sir
to the possibility of regardless of what has been put in the
budget , regardless of the prejudices that we have and
regardless of the biasises that exist in the various aspects
of our economy to re-look at the whole health situation and
in light of the health crises, in light of the national crises
the job crises to re-evaluate and tell me what the feasibility
would be if we looked at it from that prespective of adding a
200 billion dollars to the health budget in the categories
that have been considered for reduction and add that to the
budget and revitalize this very important aspect of our own
economy to promote jobs, to promote the elimination of persons
going back on his own terms, to promote more self- sufficiency.
What is the feasibility of that.
WEINBERGER: Quite a lot depends on whether you said 200 billion
or 200 million.
QUESTION: I said 200 million.
WEINBERGER: 200 million. It's an indication of how we are
oriented down here that everybody up here heard you to say 200
billion but I'm sure that you meant 200 million.
SCOTT: Mr. Secretary let me play the tape back. (Laughter)
WEINBERGER: God, you're not keeping a tape are you Stan.
GERALD R. FORD
(Laughter) Well, let me just say this it's a very general
statement and that is so far as I am concerned and I'm sure
so far as the President and everybody else in the Administration
is concerned we would never feel that we had been So right
61
at any one time or so far from being wrong that we wouldn't
be willing to re-evaluate anything, anytime. The difficulties
with what you suggest are apparent because we do have what
we felt to be an overall economic fiscal point of view a
52 billion dollar deficit's a pretty difficult thing for us
old elephants to have to swallow and when you finally agree
that that is probably the maximum amount of stimulation that
can be possibly stood in order to get the economy rolling and
all the rest and then when you see that not standing at all
is any kind of landmark but being exceeded almost every hour
and worrying as you do about whether or not you're going
activity
to have any capital left to invest in job producing activities
which is the only way in which we're ever going to pull out
of any of these problems. Then the addition of 200 million
comparitively
though it might seem small necessarily involves
consideration of where are you going to get it, whose 200
million is going to come out to get this. In and of itself
a quarter of a billion dollars against the total size of the
Federal budget may not seem like very much but as I'm sure
you know you are not the only group that wants an extra
200 million. There are a great many other groups and when I
dealt with the budget and before I went into the Department
I saw all of them every day. No body comes who doesn't have in
mind some additions. Now this isn't to say that these kind
of changes can't be made or that they might not be made by
FORD P. RALD LIBRARY 30
the Congress and accepted or that they might not be recommended
by the President and we certainly are not above and should
never be above the idea of reexaming all that we've done
62
changed
and seeing if we can rise to meet change conditions
and all the rest and obviously a lot of conditions have
changed even in the couple of months since the budget went up.
But I don't think anyone should have their expectations
improperly arroused by my telling you that of course we're going
to do that or certainly we will accept anything that's voted
or anything of the kind. I don't know. Because large as it
is I only have one department and there are a tremendous number
of other considerations over-all fiscal problems rapidly changing
conditions, inflation, all these other things that people
have to keep worrying about but I can certainly assure you
that the problems that are covered by this meeting today are
considered to be and properly so a very high prime importance.
We assigned a not inconsiderable resources to them. I know that
in every activity a great many of the people concerned with that
activity always feel that there should be more and I know that
certainly there would be useful way to dispose of the additional
amount you mentioned. Whether it can be made available or not
I don't know but we certainly will and expect and do continually
re-examine the situation and make additional suggestions to the
President and he himself on his trips around the country is getting
some very valuable imput and frequently coming back with ideas
or changes he wants to make. So to that extent we're flexible.
The situation doesn't allow for very much over-all flexibility
because we are at a point frankly where with the actions of the
a.
FORL
Congress and the apparently lack of concern as to this need to
RALD
get some capital into job producing activities and worry about
63
where you're going to get it when you have such enormous
additions to the public debt to finance which is not job
producing activity those have to be very real worries.
They may not seem as immediate but they're very real. But
the brief answer to your question is yes, of course we re-examine
all of these things all the time and certainly are perfectly
flexible and willing to recommend changes anytime we think we
possibly can.
QUESTION: Would you be willing to suggest that to the Presiden -
WEINBERGER: Well, I would be not - don't let me get into any
situation where I'm arousing expectations. I know that we
in our department do and I know the President does frequently
and on a regular basis re-look all of these things. And we
have to do it on the basis of changes that the Congress makes
or in changes in individuals conditions that occur. Bear in
mind that we've had just since the budget went up a very strong
request that something like two and a half billion dollars not
your modest 200 million but two and a half billion dollars
be suddenly applied not that it wasn't budgeted, it wasn't
planned be suddenly applied for a very limited purpose, health
insurance for the unemployed. And supposing and there's a lot
of support for that - supposing we accommodate that. Then what
happens? Well that's two and a half billion and that's the way
it has been going. So certainly we're going to re-examine all of
these things but I can't in any honesty tell you that yes I'll go
recommend that this be done. But I will recommend indeed I don't
have to that we continually re-look and see what change conditions
require.
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64
SCOTT: Thank you Mr. Secretary. (Applause) We're running just
about on time. I understand the tour guides have arrived to
take us over to the White House to get a tour. On behalf of the
panelists I'd like to thank you for attending this session
for participating in this session. I personally feel that it
was quite meaningful in that we have begun to open a dialogue.
I think that's crucial at this time that we began to communicate
with each other. I look forward to hearing from you in terms
of follow-up. My office remains open 24 hours a day to be of
whatever services possible to provide to you. I know the
panelists I would think that they feel the same way and in
terms of additional input you know their names now you know
where they are so you've got the name plates here and we're
all servents of yours so look at it that way and let's try
to maintain and strengthen this partnership in progress.
We don't have everything we need in any given area of life
today but I think by working together we can achieve some
common results and in that light with that spirit thank you
very kindly and let's move out now for the tour.
LERARY RALD A FORD