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It has long been recognized that the Federal, State and local Governments all have responsibilities for the protection of all of the population against disease. The Federal Government has recognized its responsibility in this respect in the public-health activities of several of its departments. There also are well-established precedents for Federal aid for State health administration and for local public facilities, and for the loan of technical personnel to States and localities. What we recommend involves no departure from previous practices, but an extension of policies that have long been followed and are of proven worth. What is contemplated is a Nation-wide public-health program, financially and technically aided by the Federal Government, but supported and administered by the State and local health departments.

The foregoing recommendations were made by the Committee in its report of January 15, and the President proposed in his message to the Congress on January 17, 1935, that "additional Federal aid to State and local public health agencies and the strengthening of the Federal public health service" be provided for. The specific recommendations of the Committee are included in the economic security bill now before the Congress.

C. TAX SUPPORTED MEDICAL FACILITIES AM SERVICES*

* In general and except where otherwise specified or obviously intended, the phrases "medical care" and "medical services" include not only the physician but also the hospital, dentist, nurse, pharmacist and others.

It has long been recognized that local, State and Federal governments have a responsibility in furnishing certain kinds of public medical services for individuals, as distinguished from preventive services for entire communities. To the extent that these services are provided, the risks to economic security are lessened. Before the depression, about $600,000,000 was spent annually from tax funds for these services, or about one-sixth of all expenditures for medical care. In 1929 about $1 for every $6 spent for medical care came from tax funds, while at the present time the proportion is somewhat larger. For persons who are without incomes and for whose maintenance the city, county, State, or Federal government has assumed responsibility, medical care is furnished mainly from public funds with the cooperation of physicians who often give their services without remuneration.

One hundred and sixty thousand beds for general hospital care, or nearly half of all the general hospital beds in the United States, are provided by counties, cities, or larger units of government. These beds serve not only those who are without incomes, but other persons who are self-supporting while in health, but who cannot, because of limited incomes, meet hospital expenses at the time of illness.

Nearly 500,000 hospital beds for mental disease exist in the United States, of which nearly five-sixths are supported by State governments, and only 3 1/2 per cent are under non-government auspices. Tuberculosis is another disease for which our governments have generally assumed responsibility for institutional care. Most of the 70,000 beds in tuberculosis hospitals and sanatoria are maintained under government auspices, particularly by counties. Many of these government hospitals also maintain out-patient departments for the diagnosis and treatment of persons who are not sick enough to be confined to bed, but who cannot afford to pay in a private physician's office for the care that they need. Tax-supported medical services also include care for certain diseases of public health interest, among not only dependent persons but others of small incomes, e.g., for syphilis, for some other communicable diseases, and for certain diseases and defects among children.

Various preliminary studies have been made by the Committee's staff in order to determine whether these public medical services are adequate. It was evident from these preliminary studies that these public medical services are extremely uneven in distribution in different parts of this country. Many localities are without hospitals. Many communities are without clinics, hospitals, or laboratories for the diagnosis and treatment of diseases of public health interest. Some rural areas have an insufficient number of physicians or no physicians. Many persons with little or no income receive no medical or dental care except in emergencies. The depression has greatly increased in some communities the demands upon the out-patient departments of these hospitals as well as upon clinics maintained by non-government hospitals and by health departments. The present extent of public medical service varies among the states and localities rather in proportion to their resources than in ratio to their needs. To remedy this condition is essential to the health of the people and is a responsibility which the Federal Government should share by assisting and stimulating localities and States in providing these needed facilities and services.