Library Collections: Document: Full Text

We recommend that the appropriate Federal agencies consider the following proposals (as set forth in I, II and III below) which have been submitted by the Committee's staff and by one or more of the advisory boards, and which we approve in principle:

I. The Medical Needs of Persons for Whom the Government Assumes Some Responsibility

The present necessity must be faced of providing medical care, curative and preventive, for the twenty million or more persons who are dependent or almost dependent upon public funds for their existence. Where cash is given or work is provided to the extent of a minimum or subsistence wage only, it is impossible for such persons individually to budget against the cost of any serious illness, and it is obviously unfair, even if it were practicable, for physicians, dentists, nurses, and hospitals, to furnish as charity the amounts of care now required.

Since 1933 the Federal government has assumed a share of the responsibility for the medical care of the unemployed and their families under the Federal Emergency Relief Administration system. The exclusion of any share of responsibility for hospital service to these persons has given rise to widespread difficulty and complaint. Although the policy of the Federal government is to regard the care of unemployables as the responsibility of local communities, it must be realized that some time must elapse before local communities can assume the entire burden.

On this subject three proposals have been made:

1. That out of Federal funds payments to be made as long as may be necessary through the States for a share of the cost of medical care of persons for whom the Federal government assumes some share of responsibility, and their dependents, in accordance with the general principles already developed by the system of medical care under the Federal Emergency Relief Administration.

2. That for the purpose of effectuating adequate hospital care for these persons, Federal funds pay through the states the sum of $1.00 per day for care furnished these persons in approved hospitals, provided funds from other sources pay the remainder of the cost.

3. That some temporary provision be made out of Federal funds to assist in providing medical care for unemployables in various States and communities according to need until the case of these unemployables becomes the responsibility of the local communities.

It is estimated that the cost to Federal funds during the next twelve-month period would be about $60,000,000, of which the hospital provision would constitute about $15,000,000.

II. The Extensive and Serious Needs of Many Rural Areas

The distribution of physicians is very uneven. There is about one physician to every five hundred persons in many large cities, whereas there is only one physician to every fifteen hundred or more in many rural sections. The distribution of hospitals is even more uneven. Of the 3,073 counties in the United States, 1,200 have no hospitals. While some of these counties are too sparsely settled to require one, and others are within reach of hospitals in neighboring counties, it is estimated that fully six hundred areas need a hospital or at least a building providing diagnostic facilities for the physicians and the people of the locality. Other areas need extension or qualitative improvement of their present limited facilities. Experience in sparsely settled rural areas in some of our states and in some Canadian provinces indicates that salaried or subsidized physicians associated with local public health work are the only way through which adequate medical care can be brought to many such localities. On this subject three proposals have been made:

1. That out of funds which may be available, needed hospitals and medical center buildings in rural areas be provided as part of a public works program; that this program be undertaken at a rate so as to permit careful study of suitable areas and sites; that such studies be made by existing Federal agencies and be associated with the program of the United States Public Health Service for extending public health work in rural sections.

It is probable that expenditures at the rate of ten to twenty million dollars a year would be desirable. The total program would cost about sixty million dollars over a period of four to six years.

These new hospitals will be maintained by counties or other governmental units. In view of the fact that it would be difficult for some communities to maintain them completely, at their outset, it has been proposed that:

2. Grants-in-aid for the maintenance of the new rural hospitals be made from Federal funds, meeting only a portion of the cost of maintenance during the first year of operation, and on a diminishing scale thereafter for not more than two succeeding years.

The cost to Federal funds would not exceed $10,000,000 over the whole period of four to six years, and under probable limitations in practice would be about half this sum.