To the Congress of the United States:
Because the strength of our nation is in its people, their good health is a proper national concern; healthy Americans live more rewarding, more productive and happier lives. Fortunately, the nation continues its advance in bettering the health of all its people.
Deaths from infectious diseases have diminished. During the past year, important progress has been made in dealing with such diseases as rheumatic fever, high blood pressure, poliomyelitis and tuberculosis. Intensified research has produced more knowledge than ever before about the scourges of heart disease and cancer.
The 83rd Congress, during the last legislative session, supported dramatic new strides in vocational rehabilitation. By 1959, consequently, we should be restoring to useful lives most persons who become disabled and who can be rehabilitated and returned to employment. In human terms, this will be a heartwarming achievement.
The 1954 amendments to the Hospital Survey and Construction Act opened another new chapter in the national drive for better health. Under these amendments, further provision was made to help build health care facilities for the chronically ill; to aid in the construction of nursing and convalescent homes; to provide for more diagnostic and treatment centers for patients who do not need hospital care; and to help make centers available for the rehabilitation of the disabled.
These achievements represent a major gain for the immediate and future welfare of countless Americans--in the health of both mind and body. Recent advances do not, however, represent our full capacity to wage war on illness and disability throughout the land.
THE IMMEDIATE NEEDS
As a nation, we are doing less than now lies within our power to reduce the impact of disease. Many of our fellow Americans cannot afford to pay the costs of medical care when it is needed, and they are not protected by adequate health insurance. Too frequently the local hospitals, clinics, or nursing homes required for the prevention, diagnosis and treatment of disease either do not exist or are badly out of date. Finally, there are critical shortages of the trained personnel required to study, prevent, treat and control disease.
The specific recommendations that follow are designed to meet this three-fold deficiency.
MEETING THE COSTS OF MEDICAL CARE
For most Americans, insurance--private, voluntary insurance-provides a sound and effective method of meeting unexpected hazards which may be beyond the capacity of the individual to bear. Risk sharing through group action is in the best tradition of vigorous and imaginative American enterprise.
The Government should cooperate with, and encourage, private carriers in the improvement of health insurance. Moreover, a great many people who are not now covered can be given its protection, particularly in rural areas where group enrollment is at present difficult.
Existing health insurance can also be improved by expanding the scope of the benefits provided. Not all private expenditures for medical care can or should be covered by insurance; nevertheless, many policies offered today are too limited in scope. They are principally for hospitalized illness and for relatively short periods of time.
I recommend, consequently, the establishment of a Federal health reinsurance service to encourage private health insurance organizations in offering broader benefits to insured individuals and families and coverage to more people.
In addition, to improve medical care for the aged, the blind, dependent children, and the permanently and totally disabled who are public assistance recipients, I recommend the authorization of limited Federal grants to match State and local expenditures.
Reinsurance.--The purpose of the reinsurance proposal is to furnish a system for broad sharing among health insurance organizations of the risks of experimentation. A system of this sort will give an incentive to the improvement of existing health insurance plans. It will encourage private, voluntary health insurance organizations to provide better protection--particularly against expensive illness--for those who now are insured against some of the financial hazards of illness. Reinsurance will also help to stimulate extension of private voluntary health insurance plans to millions of additional people who do not now have, but who could afford to purchase, health insurance.
The Department of Health, Education, and Welfare has been working with specialists from the insurance industry, with experts from the health professions, and with many other interested citizens, in its effort to perfect a sound reinsurance program--a program which involves no Government subsidy and no Government competition with private insurance carriers. The time has come to put such a program to work for the American people.
I urge the Congress to launch the reinsurance service this year by authorizing a reasonable capital fund and by providing for its use as necessary to reinsure three broad areas for expansion in private voluntary health insurance:
1. health insurance plans providing protection against the high costs of severe or prolonged illness,
2. health insurance plans providing coverage for individuals and families in predominantly rural areas,
3. health insurance plans designed primarily for coverage of individuals and families of average or lower income against medical care costs in the home and physician's office as well as in the hospital.
Medical care [or public assistance recipients.--Nearly 5 million persons in the United States are now receiving public assistance under State programs aided by Federal grants. Present arrangements for their medical care, however, are far from adequate. Special provision for improving health services for these needy persons must be made.
I recommend to the Congress, therefore, that it authorize separate Federal matching of State and local expenditures for the medical care needed by public assistance recipients. The separate matching should apply to each of the four Federally-aided categories--the aged, the permanently and totally disabled, the blind and children deprived of parental care.
STIMULATING THE CONSTRUCTION OF HEALTH FACILITIES
Many communities in the United States today lack the hospitals, clinics, nursing homes, and other modern technical facilities required for the protection of the people's health. In other communities, structures are antiquated or otherwise deficient in construction or equipment.
Present methods of financing are not always satisfactory in meeting this problem. Many sponsors and operators are unable to qualify for grants under the recently extended Hospital Survey and Construction Act. Sponsors of health facilities often find it difficult to obtain private capital for construction.
In other fields, Government insured loans have consistently helped produce the new construction required in the urgent national interests. The tested procedures developed by such successful Government guaranty programs as these should now be used to stimulate construction of additional health facilities.
I recommend, therefore, that the Congress authorize the Secretary of Health, Education, and Welfare to insure, for a small premium, mortgage loans made by private lending institutions for the construction of health facilities.
The continuing responsibility of the mortgagor and of the lending institution should be preserved by limiting the insurance to less than the face amount of the loan and by requiring that a mortgage loan, to be eligible for insurance, must be for less than the full value of the property. The authorizing legislation should, of course, include any needed safeguards against the encouragement of substandard or unsound projects.
HEALTH PERSONNEL NEEDS
Whether we look at health problems in terms of services for the community or for the individual--at problems of research, prevention or treatment of disease--we find that supplies of trained personnel are critically short.
The Administration's legislative program for this year therefore contains proposals addressed to crucial areas of personnel shortages. These particular areas, moreover, hold the key to other possible advances and improvements in health programs.
Two proposals are aimed at shortages in nurse personnel: First, I recommend a 5-year program of grants to State vocational education agencies for training practical nurses. Second, I recommend an expansion of Public Health Service operations to establish traineeships for graduate nurses in specialties such as nursing service administration, teaching and research.
In addition, my recommendations for the revision of the present public health grant programs include authority for the establishment of traineeships in all public health specialties, including mental health.
PUBLIC HEALTH PROGRAMS
The Public Health Service, the Children's Bureau of the Social Security Administration, and the Food and Drug Administration are skilled and vigilant guardians of our nation's health. All three of these agencies should be strengthened, and the programs of the Public Health Service and the Children's Bureau for aiding State health activities made more responsive to changes in State and local health needs. To this end, I urge the Congress to take the following steps:
1. Improve present grant-in-aid programs providing services . for mothers, for crippled children and for children requiring special health services. Separate funds should be provided for extension and improvement of these activities and for special projects designed to develop improved medical care techniques both for mothers and for children.
2. Permit greater flexibility in the use by the States of Federal grant funds for public health services. The States could adapt their programs more effectively to their own needs if the separate Public Health Service grants were combined into a single, unified grant-in-aid structure. In addition, separate funds should be provided for extension and improvement of existing public health programs and for special projects looking to the development of improved techniques.
3. Step up research on air pollution. As a result of industrial growth and urban development, the atmosphere over some population centers may be approaching the limit of its ability to absorb air pollutants with safety to health. I am recommending an increased appropriation to the Public Health Service for studies seeking necessary scientific data and more effective methods of control.
4. Provide greater assistance to the States for water pollution control programs. As our population grows and demands for water increase, and as the use of chemicals expands, our water supply problems become more acute. Intensified research in water pollution problems is needed as well as continuing authority for the Public Health Service to deal with these matters. The present Water Pollution Control Act expires on June 30, 1956. This termination date should be removed and the Act should be strengthened.
5. Authorize the Public Health Service to establish traineeships for both graduate and specialized training in public health in order to increase the numbers of trained personnel.
6. Strengthen the Public Health Service Commissioned Corps by improving its status and its survivor benefits.
Care for the mentally ill presents a special set of problems. Only in the past few decades have we, as a people, begun to regard mental and emotional disorders as capable of specific diagnosis, alleviation, cure, and rehabilitation. We now know that effective preventive and control programs are possible in the field of mental health.
I recommend, therefore, new and intensified measures in our attack on mental illness. These are:
1. Strengthening of present aid to State and community programs for the early detection, control and alleviation of mental and emotional derangements;
2. Increased budgetary support for training activities which are now authorized, so as to increase the number of qualified personnel available for care of mental patients; and
3. Authorization of a new program of mental health project grants. Such projects would aim at improving the quality of care in mental institutions and the administration of the institutions themselves. They would also search out ways of reducing the length of stay and the necessity for institutional care in as many cases as possible.
As a vital part of our attack on a serious health and social problem, I also recommend new grants to the States to enable them to strengthen and improve their programs and services for the prevention, diagnosis and treatment of delinquency in youth. There should be assistance for State planning, for coordination of all State and local agencies concerned with juvenile delinquency, for training of personnel, and for special research and demonstration projects.
INTERNATIONAL ASPECTS OF HEALTH
For half of mankind, disease and disability are a normal condition of life. This incalculable burden not only causes poverty and distress, and impedes economic development, but provides a fertile field for the spread of communism.
The World Health Organization of the United Nations is exerting forceful leadership in a cooperative world-wide movement toward better health. Its program merits adequate and growing financial support on the part of the United States. Our contribution to the World Health Organization should be raised, so that the effort to release men from the bondage of disease through international cooperation may be increased.
These recommendations to the Congress represent a broad and coordinated offensive against many of the problems which must be solved if we are to have better health for a stronger America. All the proposals recognize the primacy of local and State responsibility for the health of the community. They encourage private effort, with private funds. With the cooperation of the States and the medical profession, they can form the basis for better health for all.
DWIGHT D. EISENHOWER