Franklin D. Roosevelt

Message to Congress on Federal Construction of Small Hospitals in Needy Areas of the Country.

January 30, 1940

To the Congress:

In my special message to the Congress on January 23, 1939, I expressed my concern over the inequalities that exist among the States as to health services and resources with which to furnish such services. With that message I transmitted the report and recommendations on national health prepared by the Interdepartmental Committee to Coordinate Health and Welfare Activities and recommended it for careful study by the Congress.

Conditions described a year ago are substantially unchanged today. There is still need for the Federal Government to participate in strengthening and increasing the health security of the nation. Therefore, I am glad to know that a committee of the Congress has already begun a careful study of health legislation. It is my hope that such study will be continued actively during the present session, looking toward constructive action at the next. I have asked the Interdepartmental Committee to Coordinate Health and Welfare Activities to continue its studies.

In order that at least a beginning may be made, I now propose for the consideration of the Congress a program for the construction of small hospitals in needy areas of the country, especially in rural areas, not now provided with them. Hospitals are essential to physicians in giving modern medical service to the people. In many areas present hospital facilities are almost non-existent. The most elementary health needs are not being met.

The provision of hospitals in the areas to which I refer will greatly improve existing health services, attract competent doctors and raise the standards of medical care in these communities. The new hospitals should serve the additional purpose of providing laboratory and other diagnostic facilities for the use of local physicians, as well as accommodations for local health departments.

The proposed hospitals should be built only where they are most needed; they should not be constructed in communities where public or private institutions are already available to the people in need of service even if these institutions are not up to the highest standards. To insure proper location and good standards of operation, approval of hospital construction projects should be given by the Surgeon General of the Public Health Service, with the advice of an advisory council consisting of outstanding medical and scientific authorities who are expert in matters relating to hospital and other public health services.

Projects proposed for consideration should be submitted by responsible public authorities and should include assurance that adequate maintenance will be provided. Approval of projects should be preceded by careful survey of existing local hospital facilities and needs. Standards for organization, staff and continuing operation should be established by the surgeon general, with the advice of the advisory council. A competent hospital staff and satisfactory standards of service should be required, including medical, surgical and maternity service. When indicated, special provisions should be made for the care of the tuberculous in many areas of the South; the present acute needs for the care of Negro patients should also be met.

I suggest that these hospitals be simple, functional structures, utilizing inexpensive materials and construction methods. The facilities of the Federal Works Agency should be utilized in the planning and execution of the hospital projects. Title to these institutions should be held by the Federal Government, but operation should be a local financial responsibility.

I recommend to the Congress that enabling legislation for this program be enacted and that a sum of between $7,500,000 and $10,000,000 be appropriated to the Public Health Service to inaugurate the program during the next fiscal year.

I am confident that even this limited undertaking will bring substantial returns in the saving of lives, rehabilitation of workers and increased health and vigor of the people.

This suggestion is not a renewal of the Public Works program through the method of grants in aid. The areas which I have in mind are areas so poor that they cannot raise their share of the cost of building and equipping a hospital. Yet I believe that many of such communities have enough public-spirited citizens with means, and enough citizens able to pay something for hospital treatment, to care for operating costs of a hospital, provided they do not have to pay for its original construction and equipment, or to pay annual interest and amortization on borrowed money. Treatment in such a hospital would, of course, be available to men, women and children who literally can afford to contribute little or nothing toward their treatment.

One of the important difficulties in such areas at the present time is that young doctors hesitate to practice general medicine or surgery because of the utter lack of hospital or laboratory facilities. One cannot blame them.

In such areas also, costs of construction are generally low and many local materials can be used. It is my belief that with the assistance of the Work Projects Administration the cost of building and equipping a 100-bed hospital can be kept down to between $150,000 and $200,000. This means that we could build fifty such hospitals for between $7,500,000 and $10,000,000.

This is not an ambitious project. This principle should not be extended to Government gifts to communities which are financially able to build their own hospitals. It is an experiment in the sense that the nation will gain much experience by undertaking such a project.

At the very least it will save lives and improve health in those parts of the nation which need this most and can afford it least.

Franklin D. Roosevelt, Message to Congress on Federal Construction of Small Hospitals in Needy Areas of the Country. Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/209265

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