Special Message to the Congress on Domestic Health and Education.

To the Congress of the United States:

A nation's greatness is measured by its concern for the health and welfare of its people. Throughout the history of our democracy, this commitment has grown and deepened.

The education of our people is a national investment. The health of our people is essential to the pursuit of happiness.

Today we can set ambitious goals for the future:

--full education for every citizen to the limits of his capacity to absorb it;

--good health for every citizen to the limits of our country's capacity to provide it. The 88th and 89th Congresses have moved toward these goals. During the past three sessions, Congress has:

--enacted 20 landmark measures in health and 19 in education;

--doubled the appropriations for health programs and increased the budget for our Office of Education more than fivefold. The achievements of the past three years promise a dramatic enrichment of American life. They already include in the field of health:

1. The Medicare program which, on July 1, will make benefits available to more than 19 million older Americans.

2. Health services for more than 200,000 migrant workers in 34 states.

3. Maternal and infant care for mothers and children previously receiving inadequate services.

4. Expanded services for crippled children.

5. Thirty-two new clinics for retarded children.

6. Construction assistance for 1300 hospital and health facilities to add more than 56,000 new hospital beds.

7. Financial support for more than 16,000 medical research projects and advanced training for 25,000 scientists.

8. Construction starts for 62 institutions to enroll more than 2400 additional students each year for training in the health professions.

Our achievements in education are equally impressive. Among them are:

1. Funds to improve educational opportunities for nearly 7.5 million underprivileged children in 20,000 school districts.

2. Summer head start programs for 560,000 preschool children in 13,350 community education projects and year-round programs for 120,000 children.

3. Textbooks and other learning materials for more than 40 million children in every state.

4. College work study programs for more than 110,000 needy college students.

5. Construction aid for 1300 institutions of higher learning--including new classrooms, laboratories and libraries.

6. 12 million books to improve public libraries and training programs for more than 400 librarians.

HEALTH

With these programs and those I am recommending today, we can move closer to attainment of our goals:

--to bring every child the care he needs to develop his capacity to the fullest.

--to reduce infant mortality, concentrating particularly on those minority groups whose death rate is highest.

--to eradicate major communicable diseases as a threat to life and health in the United States.

--to reduce the burden of mental illness, and mental retardation.

--to cut the toll of the three great killers-heart disease, cancer and stroke.

The health budget which I have proposed for fiscal year 1967 is $4.67 billion--an increase of almost one billion dollars. In addition more than $3 billion in social security trust funds will be spent under Medicare to assist our older citizens.

Funds for health manpower, facilities and services are up $707 million. Funds for environmental activities and consumer protection are up $158 million. Funds for health research activities are up $78 million.

To insure continuing progress, we must:

--improve the administration of federal health activities.

--develop comprehensive health planning and services on the state and community level.

--strengthen our system of health care.

--train needed health workers.

--increase our research efforts.

--take additional steps to meet special health problems.

I. TO IMPROVE ADMINISTRATION OF FEDERAL HEALTH SERVICES

Our first concern must be the efficient and effective administration of the federal health programs.

Over the last 12 years the budget of the Public Health Service for research, training and services has grown almost tenfold--from $250 million to $2.4 billion. Yet major elements of the basic structure of the Public Health Service remain set by a law that is more than 20 years old.

The Secretary of Health, Education, and Welfare and the Surgeon General of the United States have consulted leading experts-physicians, administrators, scientists and public health specialists--in a thorough search for the best means to improve the administration of federal health programs. They all agree that the need to modernize the administration of the Public Health Service is urgent.

To fulfill that need, I will shortly submit to Congress a proposed reorganization of the health functions of the Department of Health, Education, and Welfare.

The ultimate success of federal health programs depends on the men and women who direct them. At present, the personnel system of the Public Health Service is inadequate to recruit and retain the talent needed for its rapidly changing and expanding role.

I will recommend legislation to improve the personnel system of the Public Health Service.

This legislation will:

--promote career development,

--encourage more flexible use of health workers,

--provide them with broader opportunities,

--stimulate higher standards of performance.

II. TO DEVELOP COMPREHENSIVE HEALTH PLANNING AND SERVICES ON THE STATE AND COMMUNITY LEVEL

The focus of our efforts is the individual and his family, living in their own community. To meet their health needs requires the cooperation of many agencies, institutions and experts-of state and local governments, of doctors, nurses and paramedical personnel.

These are the front line fighters in our battle against disease, disability and death. As in military battle, a winning strategy demands wise and well planned use of manpower. It demands coordinated use of all the resources available.

I recommend to Congress a program of grants to enable states and communities to plan the better use of manpower, facilities, and financial resources for comprehensive health services.

At present, the federal government offers the states formula grants for categorical programs dealing with specific diseases. This leads to an unnecessarily rigid and compartmentalized approach to health problems. Our purpose must be to help redirect and reform fragmented programs which encourage inefficiency and confusion and fail to meet the total health needs of our citizens.

I recommend a program to initiate new state formula grants for comprehensive public health services. This program would begin in fiscal 1968.

At the same time, we must recognize that special health problems occur in some parts of our nation and not in others. Certain diseases, such as tuberculosis and venereal disease, are concentrated in metropolitan communities. Others, such as rabies and parasitic diseases, are prevalent in certain geographic areas.

Resources to serve health needs are not evenly distributed throughout the nation. Special problems arise in remote rural areas and in the city slums. We need greater flexibility to pinpoint our attack.

To make certain we have that flexibility, I recommend a program, to commence in fiscal 1968, of grants to states, communities, medical schools and hospitals to meet special health problems.

III. TO STRENGTHEN OUR SYSTEM OF HEALTH CARE

The Hill-Burton program for hospital construction is an outstanding example of creative federalism in action. Now in its nineteenth year, this federal-state-local partnership has added more than 300,000 hospital and nursing home beds to our nation and more than 2,000 other health facilities in areas of great need.

My budget requests the full authorization of $270 million for facilities construction under the Hill-Burton Act.

Medical advances demand new equipment and up-to-date laboratories. Intensive care units, as well as ambulatory and extended care facilities, require changes in the structure and function of aging hospitals, particularly in urban areas.

General hospitals containing 260,000 beds--one third of our nation's--are now in obsolete condition.

When Medicare becomes operative this July, the pressure on many hospitals will grow even more intense.

To begin to meet this urgent need, I recommend legislation to mobilize public and private resources to revitalize our obsolete hospitals. This will require a loan and grant program to assist in the long-term financing of hospital renewal projects.

The need for modernization goes beyond the bricks and mortar of construction. We must find new ways to lower the cost and raise the quality of health care, to organize health services more efficiently, to develop information systems. It will take the combined efforts of university, hospital, industry, group practice clinics and many other organizations.

I am directing the Secretary of Health, Education, and Welfare to conduct systems analyses and other studies to determine the most effective means of bringing high quality medical services to all the people at the lowest cost.

I also propose a five-year program of grants for research and demonstration projects in the organization, financing, utilization and delivery of health services.

As medical practice becomes more complex, specialization becomes more common. The number of general practitioners is declining--66,000 today compared to 95,000 fifteen years ago. In 1950, there was one family physician for every 1600 Americans. Today 2900 Americans must depend on one family doctor.

Group practice benefits both physicians and patients. It makes expert health care more accessible for the patient. It enables the physician to draw on the combined talents of his colleagues.

High initial capital requirements and a shortage of long-term financing have restricted the development of this form of medical and dental practice.

I recommend that the Congress consider legislation now pending making mortgage insurance available for group practice facilities.

The first session of this Congress has liberated our citizens from the haunting fear of an inability to meet the cost of medical care in their later years. This landmark legislation assures that community hospitals, physicians and others who provide for their health will be paid the reasonable cost and customary charges for such services. I propose that this same principle be extended to the care of patients in our own Federal hospitals and I recommend legislation to permit the reimbursement of these hospitals in the same manner.

IV. TO TRAIN NEEDED HEALTH WORKERS

Trained men and women continue to be in critically short supply in the field of health. Congress has already acted to help meet that need by enacting:

--The Health Professions Educational Assistance Act to provide assistance to both schools and students.

--The Nurse Training Act to provide federal aid to increase the supply of professional nurses.

--The Vocational Education Act to provide for training of practical nurses and other health workers.

But critical specialties remain dangerously under-staffed--medical technologists, biomedical engineers, dental hygienists and other college-trained health workers.

These personnel, allied with doctors, dentists, and nurses, constitute the modern health care team.

They extend the reach and the scope of the physician.

I recommend a three-year program to provide grants for training in allied health professions:

--to construct and to improve needed educational facilities.

--to offer fellowships for students in advanced training.

--to stimulate institutions to develop new types of health personnel.

Last year, in the Higher Education Act of 1965, Congress enlisted the resources of our private banking community to make low interest student loans. By this means, greatly increased financial assistance can be provided at minimal cost.

I recommend legislation to convert the Health Professions Student Loan program to privately financed and federally subsidized loans for students in the health professions.

V. TO ADVANCE RESEARCH

Over the past ten years, Congress has increased the budget for health research thirteen-fold. The dividends from this investment are incalculable. Miraculous progress in medical discovery is making possible:

--development of support devices for the failing heart--and even replacement of a human heart by an artificial organ.

--advances toward the cure of cancers such as childhood leukemia and Hodgkin's disease.

--development of a less expensive and more efficient treatment for kidney failure.

--isolation of viruses causing respiratory infections and production of vaccines to immunize against them.

My fiscal 1967 budget provides increased funds for health research. If research makes major new breakthroughs in life-saving discoveries, I will submit requests for necessary additional funds. My overall budget provides for this contingency.

VI. TO MEET SPECIAL HEALTH PROBLEMS

1. Mental Retardation

We have begun to ease the tragic burden of the mentally retarded and their families. By construction of research and service facilities, and by support of state programs, the federal government helps combat this dread handicap.

We shall continue our increasing attack on this problem. It deserves the concern and attention of our most able specialists. Therefore, I intend to appoint a Committee on Mental Retardation to assess our progress, to seek out new and better ways to cope with this terrible disability, and to recommend along-range and comprehensive plan of action.

2. Nutrition for the Needy

It is hard to teach a hungry child. This fact, known to parents and teachers alike, underlies the school lunch program throughout the nation.

This year 18 million school children will enjoy lunches prepared and served in their schools under this program. Yet too many children still fail to get a good lunch even though the cost is low. Some cannot afford the 25 to 35 cent lunch charge. Others in low income districts go to schools which lack lunch facilities.

Demonstration programs conducted in poverty areas in Colorado and North Carolina provided lunches this year at sharply reduced rates. The results were amazing. Virtually all the children purchased the school lunch--less than one-third had done so before. The children were more alert and interested in learning. The absentee rate fell by as much as 37%. School drop-outs were reduced.

Too little of the federal assistance in the school lunch program has been directed toward children who need it most. Too much of our subsidy, particularly in the Special Milk program, goes to children who already get a federally supported school lunch, including milk, and whose parents can afford to pay for additional milk.

I am submitting to the Congress the Child Nutrition Act of 1966 to redirect our efforts to provide food to those who need it most. The Act will:

--Extend the school lunch program to more needy children and give greater flexibility in providing low cost or no cost meals.

--Assist schools serving low-income districts to acquire kitchen and lunchroom facilities.

--Provide pilot school breakfast programs for those children who start the day hungry.

--Direct the Special Milk Program to those schools without food service, to schools serving children from low-income families, and to needy school children at whatever school they attend.

--Start demonstration summer programs to provide food service for needy children at child-care centers and playgrounds.

--Help state educational agencies strengthen their staffs to improve child nutrition programs.

I am requesting $50 million from the Congress for programs designed to provide adequate nutrition for disadvantaged children. This money is an addition to the $329 million in cash and commodities already included in the budget for school nutrition programs. The total federal program of $379 million is a major redirection of our child nutrition efforts to children who otherwise would grow up hungry, suffer the diseases that come from being ill-nourished, and lack the energy so essential to learning.

No child in an affluent America should be without an adequate diet. The new program will move us far toward that goal. But it will not do the job alone.

I am directing the Secretary of Health, Education, and Welfare, in cooperation with the Secretary of Agriculture and the Director of the Office of Economic Opportunity, to examine means by which the benefits of sound nutrition can be extended to every child who needs our help.

We now know that among elderly Americans, a poor diet is a root cause of poor health. It adds to the burden of our hospitals and health manpower. It contributes unnecessary misery to the burdens of old age.

I have directed the Secretary of Health, Education, and Welfare to initiate a special food service program at multi-purpose centers authorized by the Older Americans Act of 1965. Local organizations will be able to offer balanced, nutritious meals to the elderly-without charge or at reduced prices to those who are in need.

3. Alcoholism

The alcoholic suffers from a disease which will yield eventually to scientific research and adequate treatment. Even with the present limited state of our knowledge, much can be done to reduce the untold suffering and uncounted waste caused by this affliction.

I have instructed the Secretary of Health, Education, and Welfare to:

--appoint an Advisory Committee on Alcoholism;

--establish in the Public Health Service a center for research on the cause, prevention, control and treatment of alcoholism;

--develop an education program in order to foster public understanding based on scientific fact;

--work with public and private agencies on the state and local level include this disease in comprehensive health programs.

4. Family Planning

We have a growing concern to foster the integrity of the family, and the opportunity for each child. It is essential that all families have access to information and services that will allow freedom to choose the number and spacing of their children within the dictates of individual conscience.

In the fiscal 1967 budget, I have requested a sizable increase in funds available for research, training and services in this field. The National Institute of Child Health and Human Development will expand its own research and its grant program to study human reproduction. The Children's Bureau and the Office of Economic Opportunity will support family planning to the maternal and infant care programs in local communities when requested. State agencies will be aided by federal welfare funds to provide family planning services to mothers.

EDUCATION

I have proposed a total Federal investment in education and training during the coming year in excess of $10 billion--a threefold increase since 1961.

Our education programs must be administered wisely and well. Shortly after passage of the Elementary and Secondary Education Act of 1965, I directed that the Office of Education be reorganized to carry out its expanded responsibilities more effectively and efficiently. This reorganization has now been completed.

In addition, we established the new post of Assistant Secretary for Education in the Department of Health, Education, and Welfare to strengthen program coordination throughout the government.

The Congress has already put this nation on the path toward the achievement of goals to:

1. Extend special educational help to 12 million disadvantaged and handicapped children;

2. Eliminate illiteracy within a decade;

3. Bring public library services to 15 million more Americans;

4. Reduce by half the rate of high school dropouts over the next five years;

5. Guarantee the opportunity for education beyond high school on the basis of ability to learn, rather than ability to pay;

6. Provide college building and facilities to meet the needs of 9 million students expected by 1975.

Full educational opportunity for every citizen requires that we build on the beginnings we have already made. I recommend measures:

--to expand the Head Start program for preschool children

--to strengthen the Elementary and Secondary Education Act of 1965

--to expand federal assistance to higher education

--to improve the nation's libraries.

I. TO EXPAND THE HEAD START PROGRAM FOR

PRE-SCHOOL CHILDREN

Few programs have had the visible success of Operation Head Start. The disadvantaged children who have benefited from this program are already entering first grade--with new confidence in themselves and greater eagerness to learn.

I have requested funds almost to double the Head Start Program during the coming year to ensure:

--full year programs for 210,000 children

--summer programs for 500,000 children. This marks a significant step in providing greatly expanded pre-school assistance for five year olds from disadvantaged homes, and summer nursery programs for 3 and 4 year olds.

II. TO STRENGTHEN THE ELEMENTARY AND SECONDARY EDUCATION ACT OF 1965

Though funded only four months ago, the Elementary and Secondary Education Act of 1965 has already begun to bring its benefits to the Nation.

--Special help is being provided the disadvantaged-remedial teaching, health and food services, augmented teaching and counseling staffs.

--More books--interesting and up-todate--have begun to appear on school library shelves.

--New approaches to old problems are being tried; instruction for the student extends beyond the classroom--to museums, hospitals, factories.

--Regional education laboratories are being developed to stimulate new techniques of teaching and learning in our schools.

--State educational agencies are strengthening their staffs and assuming greater responsibilities.

Educational deprivation cannot be overcome in a year. And quality cannot be achieved overnight.

I propose that the Elementary and Secondary Education Act be extended for four years.

My budget includes increased funds for each title of the Act.

In addition, I propose that coverage of the Act be enlarged

--to raise from $2000 to $3000 the family income formula for allocating aid for education of the disadvantaged commencing in fiscal 1968.

--to earmark additional funds for children of American Indians and migrant workers.

Careful study of the "incentive grant" provision of Title I shows that payments would be made to many districts unrelated to need.

I therefore recommend repeal of the "incentive grant" provision of Title I in order to focus federal aid on basic grants to more than 20,000 local school districts.

Too many schools in urban and rural slums are ancient and in disrepair. Obsolete schools aggravate the problem of eliminating de facto segregation in our northern communities, thus depriving children of full educational opportunities.

There is a pressing need for long-range, community-wide planning to bring innovation and imagination in school construction.

I propose that $5 million be added to Title III to help communities in planning school construction to encourage innovation and to deal with obsolescence, overcrowding and special problems such as de facto segregation.

A recently completed study of the federally impacted area program, requested by Congress, has concluded that certain provisions should be revised.

I recommend revision of the existing law--

--to require school districts to absorb a uniform and fair share of the burden of educating children in federally-affected districts;

--to base payments on school expenditures in local districts rather than on national or state average per-pupil cost;

--to eliminate eligibility for federal impacted area assistance in those cases where government property is leased to private enterprises that pay local taxes.

III. HIGHER EDUCATION

Today, young people are seeking advanced learning in greater numbers than ever before. 1,430,000 new students will enter our colleges next September--more than the total enrollment only twenty years ago.

Our colleges and universities must keep pace with this growing influx of young Americans. And the Federal Government must be prepared to continue its assistance.

I recommend extension of the Higher Education Facilities Act for three more years, with authorization of $458 million for construction grants for fiscal 1967.

In a society that is growing more complex, advanced training is essential. 640,000 students will enroll in universities and institutions across the nation at the post graduate level next fall. This number will grow by another quarter million in the next five years.

I recommend that the grant program for graduate facilities be continued, and I propose that $200 million be made available for loans to build both undergraduate and graduate facilities.

In addition, I will soon send to Congress legislation to permit more effective use of federal resources in certain loan programs by applying credit from private financial institutions. This will make possible an additional $100 million for academic facility loans in fiscal 1967.

One out of every four of our institutions of higher learning is not good enough to get accreditation. Congress recognized this need last year by providing assistance to developing colleges.

I recommend that Title III of the Higher Education Act of 1965 be continued for two years, with its authorization increased from $5 million to $30 million next year.

By June, 890,000 students at 1,700 institutions will have borrowed $800 million to invest in college education under the student loan program of the National Defense Education Act. Last year, Congress expanded the opportunity for student loans by establishing a subsidized program through the nation's private banking system. Together with opportunity grants and the work-study programs, there now exists a wide range of student-assistance programs to help finance higher education.

To increase loan funds available to students who want college educations, I recommend the conversion of the direct loan program to a program in which loans will be made from funds provided by the private capital market, with the Government subsidizing these loans. The teacher "forgiveness" features for students eligible under the National Defense Education program will be retained.

I am proposing an orderly transition to the new student loan program so that no eligible student will be deprived of the needed financial assistance, and I will ask for the necessary funds to accomplish this purpose.

I also recommend that the "forgiveness" provision be extended to medical personnel who will settle in rural areas where the doctor shortage is most critical.

There are more than 12,000 unfilled vacancies for qualified social workers, at a time when we need their skills more than ever before. These workers are important to the success of our poverty, health, and education programs.

A Task Force on Social Work Manpower and Education has just completed an extensive study of the problem. I have asked the Secretary of Health, Education, and Welfare to consult with educational leaders and other specialists and to submit recommendations to me to overcome this shortage in the ranks of our social workers.

IV. TO IMPROVE THE NATION'S LIBRARIES

Those who do not read are not much better off than those who cannot read. More than 100 million Americans have inadequate public library services. More than 15 million have none at all.

A library must be a living institution with trained staff and funds to obtain new books, periodicals, films, records and other material.

As the boundaries of learning are pushed back, our need for storehouses of knowledge grows greater. They offer man his link with the past and his vision of the future.

Most public libraries in the United States are poorly equipped to perform this vital role.

I recommend that Congress extend the Library Services and Construction Act for five more years, authorizing $57.5 million for Fiscal 1967.

DEPARTMENT OF THE PEOPLE

Through the programs entrusted to its care, the Department of Health, Education, and Welfare exercises continuing concern for the social well-being of all our people. Already, as I have indicated in this message, it has become possible to set ambitious goals for the future.

To improve our ability to chart our progress, I have asked the Secretary to establish within his office the resources to develop the necessary social statistics and indicators to supplement those prepared by the Bureau of Labor Statistics and the Council of Economic Advisers. With these yardsticks, we can better measure the distance we have come and plan for the way ahead.

In health and education, we build with a double purpose: to meet today's needs, and to match tomorrow's hopes.

We look toward the time when every disease which need not happen will not happen.

--when every citizen can confidently expect care--competent, convenient care-if he is ill or injured.

--when every American receives the education and training he wants to enrich his life and fulfill his hopes.

With pain and ignorance no longer such fearsome enemies, our people will find a new freedom. Our society will be great as never before.

It is too early for self-congratulations. We must continue to plan and act. We march in a campaign which can have no retreats, no truce, no end: only new victories.

LYNDON B. JOHNSON

The White House

March 1, 1966