Dwight D. Eisenhower photo

Special Message to the Congress on the Health Needs of the American People

January 18, 1954

To the Congress of the United States:

I submit herewith for the consideration of the Congress recommendations to improve the health of the American people.

Among the concerns of our government for the human problems of our citizens, the subject of health ranks high. For only as our citizens enjoy good physical and mental health can they win for themselves the satisfactions of a fully productive, useful life.

THE HEALTH PROBLEM

The progress of our people toward better health has been rapid. Fifty years ago their average life span was 49 years; today it is 68 years. In 1900 there were 676 deaths from infectious diseases for every 100,000 of our people; now there are 66. Between 1916 and 1950, maternal deaths per 100,000 live births dropped from 622 to 83. In 1916, ten percent of the babies born in this country died before their first birthday; today, less than 3 percent die in their first year.

This rapid progress toward better health has been the result of many particular efforts, and of one general effort. The general effort is the partnership and teamwork of private physicians and dentists and of those engaged in public health, with research scientists, sanitary engineers, the nursing profession and the many auxiliary professions related to health protection and care in illness. To all these dedicated people, America owes most of its recent progress toward better health.

Yet, much remains to be done. Approximately 224,000 of our people died of cancer last year. This means that cancer will claim the lives of 15,000,000 of our 160,000,000 people unless the present cancer mortality rate is lowered. Diseases of the heart and blood vessels alone now take over 817,000 lives annually. Over seven million Americans are estimated to suffer from arthritis and rheumatic diseases. Twenty-two thousand lose their sight each year. Diabetes annually adds 100,000 to its roll of sufferers. Two million of our fellow citizens now handicapped by physical disabilities could be, but are not, rehabilitated to lead full and productive lives. Ten million among our people will at some time in their lives be hospitalized with mental illness.

There exist in our Nation the knowledge and skill to reduce these figures, to give us all still greater health protection and still longer life. But this knowledge and skill are not always available to all our people where and when they are needed. Two of the key problems in the field of health today are the distribution of medical facilities and the costs of medical care.

Not all Americans can enjoy the best in medical care--because not always are the requisite facilities and professional personnel so distributed as to be available to them, particularly in our poorer communities and rural sections. There are, for example, 159 practicing physicians for every 100,000 of the civilian population in the Northeast United States. This is to be contrasted with 126 physicians in the West, 116 in the North central area, and 92 in the South. There are, for another example, only 4 or 5 hospital beds for each 1,000 people in some States, as compared with 10 or 11 in others.

Even where the best in medical care is available, its costs are often a serious burden. Major, long-term illness can become a financial catastrophe for a normal American family. Ten percent of American families are spending today more than $500 a year for medical care. Of our people reporting incomes under $3000, about 6 percent spend almost a fifth of their gross income for medical and dental care. The total private medical bill of the nation now exceeds nine billion dollars a year--an average of nearly $200 a family--and it is rising. This illustrates the seriousness of the problem of medical costs.

We must, therefore, take further action on the problems of distribution of medical facilities and the costs of medical care, but we must be careful and farsighted in the action that we take. Freedom, consent, and individual responsibility are fundamental to our system. In the field of medical care, this means that the traditional relationship of the physician and his patient, and the right of the individual to elect freely the manner of his care in illness, must be preserved.

In adhering to this principle, and rejecting the socialization of medicine, we can still confidently commit ourselves to certain national health goals.

One such goal is that the means for achieving good health should be accessible to all. A person's location, occupation, age, race, creed, or financial status should not bar him from enjoying this access.

Second, the results of our vast scientific research, which is constantly advancing our knowledge of better health protection and better care in illness, should be broadly applied for the benefit of every citizen. There must be the fullest cooperation among the individual citizen, his personal physician, the research scientists, the schools of professional education, .and our private and public institutions and services--local, State, and Federal.

The specific recommendations which follow are designed to bring us closer to these goals.

CONTINUATION OF PRESENT FEDERAL PROGRAMS

In my Budget Message appropriations will be requested to carry on during the coming fiscal year the health and related programs of the newly-established Department of Health, Education, and Welfare.

These programs should be continued because of their past success and their present and future usefulness. The Public Health Service, for example, has had a conspicuous share in the prevention of disease through its efforts to control health hazards on the farm, in industry and in the home. Thirty years ago, the Public Health Service first recommended a .standard milk sanitation ordinance; by last year this ordinance had been -voluntarily adopted by 1558 municipalities with a total population of 70 million people. Almost twenty years ago the Public Health Service first recommended restaurant sanitation ordinances; today 685 municipalities and 347 counties, with a total population of 90 million people, have such ordinances. The purification of drinking water and the pasteurization of milk have prevented countless epidemics and saved thousands of lives. These and similar field projects of the Public Health Service, such as technical assistance to the States, and industrial hygiene work, have great public value and should be maintained.

In addition, the Public Health Service should be strengthened in its research activities. Through its National Institutes of Health, it maintains a steady attack against cancer, mental illness, heart diseases, dental problems, arthritis and metabolic diseases, blindness, and problems in microbiology and neurology. The new sanitary engineering laboratory at Cincinnati, to be dedicated in April, will make possible a vigorous attack on health problems associated with the rapid technological advances in industry and agriculture. In such direct research programs and in Public Health Service research grants to State and local governments and to private research institutions lies the hope of solving many of today's perplexing health problems.

The activities of the Children's Bureau and its assistance to the States for maternal and child health services are also of vital importance. The programs for children with such crippling diseases as epilepsy, cerebral palsy, congenital heart disease, and rheumatic fever should receive continued support.

MEETING THE COST OF MEDICAL CARE

The best way for most of our people to provide themselves the resources to obtain good medical care is to participate in voluntary health insurance plans. During the past decade, private and non-profit health insurance organizations have made striking progress in offering such plans. The most widely purchased type of health insurance, which is hospitalization insurance, already meets approximately 40 percent of all private expenditures for hospital care. This progress indicates that these voluntary organizations can reach many more people and provide better and broader benefits. They should be encouraged and helped to do So.

Better health insurance protection for more people can be provided.

The Government need not and should not go into the insurance business to furnish the protection which private and non-profit organizations do not now provide. But the Government can and should work with them to study and devise better insurance protection to meet the public need.

I recommend the establishment of a limited Federal reinsurance service to encourage private and non-profit health insurance organizations to offer broader health protection to more families. This service would reinsure the special additional risks involved in such broader protection. It can be launched with a capital fund of twenty-five million dollars provided by the Government, to be retired from reinsurance fees.

NEW GRANT-IN-AID APPROACH

My message on the State of the Union and my special message of January fourteenth pointed out that Federal grants-in-aid have hitherto observed no uniform pattern. Response has been made first to one and then to another broad national need. In each of the grant-in-aid programs, including those dealing with health, child welfare and rehabilitation of the disabled, a wide variety of complicated matching formulas have been used. Categorical grants have restricted funds to specified purposes so that States often have too much money for some programs and not enough for others.

This patchwork of complex formulas and categorical grants should be simplified and improved. I propose a simplified formula for all of these basic grant-in-aid programs which applies a new concept of Federal participation in State programs. This formula permits the States to use greater initiative and take more responsibility in the administration of the programs. It makes Federal assistance more responsive to the needs of the States and their citizens. Under it, Federal support of these grant-in-aid programs is based on three general criteria:

First, the States are aided in inverse proportion to their financial capacity. By relating Federal financial support to the degree of need, we are applying the proven and sound formula adopted by the Congress in the Hospital Survey and Construction Act.

Second, the States are also helped, in proportion to their population, to extend and improve the health and welfare services provided by the grant-in-aid programs.

Third, a portion of the Federal assistance is set aside for the support of unique projects of regional or national significance which give promise of new and better ways of serving the human needs of our citizens.

Two of these grant-in-aid programs warrant the following further recommendations.

REHABILITATION OF THE DISABLED

Working with only a small portion of the disabled among our people, Federal and State governments and voluntary organizations and institutions have proved the advantage to our nation of restoring handicapped persons to full and productive lives.

When our State-Federal program of vocational rehabilitation began in 1920, the services rendered were limited largely to vocational counseling, training and job placement. Since then advancing techniques in the medical and social aspects of rehabilitation have been incorporated into that program.

There are now 2,000,000 disabled persons who could be rehabilitated and thus returned to productive work. Under the present rehabilitation program only 60,000 of these disabled individuals are returned each year to full and productive lives. Meanwhile, 250,000 of our people are annually disabled. Therefore, we are losing ground at a distressing rate. The number of disabled who enter productive employment each year can be increased if the facilities, personnel and financial support for their rehabilitation are made adequate to the need.

Considerations of both humanity and national self-interest demand that steps be taken now to improve this situation. Today, for example, we are spending three times as much in public assistance to care for nonproductive disabled people as it would cost to make them self-sufficient and taxpaying members of their communities. Rehabilitated persons as a group pay back in Federal income taxes many times the cost of their rehabilitation.

There are no statistics to portray the full depth and meaning in human terms of the rehabilitation program, but clearly it is a program that builds a stronger America.

We should provide for a progressive expansion of our rehabilitation resources, and we should act now so that a sound foundation may be established in 1955. My forthcoming Budget Message will reflect this objective. Our goal in 1955 is to restore 70,000 disabled persons to productive lives. This is an increase of 10,000 over the number rehabilitated in 1953. Our goal for 1956 should be 100,000 rehabilitated persons, or 40,000 persons more than those restored in 1953. In 1956, also, the States should begin to contribute from their own funds to the cost of rehabilitating these additional persons. By 1959, with gradually increasing State participation to the point of equal sharing with the Federal government, we should reach the goal of 200,000 rehabilitated persons each year.

In order to achieve this goal we must extend greater assistance to the States. We should do so, however, in a way which will equitably and gradually transfer increasing responsibility to the States. A program of grants should be undertaken to provide, under State auspices, specialized training for the professional personnel necessary to carry out the expanded program and to foster that research which will advance our knowledge of the ways of overcoming handicapping conditions. We should also provide, under State auspices, clinical facilities for rehabilitative services in hospitals and other appropriate treatment centers. In addition, we should encourage State and local initiative in the development of community rehabilitation centers and special workshops for the disabled.

With such a program the Nation could during the next five years return a total of 660,000 of our disabled people to places of full responsibility as actively working citizens.

CONSTRUCTION OF MEDICAL CARE FACILITIES

The modern hospital--in caring for the sick, in research, and in professional educational programs--is indispensable to good medical care. New hospital construction continues to lag behind the need. The total number of acceptable beds in this nation in all categories of non-Federal hospital services is now about 1,060,000. Based on studies conducted by State hospital authorities, the need for additional hospital beds of all types--chronic disease, mental, tuberculosis, as well as general--is conservatively estimated at more than 500,000.

A program of matching State and local tax funds and private funds in the construction of both public and voluntary non-profit hospitals where these are most needed is therefore essential.

Since 1946, nearly $600 million in Federal funds have been allocated to almost 2,200 hospital projects in the States and Territories. This sum has been matched by over one and a quarter billion dollars of State and local funds. Projects already completed or under construction on December 31, 1953, will add to our national resources 106,000 hospital beds and 464 public health centers. The largest proportion of Federal funds has been and is being spent in low-income and rural areas where the need for hospital beds is greatest and where the local means for providing them are smallest. This Federally stimulated accomplishment has by no means retarded the building of hospitals without Federal aid. Construction costing in excess of one billion dollars has been completed in the last six years without such aid.

Hospital construction, however, meets only part of the urgent need for medical facilities.

Not all illness need be treated in elaborate general hospital facilities, costly to construct and costly to operate. Certain non-acute illness conditions, including those of our hospitalized aged people, requiring institutional bed care can be handled in facilities more economical to build and operate than a general hospital, with its diagnostic, surgical and treatment equipment and its full staff of professional personnel. Today beds in our hospitals for the chronically ill take care of only one out of every six persons suffering from such long-term illnesses as cancer, arthritis, and heart disease. The inadequacy of facilities and services to cope with such illnesses is disturbing. Moreover, if there were more nursing and convalescent home facilities, beds in general hospitals would be released for the care of the acutely ill. This would also help to relieve some of the serious problems created by the present short supply of trained nurses.

Physical rehabilitation services for our disabled people can best be given in hospitals or other facilities especially equipped for the purpose. Many thousands of people remain disabled today because of the lack of such facilities and services.

Many illnesses, to be sure, can be cared for outside of any institution. For such illnesses a far less costly approach to good medical care than hospitalization would be to provide diagnostic and treatment facilities for the ambulatory patient. The provision of such facilities, particularly in rural areas and small isolated communities, will attract physicians to the sparsely settled sections where they are urgently needed.

I recommend, therefore, that the Hospital Survey and Construction Act be amended as necessary to authorize the several types of urgently needed medical care facilities which I have described. They will be less costly to build than general hospitals and will lessen the burden on them. I present four proposals to expand or extend the present program:

(1) Added assistance in the construction of non-profit hospitals for the care of the chronically ill. These would be of a type more economical to build and operate than general hospitals.

(2) Assistance in the construction of non-profit medically supervised nursing and convalescent homes.

(3) Assistance in the construction of non-profit rehabilitation facilities for the disabled.

(4) Assistance in the construction of non-profit diagnostic or treatment centers for ambulatory patients.

Finally, I recommend that in order to provide a sound basis for Federal assistance in such an expanded program, special funds be made available to the States to help pay for surveys of their needs. This is the procedure that the Congress wisely required in connection with Federal assistance in the construction of hospitals under the original Act. We should also continue to observe the principle of State and local determination of their needs without Federal interference.

These recommendations are needed forward steps in the development of a sound program for improving the health of our people. No nation and no administration can ever afford to be complacent about the health of its citizens. While continuing to reject government regimentation of medicine, we shall with vigor and imagination continuously search out by appropriate means, recommend, and put into effect new methods of achieving better health for all of our people. We shall not relax in the struggle against disease. The health of our people is the very essence of our vitality, our strength and our progress as a nation.

I urge that the Congress give early and favorable consideration to the recommendations I have herein submitted.

DWIGHT D. EISENHOWER

Dwight D. Eisenhower, Special Message to the Congress on the Health Needs of the American People Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/231983

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