Lyndon B. Johnson photo

Special Message to the Congress: "Health in America.

March 04, 1968

To the Congress of the United States:

My health recommendations to the Congress this year include five major new goals:

First, to reduce sharply the inexcusably high rate of infant mortality in the United States.

Second, to meet the urgent need for more doctors, nurses, and other health workers.

Third, to deal with the soaring cost of medical care and to assure the most efficient use of our health resources.

Fourth, to lower the shocking toll of deaths caused by accidents in America.

Fifth, to launch a nation-wide volunteer effort to improve the health of all Americans.

Each of these goals--and others which I will discuss in this message--will require an unprecedented national commitment. Each will take years to achieve. But every one of them must be reached if we are to guarantee to every citizen a full measure of safety, health and good medical care.

The first generation of Americans built their dream of a new nation on the conviction that life, liberty and the pursuit of happiness are the inalienable rights of every man.

For nearly two centuries, our Nation has sought to make those rights a reality for more and more of our people.

It has fallen to this generation to assure that those rights have real meaning for every citizen. And this generation of Americans has made an historic commitment to open new opportunities--for economic advance, for educational fulfillment, for equality--for every citizen:

--Through unprecedented economic growth during the last 83 months and the war against poverty, nearly 12 million Americans have been lifted out of the depths of want and despair.

--Through more than 18 landmark education measures in the last four years, a tripling of the Federal investment in education, and a doubling of all public and private expenditures on education in the last six years, the Nation is moving rapidly to give every American child a real chance for full growth and development.

--Through the landmark Civil Rights Acts of 1964 and 1965, we have moved closer to the day when equal justice and opportunity will become a reality for all Americans.

We have sought also to make these basic rights meaningful to the older person stricken with arthritis, to the poor child with rheumatic fever, to the infant who in an earlier day might have suffered the ravages of polio.

In the last three years, the Federal Government enacted nearly 30 new health measures. We have increased its investment from $6 billion to nearly $14 billion annually to assure that the benefits of modern medicine are available to all our people:

--To make medical care available to those who need it most, the elderly and the poor, expenditures have risen from $1 billion to nearly $8 billion. Another $2.5 billion is spent each year to bring the finest health care to our servicemen and veterans.

--To build new laboratories, hospitals and health clinics, and to train the men and women to work in them, expenditures have risen from $2 billion to nearly $3 billion annually.

--To prevent and control disease, expenditures have risen from $450 million to nearly $700 million.

The real meaning of these statistics is found in the lives of people who have been helped:

--19.5 million Americans, 65 and over, are now able to receive the medical care they need without suffering crushing economic burdens.

--20 million children who have been vaccinated against measles, and 323,000 fewer children suffer from measles each year.

--30 million have been protected against diphtheria, polio, tetanus and whooping cough, reducing by more than 50 percent the number of children who suffer from these diseases.

--43,000 retarded children can now look forward to more productive lives because of the 150 special clinics built to serve them.

--47 million Americans live in communities served by new mental health centers.

--The life expectancy of Americans continues to increase, promising millions a longer and fuller life. In 1920, it was 54.1 years; today it is over 70.

And the discoveries of modern science promise a better life for all citizens: the prevention of German measles, the advances in treating leukemia, the progress in understanding life's processes.

We must continue to build upon those proud achievements.


The American child is born into a land richer with promise than any nation in the history of the world.

But to share in that promise, he must survive the perils of birth and infancy. For too many American children, the hazards of survival are steep.

This great, wealthy, resourceful Nation-which should lead the world in saving its young--instead ranked 15th in infant mortality in 1965.

In that year, nearly 25 infants out of every 1,000 born in this country died before the age of one. Thousands more were handicapped for life because of inadequate health care in their first year.

The infant mortality rate among poor families was nearly double the national average. In certain city ghettos and pockets of rural poverty the rate was 7 times that in surrounding suburban areas.

Those figures shamed this enlightened Nation. And we acted to meet the problem.

Through the Maternal and Child Health program:

--300,000 women are now receiving family planning services.

--390,000 receive maternity care.

--680,000 infants are getting the attention so crucial to their later development.

Through the Crippled Children's program, 460,000 children will be treated for handicapping conditions each year.

Through Medicaid, thousands of needy mothers and their infants are receiving the care vital to their health and well being.

The infant mortality rate in this country dropped from 25.2 deaths per thousand in 1963, to 22.1 per thousand in 1967--a 12% decline in four years.

The success of these programs in two cities demonstrates that the tragic rate of infant mortality can be reduced even faster. Last year, because of modern medicine and a concentrated effort, the rate in Washington, D.C. fell 8.5%; the rate in Chicago in the first 10 months of the year dropped 15%.

In 1963, 100,000 infants died. In 1967, that figure was reduced to 80,000. But this progress is not enough. For thousands more did not receive the medical care so vital to their future growth and development.



This Nation must accelerate its efforts. The cost of future care rises every time a child's disease or handicap is left unattended. A man's potential is diminished every time an affliction that could be cured in childhood causes permanent damage. Most important of all, America's conscience is scarred and her future dimmed every time a child dies needlessly.

We must now attack the problem of infant mortality on a nationwide basis by providing essential medical care to the 700,000 needy mothers who give birth each year and to their infants.

To launch this effort, I recommend a $58 million increase in appropriations for the maternal and child health care programs in fiscal 1969. $25 million of this increase will provide for the expansion of maternity and infant care centers and clinics.

Our goal is to assure every needy American family:

--Adequate prenatal and postnatal care for the mother.

--A safe delivery by trained health professionals.

--Competent examination of the child at birth, and expert treatment when needed.

--The best of modern medical care for the infant during his first year to prevent disease, cure illness, and correct handicaps.

--An opportunity, on a voluntary basis, to plan the number and spacing of children.

To fulfill this objective, I propose the Child Health Act of 1968.

With this authority, the Nation will be able to provide comprehensive medical care for every needy mother and her infant.


As we launch a major new effort to improve health care for the very young, we must not lose sight of our responsibility for all of America's children. We are encouraged by the gains made under our pioneering efforts:

--Head Start and other preschool programs which have brought education health care to more than 2 million children.

--Medicaid which will provide health care to more than 3 million children this year.

--137 new mental retardation clinics have been built to serve over 40,000 retarded children. Nevertheless, the dimensions of what remains to be done are seen in these grim statistics:

--436,000 children are victims of cerebral palsy.

--424,000 have epilepsy.

--12.3 million have eye defects.

--2.5 million have hearing impairments.

--3.2 million have speech defects.

--2.3 million have orthopedic handicaps.

--4.8 million are emotionally disturbed.

To continue our efforts to meet the needs of America's children, I recommend that the Congress provide $1.4 billion in fiscal 1969--an increase of $215 million--for child health services under Medicaid and other Federal health programs. These funds will provide:

--3.5 million poor children with health services under Medicaid.

--More than 1 million children with comprehensive health services at 56 Children and Youth Centers.

--500,000 Head Start children with medical examinations and follow-up treatment.

--460,000 children with treatment for handicapping conditions.

--200,000 children with family services at Neighborhood Health Centers.


The history of our times is not solely a study in crisis. It is also one of hope: when polio was conquered; when other infectious diseases that had plagued man for centuries fell one after another; when breakthroughs in genetics brought a better understanding of the process of life.

These are the quiet successes achieved in countless laboratories, leaving their mark forever on the future of man.

1967 was a breakthrough year which brought many rich dividends:

1. Measles can now be completely prevented.

2. The creation of life in a California test tube startled the world.

3. The Minnesota-trained doctor's first heart transplant was an historic milestone.

But none of these achievements were the result of a single year's research. They came from the careful work of many years. They were made possible by the Federal Government's continuing support to scientists who seek to expand our store of fundamental knowledge. That support has grown from $1 billion in 1963, to nearly $1.5 billion today, and comprises 65 percent of the Nation's total expenditures for biomedical research.

Yet we have only begun to unlock the secrets of better health and a richer life.

Our understanding of disease and human development is woefully incomplete. We can control some types of cancer, but do not yet know their exact causes.

We are still groping to understand the causes and the cures of mental illness. We have only begun to discover the reasons for mental retardation.

The relentless search for knowledge must go on. To assure the breakthroughs of next year, and the years after, I recommend that the Congress provide $1.5 billion for health research in fiscal 1969.


Two vital fields long neglected by research are population and human reproduction. Thousands of parents want help in determining how to plan their families. Thousands of others are unable to have the children they desire.

Our lack of knowledge impedes our effort to provide the help they need.

--Far too little is known about the physiology of reproduction and its effect on all aspects of human life.

--Searching studies are needed to determine the complex emotional, sociological, physiological and economic factors involved.

A wide range of scientists must bring to these problems their specialized disciplines-biologists, behavioral scientists, biochemists, pharmacologists, demographers, experts in population dynamics.

To launch this effort, I have directed the Secretary of Health, Education, and Welfare to establish a Center for Population Studies and Human Reproduction in the National Institute of Child Health and Human Development. The Center will serve to give new energy and direction to the research activities of all Federal Departments and Agencies in these fields.

I am asking the Congress to appropriate $12 million to support the research activities of the Center during its first year of operation.

As we move to expand our knowledge of population and human reproduction, we must make that knowledge available to those who want it. Last year, the Federal Government helped to bring information and counseling on a voluntary basis to more than 500,000 women. But there are millions more who want help.

I recommend that the Congress provide for an increase in funds from $25 million in fiscal 1968 to $61 million in fiscal 1969 so that three million women can have access to family planning help if they so desire.


Several years ago, this Nation set out to encourage the training of more doctors, nurses and medical technicians.

As the result of the imaginative programs recommended by the Administration and approved by the Congress over the last five years,

--An additional 100,000 doctors, nurses, dentists, laboratory technicians, and other health workers are being trained this year to meet the health needs of our growing population.

--More than 850 medical, dental and nursing schools have enlarged their capacity or improved their instruction. This rate of progress is encouraging. But our increasing population and the demand for more and better health care swell the need for doctors, health professionals and other medical workers.

Yet we lack the capacity to train today those who must serve us tomorrow.

To train more health workers and to train them better and faster, I propose the Health Manpower Act of 1968.

This Act will extend and strengthen five vital measures which are due to expire in June 1969:

(1) The Health Educational Act of 1963 will be reinforced to:

--Provide new classrooms, laboratories and libraries needed to train more doctors and other health professionals.

--Authorize new operating and project grants which will encourage the schools to expand their enrollment, improve their curricula, and reduce the length of their training.

--Extend financial aid to thousands of students each year.

--Simplify procedures so that schools can obtain funds for joint research-teaching-library projects through one application.

(2) The Nurse Training Act of 1964 will be improved to:

--Strengthen the loan, scholarship, and traineeship program so that nearly 50,000 nursing students can be helped through school in the first year of the program.

--Encourage nursing schools to expand enrollment and overcome high attrition rates by revamping their curricula and tailoring their courses to the needs of the students.

(3) The Health Personnel Training Act of 1966 will be continued to speed the training of paramedical personnel and other health workers by

--Constructing new classrooms.

--Improving the quality of instruction.

--Developing new curricula and methods of training.

(4) The Health Research Act of 1965 will be amended to permit greater emphasis on the development of research facilities meeting critical regional or national needs.

(5) The Graduate Health Training Act of 1964 will be extended to increase the number of skilled administrators and public health workers.

I urge the Congress to appropriate $290 million in fiscal 1969 to carry forward our vital health manpower programs.

This effort will be bolstered by the Veterans in Public Service Act, which I recently proposed to the Congress. Under that Act, the talents of the veteran will be enlisted for service to his community. For those who return to meet critical health manpower shortages, there will be special benefits while they are in training and on the job.

I urge the Congress to launch this program promptly so that we can bring the skills and experience of the veteran to bear on our pressing health needs.


In 1966 we launched the Partnership for Health. Its purpose was to support State and local efforts to:

--Identify the health needs of each State and city.

--Mobilize the resources of the State to meet those needs.

--Determine what additional resources, facilities, equipment and manpower, are required.

In the brief period since its enactment, this great Partnership has pioneered in the expansion of State and local responsibility for the health of our citizens.

Every State and many communities have now created health planning agencies which are at work developing and implementing bold new health strategies. This planning, tailored to the special needs of each State, will forge Federal, State and local efforts into an effective instrument to bring better health care to the people.

This important work must continue-and it must be expanded.

I recommend that the Congress appropriate $$95 million for the Partnership For Health in fiscal 1969, an increase of $35 million over fiscal 1968--an increase of 22 percent.


In 1966, we began the Regional Medical Program to reduce the toll of death and disability from heart disease, cancer, stroke and related illnesses. Its purpose is to translate research into action, so all the people of our Nation can benefit as rapidly as possible from the achievements of modern medicine.

Fifty-four regions, spanning the nation, have begun planning. Eight regions have already begun action programs. Most of the others will start by the end of the year.

These programs are concentrating regional resources and developing more effective ways to attack the three chief killers in this country. Thousands of Americans stricken by heart disease, cancer or stroke are already receiving better care.

But these threats to our health and vitality remain stubborn and unyielding.

I recommend that the Congress extend the Regional Medical Program and increase-by almost 100 percent--to $100 million the funds available for the program in fiscal 1969.


Virtually every family feels the burden of rising costs of medical care.

Thousands of Americans today are not getting urgently needed medical care because they cannot afford it.

Others pay for it only by giving up necessities, postponing a long-held dream, or mortgaging their futures.

The outlook is sobering. It has been estimated that between 1965 and 1975, the cost of living will increase by more than 20 percent. But the cost of health care will increase by nearly 140 percent by 1975:

--Average payments per person will nearly double, from about $200 a year to some $400 a year.

--Drug payments will rise by 65 percent.

--Dental bills will increase 100 percent.

--Doctors bills will climb 160 percent.

--Payments for general hospital services will jump 250 percent. Part of these increases will be for expanded and improved health services. But a large part of the increase will be unnecessary--a rise which can be prevented.

Last year I appointed a Commission of distinguished citizens--physicians, hospital officials, teachers, business executives, and other leaders--to make a comprehensive study of health manpower and medical care.

The Commission, which reported in November, cited three major deficiencies in present practices which contribute to unacceptable increases in medical costs:

--Most health insurance plans encourage doctors and patients to choose hospitalization even when other, less costly, forms of care would be equally effective.

--Health professions are generally paid in proportion to the amount of service they render. There are no strong economic incentives to encourage them to avoid providing care that is unnecessary

--Hospitals charge on a cost basis, which places no penalty on inefficient operations. Moreover, present systems of hospital management make it very difficult to maintain effective control over hospital costs. The Commission concluded:

"If the needs for health care are to be met, the health care system must be organized to employ its resources with more wisdom and effectiveness. The two areas which appear to offer the greatest potential for improvement are (1) reducing unnecessary (or unnecessarily expensive) medical care and (2) increasing efficiency in the provision of hospital care."

It will not be easy to carry out this recommendation.

But unless we do--unless we act now-health care will not improve as fast as it should.

Congress has recognized this problem of rising medical costs. Late last year it authorized the Secretary of Health, Education, and Welfare to test different types of payment systems under Medicare, Medicaid, and the Maternal and Child Health programs.

I have directed the Secretary of Health, Education, and Welfare to begin immediately extensive tests of incentives designed to reduce the cost of medical care.

First, we must explore ways to prevent unnecessary hospitalization. Our experience in Medicare can serve as a guideline. Under that plan, hospital stays are limited to periods which are clearly necessary, and payments are provided for other less expensive types of care which serve the patient equally well: outpatient clinic service, home treatment, nursing home care. We can also draw on the experience of new private prepaid comprehensive plans featuring incentives designed to reduce unnecessary hospitalization.

Second, we must test incentives designed to control the cost of hospital care itself. The Health Manpower Commission reported that costs among some of the Nation's best hospitals vary by as much as 100%, without significant differences in quality or scope of services. This shows that savings in hospital costs can be achieved. We must find ways to encourage efficiency and penalize waste.

These tests will call for the cooperation of doctors, hospitals and insurance companies.

They will be the pioneer efforts. If they are successful--and if they can be applied on a broad basis--they will hold much promise for the American people.

I recommend that the Congress authorize the Secretary of Health, Education, and Welfare, under Medicare, Medicaid, and the Maternal and Child Health programs, to employ new methods of payment as they prove effective in providing high quality medical care more efficiently and at lower cost.

It is appropriate that the Government-which pays more than 20% of the Nation's medical bill--take the lead in stemming soaring medical care costs.

But this can be only part of the effort. Ultimate success will depend on the ingenuity of our health profession and institutions, and the insurance systems allied with them.

The rewards of success--and the penalties of inaction--demand a dedicated effort by all. Unless the cost spiral is stopped, the Nation's health bill could reach a staggering $100 billion by 1975. The cost of providing adequate medical care to a family could double.


Beyond this, we must make certain that the American taxpayer does not pay needlessly high and exorbitant prices for prescription drugs used in Federally-supported programs.

Recent surveys have shown, for instance, that 12 drugs of the same type range in retail price from $1.25 to $11 for 30 tablets. The taxpayer should not be forced to pay $11 if the $1.25 drug is equally effective. To do this would permit robbery of private citizens with public approval.

I recommend that the Congress authorize the Secretary of Health, Education, and Welfare to establish a reasonable cost range to govern reimbursement for drugs now provided under Medicare, Medicaid and the Maternal and Child Health programs.

This payment method will apply in all parts of these programs, except in those cases where hospitals and other health care institutions have established effective and reliable systems for cost and quality control.

The physician will be free to select more expensive drugs of the same quality and effectiveness, if he chooses, but reimbursement will be limited to the payment range established by the Secretary.


The wide array of medication available to the American patient is a tribute to modern science.

But the very abundance of drugs creates problems.

In our society, we normally demand that the consumer be given sufficient information to make a choice between products. But when the consumer is a patient, he must rely exclusively on his doctor's choice of the drug that can best treat his condition.

Yet the doctor is not always in a position to make a fully informed judgment. He has no complete, readily available source of information about the thousands of drugs now available.

He must nonetheless make a decision affecting the health, and perhaps the life, of his patient.

To make sure that doctors have accurate, reliable and complete information on the drugs which are available, I recommend that the Congress authorize this year publication of a United States Compendium of Drugs.

This Compendium would be prepared by the Secretary of Health, Education, and Welfare, in cooperation with pharmaceutical manufacturers, who would bear the cost of its publication, and with physicians and pharmacists.

It will give every doctor, pharmacy, hospital, and other health care institution complete and accurate information about prescription drugs--use and dosage, warnings, manufacturer, generic and brand names, and facts about their safety and effectiveness.


This is a tragedy heightened by the fact that much of it is senseless and unnecessary.

Thousands of deaths will be prevented under the Highway and Traffic Safety laws passed by the Congress in 1966. Thousands more can be prevented by prompt medical attention.

The needed medical services are often available. But because of an inadequate rescue system, the victim dies before he reaches the hospital.

The compelling need is for modern, effective rescue systems to give immediate attention to accident victims---on the spot and while they are being speeded to the hospitals.

We have proven excellent rescue systems in action, saving fighting men injured in battle. First in Korea, and now in Vietnam, the military has shown the speed and effectiveness of helicopter crews, paramedical personnel and communications experts mobilized to save the lives of wounded men.

Few States and communities have drawn upon that experience. In many areas, ambulance crewmen are not even trained in first aid. Ambulances themselves are rarely well-equipped. Communications systems are inadequate, if they exist at all.

I have directed the Secretaries of Transportation, Health, Education, and Welfare, and Defense to devise a test program to help our States and communities develop effective rescue systems to fit their own needs.

In a previous message to the Congress this year, I proposed the Occupational Safety and Health Act of 1968, to safeguard 75 million American workers on the job.

Through this Act we can attack the conditions which cause nearly 15,000 deaths and 2.2 million injuries each year.

With these measures, we can move far toward reducing the tragic toll of accidental death and injury in America.


For more than a decade the Federal government has taken a direct interest in improving the physical fitness of Americans.

President Eisenhower, President Kennedy and I have taken steps to encourage our citizens--particularly the young--to pursue the active life.

Through these efforts, boys and girls across America have discovered the joys of exercise and sports competition.

But here--as in our health programs--we must look not only at the progress that has been made, but at the problems that remain.

--In tests of physical strength and stamina, American children still score substantially lower than children in other countries.

--32 million children get less than the recommended physical fitness program in school; seven million get none at all.

--Only 50 percent of all college students meet accepted physical fitness standards. Physical fitness activities and sports contribute to more than health. They teach self-discipline and teamwork. They offer excitement and a wholesome alternative to idleness. They combat delinquency. They permanently enrich the individual and his society by developing qualities of leadership and fair play.

To expand opportunities to engage in exercise, active recreation, and sports, I am establishing the President's Council on Physical Fitness and Sports, to be chaired by the Vice President.1

1The President's Council on Physical Fitness and Sports was established by Executive Order 11398 of March 4, 1968 (4 Weekly Comp. Pres. Docs., p. 435; 33 F.R. 4169; 3 CFR, 1968 Comp., p. 102).

The Council will be a Cabinet-level group, with an Advisory Committee of distinguished citizens, to develop national goals and programs to promote sports and fitness in America.

As a first step, the Council will call a national conference to explore the long-term requirements of physical fitness and sports in the nation.


Health expenditures in the United States are now nearly $50 billion a year. The Federal Government pays $14 billion of that amount, up from $5 billion four years ago to $16 billion in fiscal 1969.

The expanding Federal programs must be managed efficiently, with the most careful attention to the most urgent needs of the American people. To that end, I am today directing the Secretary of Health, Education, and Welfare to submit to me a modern plan of organization to achieve the most efficient and economical operation of the health programs of the Federal Government.2

2On June 15, 1968, Secretary of Health, Education, and Welfare Wilbur J. Cohen submitted a report to the President recommending changes in organization and coordination of Federal health programs (4 Weekly Comp. Pres. Docs., p. 972).

But better organization and leadership will be wasted if we cannot find and hold the quality of people essential for these great tasks.

I recommend the Health Personnel Act of 1968 to modernize the health personnel system within the Department of Health, Education, and Welfare. This act will provide:

--Pay increases and a flexible personnel to attract and retain professionals of the highest caliber.

--A new promotion system based upon quality of performance.


In our drive toward a healthier America, Federal programs and Federal dollars have an important role to play. But they cannot do the job alone.

An even larger role belongs to State and local government, and to the private enterprise system of our Nation. The medical and hospital associations, the health care institutions, the health insurance industry, the communication media, voluntary civic associations, employers and labor unions, charities and church groups must join this effort. I call upon them to join in a 12-point volunteer effort to build a healthier America:

(1) To examine every child under the age of five to identify potentially crippling ailments and provide early and effective treatment.

(2) To use the public airways for public profit by offering regular health programs on television and radio to help every American preserve his cherished birthright of good health.

(3) To give prominent magazine and newspaper coverage to good health practices for our children and older Americans.

(4) To identify and reward new approaches by medical societies, group practice organizations and hospitals for delivering better health care at lower cost.

(5) To expand voluntary health insurance to those not now covered and include services not now included.

(6) To establish local systems of new incentives to recruit, train, retrain, license and effectively use nurses and medical corpsmen leaving the Armed Services, and other vital members of the health team.

(7) To make home health care part of the education of every young girl in all the schools of America.

(8) To encourage the opening of health centers to provide complete care in every community.

(9) To make physical fitness programs and recreational facilities available to people of all ages and in all walks of life.

(10) To alert teenagers and their parents to the danger of drug abuse.

(11) To develop better programs for health services for the one-third of the working poor who suffer from chronic illness.

(12) To mobilize a new spirit of public concern and private action to meet and master our health problems.

Great changes have taken place in the financing of medical care in this country. The Federal Government will invest some $16 billion in the health field in fiscal 1969. We should now expect our Nation's great private resources, through volunteer and cooperative action, to step up their efforts to bring better health to all our citizens.


In the medical research laboratories of the world, a quiet revolution is changing the condition of man. Enemies which have held man in hostage throughout history are conquered each year. Hope turns daily to promise, and promise to practical achievement. But progress cannot be measured in the laboratory alone. Triumph in a test robe is not triumph enough--if it remains there.

Success in a laboratory, however brilliant, is not complete if barriers of poverty, ignorance or prejudice block it from reaching the man who needs it, or the child who wastes away without it.

With the program I have outlined in this message, I believe we can move closer to our goal of decent health care for every American.

This is a program to assure that American medicine will continue to build on its great record, and that its benefits will enrich and improve the life of every citizen.

I urge the Congress to act promptly on this program.


The White House

March 4, 1968

Note: For statements or remarks upon signing related legislation, see Items 446, 447, 536, 545.

Lyndon B. Johnson, Special Message to the Congress: "Health in America. Online by Gerhard Peters and John T. Woolley, The American Presidency Project

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