and Lung Institute was given $44.2 mill on less than the Congress said it should get. The National Institute of Mental Health was forbidden to spend $199.2 million appropriated by Congress. Medical training was cut by $189 million. Nurse training, cut another $69.7 million. Hospital construction and improvement was funded at $195.2 million; they got not a penny of that amount.

Another area in which HEW is flouting the law is the present spending policy in areas not yet covered by an appropriation. The continuing resolution states that agencies may spend either at the old appropriations level or the lower of the two previous authorizations figures. However, the administration is again in violation of the law, and in numerous areas is spending at the level of the lowest of the new authorization figures. This is against the law and steps should be taken by the Congress to bring this to a halt.

Mr. Chairman, the figures for fiscal 1974 and beyond are even more depressing, particularly when you realize some budget figures include transfers from other agencies and funding authorized in previous years.

The National Academy of Sciences has recently analyzed the Nixon-Weinberger nonbudget for health. While the Academy draws no shocking conclusions from the data they present, there is no need for such statements. The facts speak for themselves.

For all health programs under HEW, excepting Medicare and Medicaid, the National Academy on page 26 of its report concludes, "Thus the net real increase between 1973 and 1974 is $71 million. This increase is not great enough to sustain existing programs at current levels." And we all know what current levels are they are $1.1 billion less than the Congress said they should be in laws passed by us and signed by the President. I can't help wondering what the combination of billion-dollar impoundments, plus another year of 8percent inflation will do to the little over $4 billion requested by the President for health. Back in the sixties a rule of thumb was that health programs, particularly those involved in research, needed approximately a 15-percent increase just to continue operating at the same level. I hardly think this punitive $71 million increase, minus a billion or so, will permit much progress on the health research and medical treatment fronts.

Mr. Chairman, the assault on health care by cutting spending and personnel is now full blown. The next step, by the administration, is to attack administratively and destroy the effectiveness of various programs from within their structure. Quite frankly, the analogy between what is happening here, and the process by which cancer attacks the human organism, is too strong to ignore.

A recent press story, which is part of my full statement, quoted Dr. Arthur Lesser, a 32-year veteran in the health care field, and former Director of the Maternal and Child Health Care program. Dr. Lesser, in a statement announcing his protest resignation, declared, "This is the first step in the elimination of categorical programs. It is another disregard for the intent of Congress."

This story, plus information secured from highly respected health care professionals, both in and out of Government, prompted my immediate interest in the proposed reorganization at HEW. These gentlemen confirmed what Dr. Lesser had stated in his announcement of resignation. This reorganization was designed to strip various categories

of support personnel. Leaving the upgraded Assistant Bureau Directors in charge of these downgraded programs, with only five or six apologists, would effectively kill the programs they were proposing to make more efficient.

As an expression of increasing congressional concern over the obvious ill effects on the categorical programs affected within the Bureau of Community Health, 34 of my House colleagues joined with me in writing Secretary Weinberger. We stated that it is our belief that this reorganization is not aimed at increasing efficiency, but is, as Dr. Lesser stated, "another disregard for the intent of Congress."

We asked if the Department plans to discuss this with the Congress, or, at least, ask informal approval of the plan. We requested clarification of how HEW expects transferred program people to service programs to which they were attached by statute. We also asked how the Department plans to move in light of the recent project-funding extension of title V maternal and child health care programs.

Mr. Chairman, it is my firm belief that Congress is beginning to realize that if we are going to achieve anything in dealing with this administration we must actively assert our leadership. Instead of waiting months, as is the case with the recently proposed plan for heart and lung research and treatment, we should demand that the executive meet deadlines contained in the law or congressional requests. A special in the Sunday New York Times by Harold Schmeck discussed the administration's plan for heart and lung disease. This plan, required by law, unbelievably, was disowned by HEW in the letter of transmittal. In Mr. Carlucci's words, the plan does not take into consideration all our other research needs. And increasing the funding by the needed $46 million would deprive other projects of their funding.

Well, it is my hope that the Congress will provide the extra $46 million. We can get a 1,200,000 from the White House contingency fund. It is my understanding Congressman Steed feels the President has no need for this amount in a nonelection year. Not only should we provide this extra funding, but we should watch it closely and, if it is impounded, take the administration to court forthwith.

In reasserting our leadership in health, the Congress has enjoyed extraordinary success. But that is to be expected when we go to court-after all, we do not have the law on our side. A regular flow of court decisions has continually scored the administration for playing being a legislative body. In cases for housing, health, highways, education, pollution control, mental health centers, and neighborhood youth corps, funding has been mandated by the courts.

Mr. Chairman, let's keep a good thing going. The administration has thrown itself off kilter. I don't mean to suggest the Congress kick them while they are down, but the opportunity for Congress to reassert itself has arrived. Weinberger and company have demonstrated their bankruptcy of commitment to people and, particularly, people in need. I suggest we capitalize on their legal and ideological nakedness and proceed to legislate as we see fit.

We have been gentlemen; we have behaved in an absolutely impeccable manner; we have attempted every possible means of compromise and consensus. Well, we now know it won't work and if we don't get moving in this particular area of health, there won't be any

thing much left to save, when this administration departs for their sunshine sanctuaries and leave us standing in the wreckage.

Mr. Chairman, I am appearing before your subcommittee to express not only my concern for these specific health care sabotage efforts of the administration. I also wish to acknowledge the proper jurisdiction and leadership of this committee in the health care field. We need this committee's leadership in moving ahead on the research and treatment frontiers of medicine. We also need your leadership in this period of crisis-a crisis the administration has provoked and designed a crisis that could leave us with nothing but quicksand as a structural basis for building a national health care and insurance system.

Right now we still have the bare bones of the structure we will need. But if we permit this administration to continue their depredations, we may very well be left with nothing, and arguments that a national health care system is too expensive may very well be perfectly true.

Mr. Chairman, I request inclusion of my printed statements and attachments in the record. And in closing, I should like to present the committee and the Congress with this advice from Macbeth, V. 7, "And be these juggling fiends no more believed, that palter with us in a double sense; that keep the word of promise to our ear, and break it to our hope."

Thank you, Mr. Chairman.

[Testimony resumes on p. 32.]

[Mr. Carey's prepared statement and attachments follow.]

STATEMENT OF HON. HUGH L. CAREY, A REPRESENTATIVE IN CONGRESS FROM

THE STATE OF NEW YORK

Mr. Chairman, I am very pleased to be here and take advantage of your kind offer to discuss with the Committee some of my concerns relative to the series of destructive "efficiency reorganizations proposed or initiated by the Department of Health, Education, and Welfare.

I also appreciate this opportunity to communicate the views over 35 Members of the House share with me concerning the specific ill-effects the reorganization at HEW will have on Maternal and Child Health Care programs throughout the Nation. These gentlemen joined me in writing the Secretary of HEW, requesting specific answers to very detailed and pointed questions about this proposed reorganization.

Mr. Chairman, before proceeding to the specifics of my testimony, I should' like, as a member of the House Ways & Means Committee, to assure you of my wholehearted support of your efforts in designing national health care legislation. We at Ways & Means may be revenue experts, but we certainly look to you and the membership of your distinguished Subcommittee for guidance in both developing health care programs and in fighting off ill-advised attacks on those programs presently struggling to survive.

Mr. Chairman, the second leading cause of death in the United States is birth. Heart disease takes over 700,000 a year; cancer takes about 300,000; strokeover 200,000; accidents-about 140,000. Infant mortality, however, takes 560,000 lives a year. And while it certainly is not the primary concern here, total lifetime earnings lost through infant mortality approach $90 billions. Mr. Chairman, that is approximately 10% of our GNP being lost, along with the priceless lives of Americans who will never know that name.

We are all aware of the U.S. international standing in infant mortality. It is a needless disgrace for this Nation and an even more needless time of agony for parents looking forward to the lives of healthy, happy children. I emphasize the word "needless", because that is exactly what the tragic infant mortality figures of the United States are.

The Congress has had testimony from the most distinguished medical scientists, practitioners, and pediatricians in the Nation. They all state unequivocally that

the U.S. does have the capability to substantially reduce these figures. We do have the know-how, the techniques, the health care teams, and potentially, the funds needed to see a national maternal and child health care system really work. Mr. Chairman, dramatic proof of that can be seen in every health care area served by a Title V Maternal and Infant Care project. In my own 15th Congressional District in Brooklyn, the project area of Red Hook showed a reduction of infant mortality from 29.9 per one thousand live births in 1960, to 17.4 in 1971. And, Mr. Chairman, similarly remarkable figures are bing achieved all across the Nation. They are being achieved because the Congress has stuck to its guns and has continued to protect these life-giving and life-saving projects from both fiscal malnutrition and eventual starvation, "efficiency" shake-ups designed to deprive these projects and programs of support, morale, and leadership.

Mr. Chairman, in your own district in Florida, the West Palm Beach MIC project has reduced infant mortality from 29.2% in 1965 to 22.3% in 1969. MIC projects were initiated in Dade County in 1966 and I think the following figures need no elaboration. In 1967 the birth rate for all Dade County was 14.2; the infant mortality rate for the county was 24 and the mortality rate for the MIC areas was 13. In 1972 the birth rate for all Dade County was 13.3; the infant mortality rate for the County was 16.6 and the mortality rate for the MIC areas was 4, per 1,000 live births.

Figures such as these concerning our own people would seem to be reason enough for us to continue and redouble our efforts to safeguard the work now being done in this vital area and to see that these pockets of adequate health care become, in the next few years ahead, the national system of maternal and child. health care we need-a system that will blend with and reinforce whatever administrative and operational structures the Congress establishes for comprehensive national health care.

Mr. Chairman, discussion of anything national in scope necessarily brings into play serious examination of and deliberation on the national philosophy underlying and supporting any national-impact proposal. We are discussing what you, I, and others in the Congress, know eventually will become a national, compre hensive, health care system. And we are discussing this in the context of the various medical research, education health-care, and delivery systems that Congress has designed, built, and funded over decades, in preparation for just such a comprehensive national system.

I should like, at this point, to quote from expressions by two Secretaries of Health, Education, and Welfare of what their personal philosophy is regarding a Federal commitment to health care.

First: "The main thing I would like as sincerely as I possibly can convey, is our absolute and total commitment to assure that health care is constantly improved... and that it will not be denied to anyone by the irrelevant factor or their not having sufficient income."

Second: "The great debate about Federal responsibility in health has to a considerable extent been resolved. Our health problems-whether they involve the menace of air and water pollution or the quality of care in hospitals and nursing homes are now seen as national problems."

From listening to these two statements, one could very easily and justifiably state they both were uttered by the same man, or by men of very similar ideals and commitment to the improvement of health care in this Nation. Well the first assurance was delivered by the present Secretary of Health, Education, & Welfare, Mr. Weinberger. The second was uttered by Mr. Gardner, also Secretary of H.E.W., when he made that statement.

But, Mr. Chairman, deeds indicate far more clearly than words the measure of commitment to Federal leadership and Federal assistance to "constantly improved" health care.

The distinguished Chairman of the parent Interstate and Foreign Commerce Committee, Congressman Staggers, has just released figures and correspondence with Secretary Weinberger which display clearly the massive impoundments of appropriated health care funds during fiscal 1973. They, more than any other evidence are an overwhelming indictment of this Administration's lack of commitment to health improving care for all Americans.

A total of $1,095 billion in appropriated funds, released by the Office of Management and Budget, was impounded on authority of the Secretary. Usually OMB does the routine, every-day impounding in this Administration. However, it would seem the present Secretary's good judgment could be relied upon in the managing of these funds mandated by the Congress to make and keep America.

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healthy. It is also significant that while Chairman Staggers initiated his health impoundment inquiry with H.E.W. several months before the end of the fiscal year, the reply from H.E.W. was not sent to the Chairman until well into the first month of the new fiscal year. (Mr. Chairman, at this point in my statement, I ask that the correspondence between Chairman Staggers and Secretary Weinberger, plus the attached memoranda and tables be printed in the record.) [See attachment No. 1.]

Mr. Chairman, the necrology of health-care hopes and programs is practically endless and I find this continued impoundment, budget slashing, administrative legerdemain, and equivocation increasingly outrageous. I frankly take very personally this assault on American health care structures we in the Congress have labored to build over the past few decades.

I think in Washington you have to expect a certain amount of playing politics in various government cabinet departments. I can put up with dickering with military bases, or highway location gamesmanship, or government contract competition; but when you start playing politics with, or imposing personal ideologies on the health care of this Nation, I think it is about time to draw the line.

I know what access to outstanding medical care means to a family. I've been going out to N.I.H. on a family mission, week in and week out, for the last seven months. I have seen the expertise, dedication and humanity of that magnificent organization. And while they have not yet tried direct bureaucratic euthanasia on N.I.H., this Administration's track record on health care indicates that nothing is safe or sacred.

Time does not permit a discussion of all the failures, backing-and-filling, and misleading statements of this Administration on National health insurance, Health Maintenance Organizations; failures to spend highly publicized funds for cancer and heart and lung research.

However, I would like to outline briefly the recent scenario on securing an extension of project-funding for Maternal and Child Health Care projects funded under Title V of the Social Security Act.

This program comes under the jurisdiction of the Ways & Means Committee because its enabling legislation in 1965 was an amendment of the Social Security Act. Back in 1969, the Congress authorized a change in the method of funding. Health Care allocations were to be given directly to State government under a formula grant mechanism. The states were then to provide funding for health care programs, based on its own ordering of spending priorities.

While the States may well be given credit for good intentions concerning continued adequate funding for Maternal and Child Health Care projects, the liaison between H.E.W. and state health departments was practically non-existent on this funding change.

Secretary Weinberger, subsequent to the extension of project funding for F. Y. 1973, stated in a letter to Ways & Means Chairman Wilbur Mills, dated April 9, 1973, that, "Planning for the changeover is progressing well." (Mr. Chairman, at this point in my statement, I would like to insert in the record a copy of this letter.) [See attachment No. 2.]

Mr. Chairman, that statement can only be called misleading, at best. The staff of the Ways & Means Committee have right now in their possession statements from directors of projects all over the Country, stating unequivocally that if project funding is not extended for another year, that meant the end of their program. They stated further that no plans had been made on the state level to continue their programs and that their staffs were leaving, morale was low and they were preparing to close their doors. (Mr. Chairman, at this point I would like to insert in the record the letter I sent to the membership of the Ways & Means Committee concerning project fund extension for these projects.) [See attachment No. 3.]

The letter explains the vital necessity for this extension and outlines what would be lost by failure of the Congress to act before the end of the fiscal year. Where the letter indicates "Insert" a paragraph was inserted quoting the director of a project in the Members District or representative area as to the discussion effect of our failure to extend.

(Mr. Chairman, I would also like, at this point, to insert floor remarks of mine during debate on final passage of legislation containing the needed project-funding extension.) [See attachment No. 4.]

This speech includes a press report on the protest resignation of Dr. Arthur Lesser, veteran director of MCH programs in the Department of H.E.W.

Mr. Chairman, this story, plus information secured from highly respected health care professionals, both in and out of government, prompted my immediate