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     Interview with Dr. Joseph T. English 
     Date: September 29, 1992
     Location: The Century Club 
               New York, NY 
     Interviewer: Stephen Strickland

           Memorandum for the Record Taken from an interview with Dr.
     Joseph T. English Conducted by Stephen P. Strickland at The Century
     Club New York City, NY, September 29, 1992.

           Highlights of interviews between Stephen Strickland and Dr.
     Joseph T. English, President of the American Psychiatric
     Association, former Administrator of the U.S. Health Services and
     Mental Health Administration, and former Director of Health
     Programs of the Office of Economic Opportunity.  New York, NY -
     September 29, 1992.

           In a lengthy and very informative conversation with Dr.
     Joseph English about Regional Medical Programs and the context in
     which there were created and carried out, I learned many details
     both about the RMP's and about related health policy decisions.
     Among the most important of these elements revealed in the course
     of our visit were the following: 

           1.  In pushing for the enactment of Medicare and Medicaid in 
     1965 -- the most important legislative breakthrough in health policy 
     in the 1960's and indeed among the most important in the nation's 
     history - - several crucial logistical questions had to be dealt with.  
     The first was to decide where to place the administration of these 
     programs within the government.

           Dr.  English was deputy assistant secretary at this time and
     worked directly with the Under-Secretary of HEW, Wilbur Cohen, as
     well as Secretary John W. Gardener and Surgeon General William
     Stewart, to decide on the organizational aegis for these two major
     programs.  Joe remembers a conversation between Wilbur Cohen and
     Bill Stewart, near the time of the passage of the legislation, in
     which the question of whether Medicare/Medicaid should be
     administered by the U.S. Public Health Service or elsewhere on the
     "health side" of the department.  Dr.  Stewart, speaking for and
     out of tradition of the Public Health Services, said, in essence:
     "The Public Health Service doesn't know anything about poor
     people."

           This position led to the decision by top officials of the
     department to have Medicaid and Medicare administered through the
     Social Security Administration through the "welfare side" of the
     department.

           2.  It is Dr.  English's recollection that in addition to
     President Johnson's preoccupation -- namely, "to be sure no
     research secrets were being locked up inside the laboratory" and
     not reaching people generally -- there was a corollary one: to
     insure the provision of care to poor le, including those already
     being served through the health programs of Economic Opportunity.
     Dr.  English believes that the neighborhood health centers were
     already up and running and, in many places, providing the first
     direct non-emergency medical care to poor people across the
     country.  Thus the neighborhood health centers were quite relevant
     tot eh RMP legislation.  This is important because the principal
     model of the Debakey Commission was on the other end of the
     spectrum, the tertiary care center, highly sophisticated teaching
     hospitals and medical research centers in large institutions such
     as the M.D. Anderson Hospital in Houston.

           3.  Despite the language of the legislation to the effect
     that Regional Medical Programs would not interfere with the private
     practice of medicine not the selection of physicians by patients,
     inserted in the legislation at the insistence of the American
     Medical Association, there remained considerable apprehension in
     organized medicine and among private practitioners generally about
     any government program having to do with the deliver of medical
     care.  But an equally important source of concern and apprehension
     was the state and local public health agencies, who feared the
     creation of new organizations not under the control of state,
     county, or other health departments, but 1) extending across
     traditional jurisdictional boundaries and 2) involving
     professionals and lay persons in decisions about medical care
     delivery.

           This led to a push to secure equal statues, in some public
     health agencies.  Hence Health planning legislation, which gave
     state and local planning officials their due followed quickly on
     the heels of the RMP legislation.  The planning neutrally re-
     enforcing of it.  But instead, in many cases, it turned out to be
     an inhibiting factor which prevented systems of deliver of newly
     identified and effective treatment modes from being effectuated.

           Further, the persistent concern, even paranoia, of the old
     public health people was a generally negative influence on the
     steady development of Regional Medical Programs.  Dr.  English
     believes that the rivalry between the health planning function was
     one of the factors that facilitated the decision, in the early part
     of the Nixon administration, to eliminate Regional Medical
     Programs.