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By Edmund W. Murphy

At the first workshop on Surface Subsidence Due to Underground Mining (1 981 ) , Yarbrough delivered a paper (1 ) describing the mine subsidence insurance program in Illinois operated as the Illinois Mine Subsidence Insurance Fund (IMSIF) . In this paper we will present claims data and describe changes that have occurred in the Illinois Insurance Code during the first six years the IMSIF has been in existence. The change in the original Illinois Public Act 80-1 41 3 that most affected the public was an amendment increasing the maximum amount of mine subsidence insurance avail- able on a structure from $50,000 to $100,000. Seventy-two counties in Illinois have been undermined for minerals, primarily bituminous coal. In Franklin County (.in the southern part of the state) 36 percent of the land area has been undermined for coal extraction. In St. Clair and Madison Counties , two counties that include the St. Louis Metropolitan area along the western border of the state, 10 percent and 7 percent of the land surface have been undermined. Most of the undermined area in the two counties is beneath urbanized land. In 34 counties, approximately 1 percent or more of the land surface has been undermined (2). The first shaft mine in Illinois was sunk in the city of Belleville (east of St. Louis) in 1842, and the mines of early vintage have initiated the majority of the mine subsidence claims. Data compiled from the first six years reveals that most Illinois mine subsidence events that affect structures occur over abandoned mines where early methods of high- extraction mining practices were used. Maps of these mines operated in the 1800s reveal irregular development of room and pillar areas and poorly defined production areas (panels). Rooms in the mines varied from 15 to 40 feet in width and the pillars varied in width from 5 to 40 feet. The pillars were often long and narrow. Recovery rates in mines that operated prior to 1900 generally averaged 50 per- cent, and extraction rates as high as 80 percent have been documented (2). Some pillar robbing occurred.

Jan 1, 1986

By Manfred G. Raschke

INTRODUCTION In the past decade, the international coal trade has been undergoing a period of gradual change. This change will continue through the remainder of this century until by the year 2000 the international coal industry will look very different from the industry which existed in the early 1970's. The industry which will emerge from the thirty year period of change (1970-2000) will be different in many ways. -The volumes of coal transported will be much larger. - The primary type of coal traded will be steam coal rather than metallurgical coal. - A much broader group of countries will be participating in the trade both as suppliers and as consumers. - The trade will be dominated by a relatively small number of large producing and trading companies. - The coal mined for international shipment will be primarily surface- mined. – The United States will play a decreasingly important role in international coal trade. In the course of this paper I propose to address three questions which are crucial to the formulation of an understanding of the changes outlined above : (1) Which supplier nations will be most successful in the international metallurgical and steam coal trade in the next decade and a half? (2) What emerging trends will shape the international coal trade in the 1980's and 19901s? (3) Where are U.S. producers likely to fit in this scheme of things? As a background to my remarks, I should note that what follows is based on five years of work in a consulting capacity on coal supply and demand issues worldwide. Although in the course of this work I have had occasion to develop mining and transportation cost figures for all of the countries discussed below--both my own and those obtained from coal producers--it is apparent that success in the marketplace can be determined in some instances by considerations other than costs. Nevertheless, my comments today about international competitiveness will be dominated by cost considerations; there are, after all, not many markets that reward the high-cost producer with success. Let us begin by establishing some criteria for success in the international coal market and then compare some of the producer nations to some of these criteria. The criteria are: - Low delivered cost, - Good quality coal, - The producer's partnership in a joint mining venture with an importer or a consumer of coal, - The producer's international business orientation and commitment to penetrating the market, - The producer's reliability as a supplier, and - Political pressure exerted by the producing country on consumers.

Jan 1, 1986

Due Dilligance does not only lie in the statistics, but rather in the practical process aspects, which is the window to understanding the statistics.

Jan 1, 2005

By Archie M. Richardson, Carl E. Brechtel, Tom R. Kelly, Frank Feero

Recent work to upgrade the ventilation system for the el Mochito lead/zinc mine in central Honduras is discussed. Network modeling and underground measurements were used to evaluate cost-effective alternatives for achieving satisfactory ventilation in a complex and expanding underground operation. Both interim and long-term solutions were implemented to make mining possible under difficult conditions. INTRODUCTION Mining operations at the el Mochito Mine, located in the central highlands of Honduras, Central America, have been virtually continuous since the opening of the mine in 1948. Initially a high-grade silver mine, the mine has expanded along a westward trend of pipe-like orebodies to a distance of roughly one mile from two centrally located shafts. Production of the relatively large San Juan orebody at the western most extension of the mine (Paddock, 1981) led to the introduction of diesel-powered equipment; however, the ventilation infrastructure was insufficient to meet the needs of mechanized mining. A succession of owners/operators in the 1980s allowed the existing ventilation infrastructure to decay to the point that ventilation in the production areas of the mine was very poor. Environmental conditions in some working areas were not conducive to efficient ore extraction because of high dry bulb temperature, high humidity, and diesel emissions. Upon acquiring the mine in 1990, Breakwater Resources of Tucson, Arizona began an aggressive program to refurbish the mine infrastructure to complete extraction of the San Juan orebody and to allow the extension of the mine another 2500 ft to the west for extraction of the Nacional orebody. The program included increasing the capacity of the main ventilation system. This article presents a case history of the process of upgrading the ventilation system in a mine where extensive old workings cause large air leakage. This process has been one of selecting solutions to difficult technical problems that are compatible with the existing mine infrastructure and economic constraints. The initial ventilation system is described in the background section, along with ventilation projections for the mine expansion. Field characterization of the ventilation system for design verification and fan specification is then discussed. The paper describes a series of interim changes to the system to improve ventilation pending completion of new ventilation boreholes. In addition, the temperature/ heat problems in the mine are described. BACKGROUND Initial Condition of Ventilation System The ventilation system is illustrated in Figure 1, which shows the extent of mining with the main ventilation paths superimposed. Early mining around the two shafts opened up vertical connections (stopes and raises) over the entire 2420 ft (737.6 m) of vertical extent, and mining progressed to the west primarily using compressed air and electric-powered equipment. Since ventilation was not a complex problem in the original mining system, the stopes and interconnecting raises were not sealed. The San Juan orebody was much larger than the silver ore zones mined previously, being primarily zinc and other base metals. Its geometry, size, and grade allowed the use of vertical crater retreat (VCR) stoping with diesel mucking and haulage equipment. Its depth, along with the existence of warm groundwater, resulted in a mine climate problem on the lower levels. To establish a complete ventilation circuit, two vertical boreholes (Bonanza Nos. 1 and 2) had been drilled by previous owners from the surface in the vicinity of the San Juan orebody. The system design called for air to be drawn down the intake shafts, across the lower mine levels to the San Juan workings, then up through the San Juan ramps and ore passes to these two exhaust boreholes (see Figure 1). In practice, however, only the Bonanza No. 1 borehole was drawing air through the desired path. Leakage across the old upper levels from the intake shafts, the Caliche tunnel, and from intervening abandoned stopes and raises supplied most of the air flowing to the base of the Bonanza No. 2 borehole. In effect, there were two ventilation circuits in semi-parallel through the mine, of which only one was delivering appreciable air to the San Juan workings.

Jan 1, 1993

By H. Copur

Roadheaders have become widely used in underground mining and tunneling operations because they offer the flexibility to excavate soft- to medium-strength rock formations. A critical issue in successful roadheader application is the ability to develop accurate and reliable estimates of machine production capacity and the associated bit costs. Increased pressure to improve productivity and lower costs in the mining and civil construction industries has been the driving force behind the more wide- spread use of mechanical excavation systems. This has caused both industries to move away from the conventional drill and blast methods. Additional benefits of mechanical mining include improved safety, reduced ground support requirements and fewer personnel. These advantages, coupled with recent enhancements in machine performance and reliability, have resulted in mechanical miners taking a larger share of the rock excavation market. Roadheaders are the most widely used underground partial-face excavation machines for soft- to medium- strength rocks, particularly for sedimentary rocks. They are used for development and production in soft rock mining (main haulage drifts, roadways and crosscuts), particularly in coal, industrial minerals and evaporitic rocks. In civil construction, roadheaders are used to excavate railways, roadways, and sewer and diversion tunnels in soft ground conditions. They are also used to enlarge and rehabilitate underground structures. Their ability to excavate almost any profile opening also makes them attractive to those mining and civil construction projects where various opening sizes and profiles are needed. In addition to their high mobility and versatility roadheaders are generally low capital cost systems com- pared with most other mechanical excavators. Because of higher cutting-power density due to a smaller cutting drum, roadheaders can excavate rocks harder and more abrasive than continuous miners and borers.

Jan 1, 1998

By Henry T. Miller

INTRODUCTION The basic purpose of this paper is to suggest procedures and practices to insure that no employee working in a uranium milling operation receives exposure to radioactive, toxic, or other materials or agents that might produce a permanent, deleterious effect upon his physical health and well-being. This program is also designed to insure that each employee can carry out his assigned duties without risk to his health or to that of his fellow workers. The assumptions underlying this program are by necessity, conservative, with emphasis being placed upon prevention rather than correction or reaction to an undesirable situation. The limits specified-either as Threshold Limit Values (TLVs), Maximum Permissible Concentrations (MPCs), or Radiation Protection Guides (RPGs)--represent both standards of best practice and those of law and regulation. The total program is envisioned as a balanced combination of occupational hygiene and radiation monitoring. This includes surveying, air sampling, personnel dosimetry, bioassay, medical surveillance, epidemiology, and training--all backed by a thoroughly tested and evaluated set of emergency procedures. The program, as presented, is keyed to the results of monitoring, surveying, air sampling, medical surveillance, and epidemiology--it being obvious that no problem can result when no hazard can be identified. The lack of an identified hazard, however, does not negate the need for such a program and prudence suggests the need for routine surveillance programs in the best-designed facility. [The Model Mill] The model mill used in this paper is that presented by the U. S. Environmental Protection Agency in its study of the uranium fuel cycle1. The model mill processes 600,000 metric tons of ore per year into 1,140 metric tons of U308 as yellowcake per year using an acid leach process. Other characteristics of the mill such as location, tailings dam design, number of light water reactors supported, and geographical location are not pertinent to this paper. The usual remote western location of these facilities produce some difficulties in delivering the required occupational medical services and is not within the scope of this paper. The operating lifetime of most mills is commonly estimated as from 12 to 15 years in actual practice; however, the U. S. Environmental Protection Agency estimated a 20-year lifetime for its model. The principal steps in the acid leach process include :2 (a) Ore is blended and crushed to pass through a 2.5 cm (one inch) screen. The crushed ore is then wet ground in a rod or ball mill and is transferred as a slurry to leaching tanks. (b) The ore is contacted with sulfuric acid solution and an oxidizing reagent to leach uranium from the ore. The product liquor is pumped to the solvent-extraction circuit while the washed residues (tailings) are sent to the tailings pond or pile. (c) Solvent extraction is used to purify and concentrate the uranium. (d) The uranium is precipitated with ammonia and transferred as a slurry. (e) Thickening and centrifuging are used to separate the uranium concentrate from residual liquids. (f) The concentrate is calcined and pulverized. (g) The concentrate or yellowcake is packaged in 208 liter drums for shipment. This process is illustrated in Figure 1.3

Jan 1, 1981

By Robert E. Goodwin

There are four main requirements which must be considered when selecting a wire rope for the best serviceability. A proper choice is made by correctly estimating the relative importance of each of these requirements and selecting s rope which has those qualities best suited to withstand the combination of destructive forces expected under continued service. A wire rope should possess: 1. Strength sufficient to support the maximum load expected and with s proper safety factor. 2. Ability to withstand bending and to resist bending fatigue without failure of the wires. 3. Ability to withstand surface abuse such so abrasive wear, pounding, and wire scrubbing. 4. Ability to withstand abuse such as crushing and distortion.

Jan 1, 1968

By Delbert L. Keenon

The principal concepts of computer control and automation have been successfully applied in industries world-wide, The enthusiasm generated by the proponents of computer control, and the apparent mystery enveloping the techniques of computer control, have caused attention to be focused on this infant industry from all quarters. Consequently, the motivation to "computerize" may be the hope that computers will solve all economic problems. The truth remains that not only have there been monumental successes, but there have been some colossal failures. This paper will attempt to outline a generalized guide to computer control and present methods for avoiding some of the major pitfalls. Since the investment required for computer control systems has been drastically reduced in the past year, small operations will likely find that computerized process control is attractive in areas where it has never been considered before, The discussion presented here is intentionally non-technical and directed towards those who may soon find they have a possible application for a control computer. The primary purpose of computer control is to reduce expenditure and increase profits by improving the quality of product, increasing the efficiency of operation, reducing the materials and man hours required or a combination of these. Success or failure to reach the desired goal depends, to a large degree, on a well-planned approach. This includes recognizing a possible computer application, properly defining the job which is to be accomplished, evaluating computer systems, selecting a capable manufacturer, and following through with sound systems engineering and programming.

Jan 1, 1965

By Erle I. Shobert

In the comparison and consideration of synthetic and natural materials, graphites represent a situation in which natural graphites amount to less than 10% of the total carbon and graphite production by weight, and less than 5% in dollar volume, There are few applications where it could not be re- placed by synthetic graphite. On the contrary, synthetic graphite materials can be engineered to cover an extremely wide range of applications. These include electrographite brushes for rotating machinery, pyrolytic graphite, graphite-impervious pipe, nuclear moderators, high purity spectrographic graphite, power tube anodes, graphite rotary shaft seals, and rocket nozzles. The special qualities of natural graphite and its limitations are delineated and the almost unlimited possibilities in artificial graphite materials are discussed.

Jan 1, 1964

By John T. Cumberlidge

The Groveland deposit, in the Upper Peninsula of Michigan, consists of an E -W trending overturned syncline of Middle Precambrian Vulcan iron formation. At Groveland, the Vulcan formation can be divided into four units or facies. The total succession may be more than 550 feet thick, and consists of a basal unit composed of a lean chemical quartzite with traces of magnetite; a non-banded, partly clastic unit characterized by the preponderance of hematite over magnetite; a transition unit of well-banded magnetite-bearing iron formation interbedded with non-banded oolitic hematite; and a well-banded magnetite-quartz silicate unit at the top of the exposed sequence. The present magnetite-hematite ratios of different units within the orebody are considered to be a primary (post-diagenetic) feature of the original sediment. Subsequent regional metamorphism has increased the grain size of the original iron oxide minerals, but did not appreciably alter the oxidation state of the original sediment.

Jan 1, 1964

By Joseph L. Condon

The U.S. Department of the Interior, Bureau of Mines, is doing research on methods to obtain premining information on problems such as detection of old mine workings, abandoned oil wells, channel sands, faults, and other geologic features that are undesirable from a production or safety aspect. Techniques being developed to acquire the necessary information include seismic and electromagnetic. The seismic methods include high-resolution seismic and acoustic methods applied from the surface and inseam channel waves applied under- ground. The electromagnetic, or radar, methods are applied from the surface, from boreholes, and from the working face underground. All of these methods are useful under certain site-specific conditions, but none of these methods is universally applicable for all mining conditions.

Jan 1, 1980

By Edward L. Vickers

When I was originally asked to give this talk, I had certain preconceived ideas of the mining industry's reaction to Operations Research. It seemed at the time to be a rather simple task to collect these ideas for presentation here today. Jotting down these notions, I became concerned that overexposure to this activity called OR perhaps had clouded my outlook on what was actually being done on a nation-wide scale. I felt, to have a better cross section, a questionnaire of current industrial activity was in order. I solicited the response of some 75 mining companies varying in sizes and operating characteristics, and I am pleased to report that the response was good. I received answers from 51. The questionnaire was intended to measure the degree to which their concerns were actually engaged in OR efforts. With all due respect to the people who were so gracious as to answer the questionnaire, I feel that there is a tremendous misconception as to the designed purpose of OR. This is not to imply that there are no active OR groups in the mining industry. But by in large, the majority of the companies sampled appear to be somewhat confused as to what OR really is.

Jan 1, 1962

By K. W. Lentz

The Maybell Mill of, Trace Elements Corporation, Unit of Union Carbide Corporation is located approximately five miles northeast of Maybell, Colorado, and twenty-five miles northwest of Craig. It is located in the midst of the uranium ore deposits whose presence, made it possible. In November 1953 Russel Cutter, Chief Geologist for the original Trace Elements Corporation, picked up high readings on a scintillometer while flying over this area. Later, with George Morehouse, Chief Engineer for the original. Trace Elements Corporation, he started a search for surface indications. In this search, they found an out crop which can be regarded as the discovery lode on this property. The actual locating of claims and acquiring free lands and state lands was begun in March 1954. During 1955 enough drilling was done to indicate that a sufficient tonnage of ore existed to make possible a mill. These ore deposits are located in the Browns Park formation which is an unconsolidated sandstone with a few hard lime ribs running through it. The geologists tell us that this region was once a vast basin which became filled with wind blown sand and volcanic tuff, Later on, ground waters brought uranium into the basin which precipitated out in the sand. During the late summer and fall of 1955, a small pilot plant was operated under the supervision of John L. Chapman testing these Browns Park ores. During the operation of the pilot plant, three small open pits were developed and the ore from these pits shipped to Union Carbide Nuclear Company, Division of Union Carbide Corporation, at Rifle. To date all ore is being mined from open ptis. In the fall of 1956 the original Trace Elements group signed a contract with: the AEC for a mill at Maybell and on November 5, 1956, Union Carbide acquired the Trace Elements Corporation properties and contract. During the next two months, intensive research was carried out on the Browns Park ores by our research lab at Rifle. They also checked some of the metallurgical results which had been obtained through the operation of the pilot plant by the original Trace Elements group. During this period, a report on Trace Elements Corporation ores was also prepared by the Colorado School of Mines Research Foundation. This report contained data on representative samples of the ore tested for the original Trace Elements group. From this research and study a flow sheet was decided upon.

Jan 1, 1959

By Robert E. Barrett

The history of mine safety legislation in this country is also a history of mine explosions. Nearly every piece of safety legislation that has been introduced or amended has resulted from some type of a disaster. When coal was first discovered and mined, it was extracted from along outcrops. As the coal became depleted near the surface, underground mining developed. When the first mine penetrated the outcrop, a great number of problems developed, many of which remain with us today. One of those problems is the potential for mine ignitions and explosions. Naturally, when underground mining progressed a few feet into the outcrop, some type of artificial light was needed. Early accounts of mining in Spain, Italy, Japan, and Great Britain indicate that torches served to light the mines. Later, candles were used, and still later, earthern oil lamps containing fish oil were used. As workings got deeper, explosions began to occur. When one did occur it was thought to be the work of goblins or the devil. As explosions became more frequent, it became very obvious that the use of open flames for lighting was very dangerous. A substitute was sought. Dried fish skins which gave off a weak phosphorescent light were tried. A mixture of flour and lime made from oyster shells called Canton phosphorous was also tried unsuccessfully. Fireflies in a bottle were also used.

Jan 1, 1976

By Vincent T. Ricca

Acid mine drainage is a serious water pollution problem, for its contaminants will eventually effect the quality of the receiving streams. According to the Appalachian Regional Commission (1969)1, 10, 500 miles of streams have been polluted by mine drainage, and 70 percent of this acid pollution is accounted for by underground mines. Due to the severe damage to aquatic life, to recreational and industrial use, and to domestic water supply, more stringent mining and anti-pollution laws have been legislated and coal mine operators are required to treat the mine water discharges to meet the minimum standards. For years now, abatement and treatment methods have been extensively studied. Progress reports presented in the Fourth Symposium on Coal Mine Drainage Research, 1972 1 suggest that a thorough investigation and understanding of the basin discharge is necessary in order to cope with the mine drainage problem. The extent of mine water discharge contamination can be considered as a function of the basin streamflow and acid generation load.' A conservative treatment cost estimation these days is $0.40 per 1, 000 gallons for water with 100 ppm iron, 500 ppm acidity. These figures need not include collection and pumping costs nor the cost of dispersing of chemical waste by-products. To achieve optimal abatement and treatment of mine drainage, predictions of the quantity and quality of mine water discharges are needed. Basin discharge is a continuous process and it can be considered as a. macro-system. This system can be subdivided into micro-systems to describe the various mine discharge .types in the basin. The mining activities could produce acid water discharges from deep mines, stripmines, or associated gob piles. A total study entitled ?Resource Allocation to Optimize Mining Pollution Abatement Programs?* will consider all of these sources. However, this paper will discuss only one micro-system, the drift (deep) mine type. We will look at a single mine and its watershed. The total research project considers a multiple mining complex in an extensive stream basin.

Jan 1, 1973

By I. S. Parrish

Gold deposits in Hebei and Shanxi provinces in northeast China fall into three general classes: - Placer deposits - Mesothermal vein deposits - Disseminated and oxidized volcanogenic deposits Past production dating back thousands of years has all but exhausted the placers. The mesothermal vein deposits, incorrectly considered in the past as "greenstone" type, are small to moderate in both size and grade. Production from these granulite and amphibolite hosted veins, at present greater than from the newly discovered disseminated deposits, is expected to wane. Production from the disseminated deposits achieved only in the past few years is expected to equal or surpass that from the other classes of deposits. At least one "world-class" deposit is being developed.

Jan 1, 1989

By Lloyd H. Yeager

Good morning gentlemen. I'm very pleased to be a part of this fine program for the Society of Mining Engineers. Gypsum, as many of you know, is one of the most unique minerals on earth. The very excellent presentations which you have just witnessed, revealed the geological aspects of gypsum operations. It is not our purpose this morning to pursue this subject further. Instead, we felt you would be interested in some of the uses of gypsum . . . and what the future holds for gypsum products. To help accomplish this, we're going to first show the Gypsum Association's new film, "Shape Of The Future. ' This short movie traces gypsum f ram mines and quarries to its ultimate destination in homes, schools, offices -- in virtually every type of construction. We think you'll be particularly interested in the description of gypsum's fire resistive nature.

Jan 1, 1965

By Steve Kral

The power industry throughout the world is in the midst of a significant transition that will result in a major restructuring. Deregulation of utilities in the United States is continuing, resulting in increased competition among power providers. The traditional ways that electric power is globally bought, sold and delivered will also change. However, according to the Department of Energy's (DOE) Pat Godley, one thing is clear: "Those who provide the power during the 21 st century will be those who are willing to change - those who are willing to accept new ways of doing business and willing to employ new technologies." Godley is assistant secretary of fossil energy with DOE. Her comments came during the opening remarks at the Fourth Annual Clean Coal Technology Conference, held in Denver, CO, Sept. 5-8, 1995. The conference was sponsored by DOE and the Center of Energy and Economic Development. Under the theme "Global Opportunity," more than 300 coal and utility executives spent three days discussing the new face of the electric-power industry throughout the world and the new, mostly clean coal technologies (CCT) that will be available to power providers.

Jan 1, 1995

By D. B. Desai, J. T. Waggoner, J. S. Hill, R. R. Redd, S. J. Klein

The 13 km (8 mile) long Riverside Badlands Tunnel is planned for construction starting in 1998. Extensive geotechnical investigations indicate that the 3.7 m (12 ft) finished diameter tunnel will be excavated through soft ground, weak sedimentary rocks, and heavily fractured metamorphic rocks. Nearly 80 percent of the tunnel will be excavated beneath the groundwater level. Tunneling conditions are expected to range from raveling and over-stressed in the sedimentary rocks, to blocky and seamy/crushed with some squeezing in the metamorphic rocks. Two alluvium reaches will require dewatering. The variable and interspersed ground conditions are expected to be a key factor in selection of tunneling methods, equipment, and initial support.

Jan 1, 1997

By Lowell T. Harmison

I appreciate very much the invitation to speak with you and the opportunity of bringing you messages from both the Secretary of the Department of Health and Human Services and the Assistant Secretary for Health/Acting Surgeon General of the U.S. Public Health Service. I would like to take this opportunity to congratulate you (the organizers of this Conference) on identifying the critical issues in the field and assembling such a broad array of experts to address them. I would like to present a brief view of the emerging framework for health that puts into perspective some of the aspirations of the Administration and to highlight several points with regard to prevention and occupational health. The goals are: 1. To improve the overall health status of our people. (This has been and will remain the National policy regarding health.); 2. To engage the Nation in the important effort of enhancing public health. (This is not reserved exclusively for the activity of the Federal Government or for State Governments. Public health has to be a cooperative effort that brings together all of the people engaged in the process of serving the people.); and 3. To pledge that health care will not be priced out of anyone's reach because of inflation. (It is clear that there are major tasks of bringing about economic recovery in our country. One aspect of this effort is to guard against the cost of health care not being allowed to rise beyond the reach of persons who need that care.) "How will these goals be achieved and what must change in the delivery of health and medical care in our society?" There are a number of real issues as well as perceptions that adversely affect the attainment of these goals: First, The cost of medical care is soaring and the public, industry unions and other elements of our society are becoming concerned. (They recognize the problem and are demanding a solution.); Second, There is a growing concern about the priorities that have been set. (For example, the evidence that preventive interventions are the most effective approach is overwhelming, yet medicine has not yet given that a high priority.); and Third, There is the perception that physicians do too much to too many people at too great a cost and that too much and too costly technologies are used. In view of the perceptions, we all must accept some changes and the challenges that needed changes will bring. A month before the new budget went to Congress, President Reagan went on nationwide television and told the American people that, "It is time to recognize that we have come to a turning point and we are threatened with an economic calamity of tremendous proportion and the [old business as usual treatment can't save us. Together we must chart a new course]." Now eight months down the road from this and a long Spring and Summer of discussion both within the Executive Branch and in the Congress, many plans and programs and concepts have emerged. The new course has been charted and the turning point has been made. Business as usual has been put aside and the Administration's leadership has been stretched and tested in putting forth a better approach with the reality that money is tight and that old habits of delivering care are difficult to change. The Congress has now given us a look at a new health budget that takes into account some of the harsh economic realities and that does make allowances for the persistence of familiar behavior. Against this background, it is now possible to begin addressing ways to provide health services to people at a price the Nation can afford to pay. There are without question difficult decisions involved but the Administration is committed to supporting and improving health care in America. It has been the President's contention that one of the principal causes of the inflationary spiral in the country was the steady and indefensible growth of the Federal budget. The problem stems from the fact that we have been living well, but beyond our means for nearly 30 years. Now we are discovering that there is a bottom to the barrel after all. It is possible for our society to run out of things like energy (oil), water or money. The health bills must be paid -- by Government, by insurance, by parents or by someone. Each year with a bigger shopping list and more money to spend the Federal Government went into the marketplace to buy. This action altered the

Jan 1, 1981