[Congressional Record Volume 140, Number 14 (Friday, February 11, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                   FOURTH DISTRICT HEALTH CARE REFORM

                                 ______


                          HON. DAVID E. PRICE

                           of north carolina

                    in the house of representatives

                       Friday, February 11, 1994

  Mr. PRICE. Mr. Speaker, on January 20 I conducted a health care 
reform and community meeting in Raleigh. The purpose of this marathon 
session, which went from 9 a.m. until 10:30 p.m. with brief breaks to 
take nourishment, was to bring the national health care debate home to 
North Carolina--to assess the strengths and weaknesses of the health 
care system in our part of the State, to examine the stake we have in 
reform, and to discover what positive contributions we might make to 
the national debate. After hearing from five panels on special health 
care topics throughout the day, the community meeting provided a useful 
opportunity for individual constituents to voice their concerns. Over 
50 constituents took the microphone, often recounting experiences that 
put a human face on this daunting policy challenge. The enthusiastic, 
sometimes heated participation of my constituents suggests that this is 
indeed a front-burner issue in North Carolina. Over 200 people attended 
our morning and afternoon sessions, and over 250 people took part in 
the evening's community meeting.
  Throughout the day, several moderators joined me and an overflow 
audience at North Carolina State University's McKimmon Center in 
receiving testimony from panels of expert witnesses on children's and 
adolescents' health needs, health care innovations, the needs of the 
uninsured and underserved, small business concerns, and alternative 
reform and cost containment strategies.
  Joining me in moderating the five panels were Lt. Gov. Dennis Wicker, 
North Carolina House of Representatives Speaker Dan Blue, Health Care 
Financing Agency (HCFA) Deputy Administrator Dr. Helen Smits, and North 
Carolina Division of Medical Assistance Director Barbara Matula.
  The day's testimony left little doubt that American health care, at 
its best, is the most proficient and innovative in the world. But we 
also found ample evidence that this care is not being delivered 
equitably or at acceptable cost to all of our citizens. Part of the 
solution, almost all witnesses stressed, is insurance reform, so that 
basic coverage is not jeopardized or priced out of reach when one moves 
or changes jobs or gets sick. But many also stressed that insurance 
reform is not the total solution. Insurance coverage may be of little 
benefit to families who have no medical providers or facilities nearby 
or have no knowledge of the basics of health care or of what services 
are available to them. Efforts at education and outreach must be 
stepped up, and both patients and providers must pay more attention to 
healthy lifestyles and preventive care.
  We also heard a great deal of testimony about the progress we have 
made in discovering new drugs and therapies, reorganizing the delivery 
of care and controlling costs, and reaching underserved populations--
and of how reform must nurture such innovations and preserve the good 
coverage and freedom of choice that many people already enjoy. It also 
became clear that while no perfect solution is available--if it 
existed, we no doubt would have discovered it by now--the status quo 
cries out for change. The President and Mrs. Clinton have successfully 
brought this issue to the fore, but a great deal of debate and hard 
work still lie ahead.
  Our first panel focused on the health needs of children and 
adolescents. John Niblock, president of the North Carolina Child 
Advocacy Institute, and Dr. Stephen Edwards, a prominent Raleigh 
pediatrician, gave an alarming health profile of North Carolina's 
children--some 300,000 of whom are without health insurance--and 
outlined what changes in health policy are required to address their 
needs. Dr. Michael Durfee and State school nurse consultant Marilyn 
Asay portrayed adolescents as the most underserved population and the 
most difficult to reach, and described their respective outreach 
efforts through Wake Teen Medical Services and school-based clinics. 
Paul Hildebrand, executive director of the Alice Aycock Poe Center for 
Health Education in Raleigh, told of the enthusiastic reception that 
the modern, multimedia presentations of the Poe Center have had from 
North Carolina school children. Kathy H. Richardson, maternity care 
coordinator for the Baby Love Program at Twin County Rural Health 
Center in Hollister, NC, told of the innovative ways this program had 
reached out to poor women in a rural county to ensure that they 
received proper maternity care.
  The second panel, health care and innovation, brought together a 
number of different ideas that have worked well in North Carolina and 
deserve wider dissemination. Gale Johnston Adcock, coordinator of 
primary care services and wellness education at SAS Institute, told how 
95 percent of SAS's employees and families took advantage of the 
company-based wellness program and of the positive effect the program 
had on company health care costs. Dr. Robert C. Bast, Jr., director of 
the Duke Comprehensive Cancer Center, highlighted recent advances in 
cancer prevention and treatment and stressed the importance of 
sustaining vital research. Dr. Leah Devlin, director of the Wake County 
Health Department, told of several innovative ways that the county had 
put together partnerships and combined various sources of local, State, 
and Federal moneys to deliver public health services. Dr. E. Harvey 
Estes, Jr., director of the Kate B. Reynolds Community Practitioner 
Program of the North Carolina Medical Society Foundation, told of the 
foundation's program to recruit and retain primary care physicians for 
underserved areas in North Carolina. Dr. David Goff, a pediatrician, 
discussed the positive ways that managed care systems and primary care 
physicians can expand access to care and help contain costs. Meg 
Molloy, nutrition program director of the Sarah W. Stedman Center for 
Nutritional Studies at the Duke Center for Living, emphasized the 
importance of nutrition education in encouraging healthy lifestyles and 
of nutrition therapies as a cost-effective treatment of heart disease 
and other disorders. Dr. James E. Niedel, director of Glaxo Research 
Institute, stressed the promise of pharmaceutical research in 
developing cost-effective treatments. Bill Remmes, administrator of 
Rural Health Group, Inc., related how a network of five medical 
offices, a nursing home and rest home, apartments for the elderly, and 
a senior center had been built and organized over a decade in two rural 
counties.
  Our third panel dealt with health care and small business. Two North 
Carolina businessmen--Robert B. Allbert, owner and operator of 30 
Precision Tune shops, and Joe Stanley, owner of Joe and Moe's Auto 
Repair in Shallotte, NC--told about the special problems of small 
businesses in obtaining affordable health care coverage for their 
employees but also sounded a warning about the possible costs of 
reform. Jim Long, insurance commissioner for North Carolina, discussed 
the initiatives his department had used to expand coverage throughout 
the State. Parham McNair, representing the Independent Insurance 
Agents, told of the special services independent agents provide as the 
link between insurance providers and small businesses. Elizabeth F. 
Kuniholm, speaking both as a small businesswoman and representative of 
the North Carolina Academy of Trial Lawyers, discussed the issue of 
malpractice reform. Harrison J. Kaplan, counsel and government 
relations manager for Kaiser Permanente, discussed business 
participation in health maintenance organizations and their success in 
rendering cost-effective health care services.
  On panel four we turned to competing reform proposals and their 
implications for North Carolina and the Nation. Brad Adcock of North 
Carolina Blue Cross/Blue Shield, Moses Carey, Jr., executive director 
of Orange-Chathman Comprehensive Health Services, Inc., Robert J. 
Greczyn, Jr., chief executive officer of the Carolina Physicians' 
Health Plan, Dr. Donald T. Lucey from the North Carolina Medical 
Society, and Eric Munson, executive director of the University of North 
Carolina Hospitals, each diagnosed the strengths and weaknesses of the 
present system and presented their priorities for reform. Christopher 
J. Conover of Duke University's Center for Health Policy Research and 
Education gave a careful analysis of how and why ``managed 
competition'' could work. Joe Graedon of the syndicated column and 
radio show ``The People's Pharmacy'' stressed the importance of 
outcomes research and other means of informing and empowering consumers 
to successful reform. Pam Silberman, project director with the North 
Carolina Health Access Coalition, set down the elements of successful 
health care reform as identified by the coalition she represents.
  Our fifth and final panel, ``Underserved Health Care Needs,'' focused 
on three key areas of need: Older Americans and long-term health care, 
mental health, and low-income rural and urban populations. Martha 
Brown, with the Home Health Care Association of Chapel Hill, told of 
the value and cost-effectiveness of home-based care. Travis H. 
Tomlinson, Jr., president of Whitaker Glen, a 96-unit comprehensive 
retirement community in Raleigh, discussed several aspects of President 
Clinton's proposed health care reform plan and emphasized that home-
health care and nursing home care served two distinct populations. 
Bennett Cotten, a clinical social worker representing the North 
Carolina Association of Social Workers, and Dr. David Smoot, 
representing the North Carolina Psychological Association, discussed 
the extent of mental illness and the benefits of including adequate 
coverage in any health care reform plan. Maureen Darcy, certified 
nurse-midwife, and Torlen L. (Tork) Wade, associate director of the 
North Carolina Office of Rural Health and Resource Development, 
discussed the difficulties in attracting and retaining primary care 
providers in rural areas and the efforts underway in North Carolina to 
do so. Barbara Zelter Earls, representing North Carolina Fair Share, 
stressed the importance of securing comprehensive coverage for all 
income groups.
  Helen Smits of the Health Care Financing Administration, representing 
the Clinton administration, joined me for the evening community meeting 
at which over 50 citizens told their stories and expressed their views. 
In policy preference, they ranged from some who thought the Clinton 
plan not comprehensive enough to others who would repeal even Medicare 
if given the chance. Several farmers protested the singling out of 
tobacco for a hefty excise tax increase, wondering why other products 
with associated health care costs were not included. Some spoke for and 
others against the inclusion of abortion in the basic health plan. 
Small business owners expressed apprehension about the expense of 
coverage, although some argued for leveling the playing field between 
businesses that did and did not cover their employees. Some people 
reported having good coverage and positive experiences with local 
hospitals and doctors, and warned against disrupting those 
relationships. But others recounted losing their coverage after serious 
illnesses and having to fight for payments for procedures they thought 
were covered. Many were willing to tell intensely personal stories, 
which underscored the high stakes we have in reforming the system but 
also in getting it right.
  A full transcript of the health care forum is being prepared and will 
be distributed to the congressional committees of jurisdiction and to 
others who are interested. I am grateful to the many panelists and 
other constituents who participated. I believe that all of us there 
came away with a better understanding of the importance of health care 
reform to North Carolina and the Nation and the implications of the 
policy choices we face.