Report to Congress & the Nation On Health Care (Reel 1)

National Public Radio's report to the people and the Congress on the health care crisis. The following hour long program presents a taped summary of National Public Radio's six public hearings on problems facing America's health delivery system. In Boston San Francisco New York Philadelphia and Arbor Michigan and Atlanta. We heard many opinions expressed. Some more from experts. Others were from simple people who have had problems obtaining health care. Some tried to give an objective analysis of our health care problems. Others admittedly represented special interest groups during the past few weeks. We have gone through the total of 36 hours of testimony looking for recurring themes. But we also look for the new and unusual idea the sort of thing that hasn't been widely discussed in debates over national health insurance. We've put those themes and ideas into this one our radio report. Members of Congress also receive the report as the president of National Public Radio. Donald Quayle presents a transcript of this program to the House Ways and Means Committee. Dan Quayle will not be advocating any particular legislation before the Ways and Means Committee. That is not our function in

this case National Public Radio is acting as a conduit to carry the views of a large variety of Americans to their representatives. But that was only a secondary goal for many listeners of National Public Radio's health care hearings where their first and only exposure to the issues involved in America's crucial debate over the future of our health delivery system. We hope it was informative. We hope it will stimulate them to make their views known in a few minutes. Barbara Newman narrates National Public Radio's report to the people and the Congress on the health care crisis. Now a portion of Don quails introduction prepared for the House Ways and Means Committee. My name is Dan Quayle. I'm president of National Public Radio which is the noncommercial radio network with 114 stations broadcasting in 34 states Puerto Rico and the District of Columbia. We do not appear here today as experts on the intricacies of national health insurance nor do we come here to espouse one of the proposed bills. We appear here

today to transmit to you the findings of the NPR health here. Our purpose in holding them was twofold first because the health crisis is undoubtedly one of the most important issues on the legislative agenda of this body. We felt that it was important to inform people regarding the complexities of the proposed national health insurance legislation to enable them to participate meaningfully in this public debate. Secondly it was our purpose to facilitate communications between those most concerned about health consumers providers and insurers and those who will ultimately enacted health legislation. Members of the U.S. Congress. We realize that this committee has permitted testimony from all who desire to appear here. However the fact remains that the average citizen is not the customary congressional witness. So it is our hope that we can transmit to you today knowledge which you otherwise

might not have received. I think that the primary function which we can serve is to humanize the debate these several weeks. You have been hearing testimony regarding the health crisis testimony replete with statistics of the soaring costs of health care which command seven percent of the gross national product of the inaccessibility to health care of the health manpower shortage and all uneven quality of care. Well statistics are a somewhat cold commodity devoid of the urgency of human experience. What we found during our health hearings was a widespread concern about the health crisis and what we heard was the human agony which people experienced at the hands of the health system. According to their you know Research Department 60 percent of all personal bankruptcies in America are directly attributable to health cause. But beyond the bankruptcy These are the millions of people who simply do without health care except as a

last resort. We delay treatment because they cannot afford it. We do not fill their prescriptions because of the cost of drugs. We must allow minor health problems to become major because in our health industry today the cash register sits next to the appointment book. I am alone with the court my three children one of whom is an asthmatic. Nearly every year of his life he must be hospitalized with pneumonia medical insurance for the whole family was cancelled on the grounds that we did not list the child as much as a preexisting condition when in fact we did not know we had asthma. This left us unexpectedly in debt for several hundred dollars. We had been a middle class taxpaying family who believed in yearly medical checkups and trips to the dentist. But from that point on our economic situation and level of health care deteriorated. One of the worst effects of the situation was of course psychological. We found that we lost our dignity

when we lost our money. Health care in this nation is in crisis. I speak to almost any person in America and you get a health horror story you hear about families with savings wiped out about an availability and shoddy quality of care and a growing resentment against health providers. The image of the Doctor has become somewhat tarnished. Chairman Wilbur Mills of the House Ways and Means Committee recently opened his committee's health earrings with the remark that Americans are increasingly resentful of trying to find their way through a maze of referring practitioners to find services for which a higher and higher part of the family budget must be used. And this without confidence that the care finally obtained is appropriate or of high quality. Congress will undoubtedly pass a health bill within the next few years. A Harris poll found public support for passage of national health insurance running at almost two to one. And most politicians on Capitol Hill are in favor of one of the national health insurance proposals pending before

Congress. The question is what kind of bill will be passed and how adequate Will it be in ending the health crisis because health is such an important issue. And because the House Ways and Means Committee has not permitted live coverage of its health hearings. National Public Radio this past September sponsored a series of six public hearings on health care and national health insurance with the belief that the public should be apprised of the differences in the pending legislation and that legislators in turn should be apprised about the wishes of the public. We went to San Francisco to Boston to an Auburn New York Philadelphia and Atlanta as participants we invited those most concerned with the issue of health health consumers insurers physicians and hospital officials as well as those who will enact national health legislation. U.S. Congressman. One of the most insistent things throughout the hearings was the hardship brought by rising health costs. The two people you heard at the beginning of this program Einar moment of

the California Teamsters Union and Yves Mapes a Los Angeles housewife testified at our San Francisco hearing. National health costs seventy billion dollars a year are rising at twice the rate of the Consumer Price Index. According to the Department of Health Education and Welfare medical expenses will rise 50 percent in the first half of this decade and the rise in the health share of the gross national product will be as great as the rise in defense spending at the start of the Vietnam War. One health planner characterizes health as the Vietnam of the 1970s. He sees billions and billions of dollars going into a quagmire at the NPR New York Health hearing. Surely Kronberg director of the neighborhood service councils of the New York hotel Trades Council recounted some incidents of high medical costs in a discussion with New York Republican congressman didn't read. I have one bill here where women intrude on this but only a very and I know I am was the charge to pick on Rabiya was three

hundred and ninety dollars. Interesting we're not laboratory services $127. We are not. Little probe right down these laboratory records they say a list of all of the names and we understand that there is now a computer through which they put these few drops of blood and cannot train for a very very small thing. Now do I make sure I get you know $15 $20 $25 whereas in fact these tests cost them very very little actual room charges there $75 for one point for less than 24 hours six hours. Christ pays $80 for maternity confinement and is now increasing this to $100 but the average bill is over $600 and I have a very interesting bill that was brought in by one of my

workers this week. His wife delivered prematurely at home. Policeman was called he got the ambulance she was brought to the hospital she was in a spittle for three days she had already delivered the baby. Here's a pill for this. Three days and it was $299 for the baby. So you now have a baby becomes a patient $219 for the baby and when you're sixty two hours and 50 cents from the mother. Now this is for three days and here are the two bills and Blue Cross paid $80 peer pressure. I don't I don't see where people judgments along with anything I know that I am a friend. Millions of dollars fighting against Medicare and they've been the greatest beneficiary beneficiary of Medicare. Insurance

companies haven't done anything over the years to the rising cost and insurance companies and in some cases such as what your doctors have certainly not done anything about questioning courses by the doctors or hospitals. That was surely Kronberg at our New York hearing. The greatest increase in health spending has been in hospital rates they have risen five fold in the last four years and now hover at about $100 a day. The New York Times states that some projections put average hospital room charges at a thousand dollars a day by 1981. Critics of the health insurance industry charge that private insurance companies have not acted effectively to keep these costs down. Much of the criticism of the health industry is directed at Blue Cross which pays about 50 percent of the nation's hospital bills. Blue Cross is nonprofit and tax exempt. But some think that it's very institutional structure

perpetuates the interest of the hospitals at the expense of the health consumer. The American Hospital Association actually owns the Blue Cross trademark and in most of the nation's 74 local Blue Cross plans the board of directors preponderantly represent hospital and physicians interest. A key area of debate then a national health insurance will be the role of the insurance industry of the major national health insurance bills pending before Congress. Only the Health Security Act introduced by Senator Edward Kennedy would eliminate the insurance industry from health care under the Kennedy legislation cradle to grave health coverage would be available to all U.S. residents. It would be administered by the federal government. The administration's health insurance partnership backed retains the insurance industry as fiscal intermediary in health care. It actually mandates that all employed persons months purchase private health insurance. The administration has proposed tighter regulation of the insurance industry but would leave enforcement up to the states.

They amaze many credit and the health insurance associations health care bill both provide tax incentives for the voluntary purchase of private health insurance. There are a great number of health experts who question the advisability of retaining the private insurance industry under national health insurance. From Boston John a lawyer a former Massachusetts rate commissioner. And from Ann Arbor Dr. SJ Axelrod professor of medical care organization at the University of Michigan. First O'Leary I have considerable question in my mind as to the role that the health insurance industry should play in a national health assurance program. I cannot help but express extreme concern over the lack of effort on the part of the insurance industry generally speaking in the past. To try and influence the organization of the health care delivery system

in order to bring about somewhat more efficient and economical delivery of service the very widespread interest in health insurance as evidenced by the numerous proposals now before Congress. It seems to me is largely a response a political response to the high and rising costs of medical care primarily and also a response to the inadequacies of private that is to say voluntary health insurance as a means for handling these costs. A private enterprise ethos if you will of the. Health service industry sees further expression in the fact that private commercial health insurance dominates the field. And this kind of dominance results in considering health insurance not so much a means of providing adequate service but

rather a means of paying bills. Along with this fiscal view of health insurance of course it is accepted that there will be payments levied on patients who regard themselves as insured but payments through deductibles and co-insurance which very often act as important deterrence to the receipt of care. Oh the fiscal view of insurance concentrates on large medical bills which relatively few people have very large medical bills that is. And in general the whole coloration of our health insurance industry takes the view that health insurance should be a mechanism for exchanging dollars rather than for providing necessary and adequate health services. That was Professor Axelrod of the University of Michigan from California Labor leader.

I know my own for 25 years we have gone to the bargaining table with employers and come away with more and more money to pay for health care money that was needed for wages and other benefits for 25 years we have given the private insurance industry every opportunity to work. We have put our hard won health benefits into their hands asking them to restrain costs and to exercise some control over the quality of care provided in hospitals and physicians offices. The record of achievement by the insurance industry is marked by failure or disinterest neglect of health needs and certainly profiteering. California unions are now pumping 1 billion dollars annually into the health industry through a negotiated benefit. Our estimates make us believe that at least 20 percent of the money negotiated for it are contra. X does not go to provide health care. It goes for coffee or for a lot of other things that do

not provide health care. That's far too high a cost in good faith. Labor has tried to level the private insurance industry and try to live with voluntary methods of policing quality. But the experiment is over. We now want and need national legislation that will publicly manage our dollars and exercise public employee over the health industry. On the other side of the issue are representatives of organized medicine the insurance industry in the hospitals who wish to retain the private health insurance industry. These views were best expressed at our San Francisco hearing by William Wayland executive secretary of the California Hospital Association and Dr. Roberta Fenlon president of the California State Medical Society in Ann Arbor Edward Connors director of the University of Michigan hospital spoke for the hospital interests in favor of retaining the insurance industry and health care. First William Wayland. Despite the criticism of the health industry it has been eminently successful in

fulfilling its basic goal the provision of good quality health care and a show system of health care. Let's be based on the insurance can jam get it every driver in California is required to have automobile insurance. Everyone would be required to carry adequate health insurance. I believe that government's role in financing should complement and strengthen the basic health insurance mechanisms rather than replace it. I acknowledge without question the health insurance needs to be strengthened. It needs to be required or assured for all citizens and it needs I believe to be subject to tighter regulation. But I think the record in many respects of health insurance in this country has been remarkably good and I would disagree with some of the former speakers that implied that all they are interested in these

are health insurance now that all they are interested in is just the financing portion in trading dollars. And I think sitting from my perspective as a provider there's been a fair amount of progress. Probably more progress than in any other sector that I know of. Prompted by particularly the blues in health insurance on such important issues as the appropriate use of the hospital and cost containment and control. And from my view I think it would be a tragedy. As a public policy to dissolve this vital link in the system that was Edward Connors director of the University of Michigan Hospital in Philadelphia Robert Carpenter vice president of the Penn Mutual Life Insurance Company critic the proposed national health insurance bills for the insurance industry's viewpoint. The health insurance industry's plan does not attempt to promise more than can be provided. Establish a whole new governmental bureaucracy create huge new huge new

demands on existing facilities by promising quote free care or but impose huge new taxes on the constituency which is already reeling from tremendously increased taxation in recent years such as the Health Security Act program sponsored by Sen. Kennedy does. Neither does it force a substantial financial burden. On employers or provide different standards of care for different classes of citizens which the administration proposal includes. It covers a broad range of the problem as contrasted with the limited approach to covering catastrophic health care costs. Under Senator Long's bill does not place its complete reliance on a yet relatively untested organizational structure for delivering care is proposed by the American Hospital Association of America plan and it does not rely primarily upon tax incentive incentives for private health insurance programs as proposed by the American Medical Association. Thank you very much Mr. Carpenter. The report of the staff report of the Senate Finance Committee of 1970 stated carea performance under

Medicare has been the majority of instances been erratic inefficient costly and inconsistent with congressional intent. Unquestionably many millions of dollars of public funds have gone to subsidize carrier inefficiency. In view of this why should we retain the insurance industry and national health insurance legislation. That's always an interesting question. The health insurance industry. Does he have to stand on its record. I believe that when any program is inaugurated you're going to have these type of problems. I think that if you were to move away from private insurance toward the direction of the national security health program I became basically candid you would find that the governmental bureaucracy to be created would be so much tremendously more inefficient that it would have much greater problems insurance executive Robert Carpenter found a surprising ally in Pennsylvania State Insurance Commissioner Herbert Denver.

Dr. Denton Berg is a vociferously reformer and critic of the health insurance industry. But surprisingly refused to endorse the Kennedy health security bill. He question the advisability of administering national health insurance through a governmental bureaucracy. Public confidence must be re-established in the federal bureaucracy before great additional responsibilities are entrusted to it. The Kennedy proposal the National Health Security plan scraps private health insurance altogether. Thus the proposal scraps good in bad health insurance companies without distinction. It is true that private health insurance is not performed effectively but it is also true that we have not subjected it to effective regulation. We are trying to make up for the shortcoming in Pennsylvania. The Kennedy bail in view of the deficiencies of private health insurance would therefore abandon private insurance and substitute government insurance. Medicare demonstrates government insurance is not the whole answer and it can be as non satisfactory as private insurance. Many nonprofit insurance companies for example are doing a better job than Medicare and controlling cost

in quality. Here you see bureaucratic distortion of the intent of Congress and the establishment of Medicare program. Congress intended Medicare to pay for the necessary costs of patient care of our senior citizens. The bureaucrats somehow distorted the congressional intent and turned Medicare for the aged into an uncontrolled educational subsidy for the medical profession. Medicare However a lot of all in its social purpose has greatly contributed to our runaway inflation of medical costs. Medicare which should have been part of the solution instead has become a central part of the problem of our health delivery system. Medicare not only contributes to the problem but attempts to veil its operations in a cloak of secrecy. We asked for certain studies of Medicare fiscal intermediaries and were turned down on the basis of executive privilege. The Medicare people thought the studies might be quote misinterpreted unquote. Others were refused access to the studies as well. We have finally obtained copies of the study only for our own use but they still have not been made public.

How can we entrust further responsibility to a government agency that now betrayed its public trust. How can we extend Medicare to a national health insurance scheme when Medicare now fails to perform its central function of cost and quality control over medical and hospital care. The key issue is not so much the mixture of government and private insurance as the mixture of cost and quality controls in a system that emerges. Pennsylvania state insurance commissioner Herbert dent and people often love quality and cost together when they discuss the health crisis. For example proponents of each of the national health insurance bills claim that their bill will provide cost controls while upgrading the quality of care. New York City under the direction of its deputy health commissioner Dr. Loeb Ellen is embarked on a unique program of auditing cost and quality of care rendered by private practitioners to New York's Medicaid patients. Dr. Bell and staff actually goes into doctor's offices randomly pulls patient files and examines medical

records. This is the only medical audit of its kind in the nation and has aroused great resentment from physicians. Dr. Bell and is one of the most outspoken critics of poor quality medicine and the ineffectiveness of medical peer review medicine is self-regulated traditionally doctors have argued that only doctors can regulate quality and costs. Dr. Bell and doesn't dispute this point. But he does feel that peer review must involve outside physicians who don't have a stake in protecting their colleagues. He is not optimistic about the quality controls within any of the national health insurance bills. In an attempt to meet the health care crisis every proposal deals with financing manpower and improvement of the livery system. Regrettably every proposal also bypasses quality control of services provided to patients. For example the major emphasis of the president's program in the Kennedy bill are cost controls and minimum standards.

The American Hospital Association plan stresses cost controls and peer review. And the health insurance industry plan provides for state control and controls on or utilization through patient payments of deductibles and co-insurance. Quality control which includes the availability acceptability and nature of care is defined as a system for verifying and maintaining a desired level of quality in a product or process by careful planning use of proper equipment continued inspection and corrective action where required. Quality is the prerequisite element of cost control. Without it any cost is too much because the major abuse in dollar value is only utilization of service. Enormous sums of money can be saved by constraining all we can. Not only within private offices but particularly within hospitals. People who emphasize how much auditing of

health care services cost the government. Formed a wish to keep others misinformed. At present the New York City Department of Health is saving and recovering two and a half to three dollars for every auditing dollars spent. There is only one spot to place ultimate operating activities of publicly funded health care services. That spot is a public agency. This means that the public agency must have courage. Many of our public agencies are craven as well as technically incompetent. After the instructive experience of the past five years with Medicare and Medicaid it is in Congress that anyone dare suggest to legislators that the appropriate place for auditing is exclusively aid within professional societies or be within the physical intermediary. They both are too intimately associated with their constituents to be granted the ultimate responsibility of either quality control or cost control. It

is an administrative truism that evaluation must be isolated from operations. For the federal government to violate this principle by funding evaluation of health care services primarily in professional societies and or in fiscal intermediaries it is to replicate the folly that has bee deviled Medicare and Medicaid since the mid 1960s. Since 1965 we all should have learned that tokenistic regulation of quality and cost of health services always discredits any publicly funded health care programs. Dr Lobelia New York's deputy health commissioner.