Home health care has proven to be an effective and efficient method of providing health care. It often serves as a cost-saving alternative to expensive institutional care, when such an alternative is medically appropriate. Home health care can help shorten the length of required hospitalization when it is properly used in conjunction with the hospital. For example, in 1970 the Denver Department of Health and Hospitals realized a savings of $515,729 in hospital costs for Medicare patients, through the early discharge of 292 patients from hospital to home care programs. Many tax dollars could be saved nation-wide by the provision of adequate home health care as an adjunct to hosptial care. An additional savings could result by attempting to prevent the need for hospitalization through the use of home health care. Home care is attractive to the patient because it is economical and provided in a familiar environment. This Subcommittee is examining a total health care system. Home health care is an important component of such a system. Its purpose is to promote, maintain, or restore health, or to minimize the effects to illness and disability. A home health care agency must be able to provide a full range of services in order to meet the needs of each individual patient and family through a plan of care. Some of the services which might be required in a plan of care include: medical care, dental care, nursing, physical therapy, speech therapy, occupational therapy, social services, nutrition counseling, homemaker and home health aide assistance, transportation. laboratory services, and medical equipment and supplies. By working with the patients' physician, our health agencies throughout the country are saving the taxpayers and patients many dollars that would be required for institutional care by meeting the patient's health care needs in his own home. In order to continue and increase these savings under a program of National Health Insurance, I would make these recommendations to you. 1. Prior hospitalization should not be a requirement for receiving home health services. 2. No limitation should be placed on the number of visits an individual is allowed to receive. 3. Home health services should be provided to a patient, on physician's orders, without a deductible or co-insurance. 4. Certification of need should be required to establish a new home health care agency as a means of containing costs. 5. A Federal regulatory agency should be established to set and enforce uniform certification standards which are at least equal to existing Medicare standards. 6. National League for Nursing-American Public Health Association accreditation could be accepted in lieu of Federal certification. 7. Funding for creation or expansion of home health care agencies and services should be appropriated by the Congress. This is especially important in underserved areas. I must re-emphasize the need for establishing comprehensive home health care services. Fragmentation of these services greatly reduces their effectiveness. Let me relate to you an example that points out the need for a comprehensive service capability: A 37-year-old mother, who is responsible for four dependent children, became a paraplegic as a result of a stab wound to her back. This patient receives medical supervision on an outpatinet basis from our County hospital. She is covered by Medicaid for medication and hospitalization. As a result of her confinement and mental depression, she has developed decubitis ulcers on her back and thighs. Plastic surgery has been performed twice to correct this, however the lack of a means to pay for home care equipment such as a gel pad and flotation mattress prevents recovery and makes recurrence likely. Incidentally, this patient has exhausted the number of visits covered by Medicaid. Fortunately, our health department is able to continue to provide care at the present time. In other localities, she might not have been so furtunate. Thank you very much for this opportunity to share our ideas with you. STATEMENT OF JUDITH A. RAHM, NORTH CAROLINA NURSES ASSOCIATION I am Judy Rahm, a member of the faculty of the School of Nursing, University of North Carolina, Chapel Hill, and I am here also as a representative of the North Carolina Nurses Association. I have worked as a public health nurse in the past and it is in the community health care delivery system that I supervise students clinically. My testimony is addressed to recognizing and designating nurses as health care providers under National Health Insurance. Therefore, my brief statements will support and reinforce what already has been said. Health, at whatever level, is a need expressed by all human beings. Care to meet the expressed health need is recognized as a right for all peoples. National Health Insurance, at present, is more imminent than it is remote. It is through this medium, NHI, that this right is expected to be fulfilled. Health care means and includes more than what is meant by medical care. While nursing represents the largest number of health care practioners in this country, nursing care is necessarily a part of health care. Nursing care is not limited to the services that nurses provide in a hospital or an acute care setting. My work as a public health nurse included providing health care in the home, in neighborhood clinics, in schools, in health departments, and in nursing homes. The health care I provided was not unique to me and the job that I had. Much of the care given by nurses in such primary care roles is both interdependent and independent, but not necessarily at the same time, of medical care. The nursing care given is based on nursing judgments derived from objective data provided by the clients and correlated with education and experience. We, the North Carolina Nurses' Association, recommend that all proposals for National Health Insurance: 1. recognize and designate nurses as health are providers, thus broadening the care provided to "health care" as opposed to "medical care"; 2. provide methods of reimbursement for services provided by nurses. With these recommendations, we believe health care will be delivered to a greater number of people; the client will be able to choose a provider of health care who is more satisfying and suitable to his needs; and finally, nurses and nursing will be recognized for the care they have long provided and will be more fully utilized throughout the health care delivery system. Thank you. DIXIE KITCHEN DISTRIBUTORS, INC., Knoxville, Tenn., July 22, 1976. GENTLEMAN: It is my understanding that this hearing is to give some input to the Committee as to what the public thinks should be included in National Health Insurance. If we have to have National Health Insurance I think it should be all inclusive as to all types of Medical care from simple hospitalization to Major Medical coverage. I think that Chiropractic coverage should be inclusive in the Act. Chiropractic is not a cure all but it does have its place'with other branches of the Healing Arts. I have gone to a Chiropractor, when I needed them, for several years. They give a service not provided by Medical doctors. They seem to get most back conditions well quicker at less cost, and without expensive hospital care. I provide Chiropractic coverage for my employees if they desire it. I think National Health Insurance should provide it also. I feel also that coverage should not be limited to spinal manipulation only, but also should cover X-Rays, laboratory work, and physical therapy, as is provided in the Federal Workmen's Compensation Act. I hope the Committee will follow this recommendation. Sincerely yours, J. PAUL RICE. STATEMENT OF MIKE STRATTON, C.L.U., KNOXVILLE, TENN. My name is Mike Stratton, CLU. I am a professional insurance man. Professional in that I earn my living from a sale and service of products that insure against a catastrophic loss of our non-replaceable living human assets. I do not sell or service insurance products for non-living physical assets such as plants, equipment, houses or automobiles. I consider myself a professional in the practice of my trade in that I make every effort to purchase for my client the product that most adequately meets his needs and desires. It is with this view that I testify before you today. I welcome this opportunity to again represent my clients. I will show some of their concerns about cost, the benefits available, the unfair omissions of coverage, the unavailability of coverage and in short, I wish to relay to you some of the injustices of the present system. I do not come here to talk for or against any national health care system specifically, but instead I want to speak about a program that will provide health care for the people of our nation. Since the larger part of my practice is of the group insurance area and since 75% of the people of this nation that are covered by insurance are covered through group insurance, I will address this area. If you also include those persons covered by a Blue Cross and Blue Shield Groups and the pre-paid group practice plan; about 85% of all health insurance benefits are paid by private insurors. And these are 1970 figures. Now, even a one man operation has group insurance available to him with benefits that rival some of the larger corporations. The uses of multi-employer trust for these groups have mushroomed since 1969. Now for the bad part. (1) Some contracts provide no coverage for "job related sicknesses or injuries". Thus a farmer (who is not eligible for Workmen's Compensation) whose wife has him covered under her group plan may be denied coverage for an injury due to farming because the group contract did not read, "coordinated with workmen's compensation". (2) An employer changes his insurance carrier pursuant to the free enterprise selection process. But one of his star salesmen is not working due to a heart attack. The new carrier says "no coverage for him or his family until he is actively at work". The old carrier says coverage for him only and for the heart attack only and only then for three months to one year. What should his employer do, penalize the rest of his employees for one man or exercise his free enterprise judgment to the benefit of all of his employees. It is possible that the employer could just pay all the premiumns and all of the expenses himself and pass the cost onto the consumers. I believe the economists call it inflation when the employer does it but they call it progressive legislation when the Federal government makes him do it. (3) I've seen many insurors that write their contracts not to cover any preexisting condition until a person could go treatment free for 90 consecutive days. Many employers and dependents could never meet that condition. Especially, since many states say that a pre-existing condition is any condition that the person ever had. (4) Let's suppose that you have heard enough of this talk and are fed up with your job and you just quit. Medical coverage? Oh! "I'd just convert my group insurance". Won't you be surprised when that policy says it will pay $10 per day in the hospital and $500 of other expenses and $50 toward an appendectomy and that's all? “Yes" the insuror says, "that's all". Free enterprise is a great system but its greatness depends upon the people having the knowledge of all the facts so that they can make intelligent choices. Employee groups are no longer intra-state they extend to every state in the nation. Individual state regulation is no longer adequate. It seems to me that we should first make every effort to use and regulate the competitive factor of our present system before we pitch the baby out with the dirty water. Our Federal Government has protected our free enterprise system against the abuses to labor by management during the industrial revolution; it has protected the consumer against the monopolies through anti-trust regulation and against the abuses of huge public welfare programs such as telephone, railroads and air travel by regulation. Is the welfare in the physical well-being of the people of our nation any less important? Should we do any less for the huge health care system presently operative? I beseech you please to reform and regulate but do not destroy and (attempt to) reconstruct. STATEMENT BY Bishop Walter F. SULLIVAN, RICHMOND, VA. I am Bishop Walter F. Sullivan of the Catholic Diocese of Richmond, Virginia. I serve on the Health Affairs Committee of the United States Catholic Conference and also as a Board member of five Catholic hospitals within my own diocese. I am also a member of the Committee for National Health Insurance. However, I am here with you today not as an official representative of a national or church organization; I cannot claim to speak for the American Catholic Bishops or for the Catholic population. Rather, I am here with you today as a concerned pastor and as a religious leader. I am the Catholic Bishop of a newly-aligned diocese of over 30 thousand square miles in the State of Virginia. Not the Virginia that can be seen in the suburbs across the Potomac from your Washington offices, but the other four-fifths of our state from the farmlands of the Eastern Shore to the coal regions of central Appalachia. From my travels and ministry in the different parts of our vast diocese, I can put very human faces with all the dimensions of the current crisis in our health care system-the migrant farmworkers of our Eastern Shore, the black lung miner of Appalachia, the trapped share-cropper of southside Virginia, the despond ent unemployed and the fearful marginally employed of our central cities. But I know that you, too, have names and faces to go with the problems and injustices that we face in many aspects of our current health care system. There is no need for me to elaborate greatly on the crisis of obtaining adequate health care today for the poor, for the oppressed and even for the middle-class. Nor is there a need for me to elaborate greatly on the vast inequities in the quality of health care received by different segments of our society. Rather, I wish to convey three points to you based on my experience as a pastoral leader of a very diverse geographic area. First of all, I wish to convey my belief that today's crisis in health care is related to great inequities in our socio-economic system. Those in our society who are most in need of health care and unable to attain it continue to face many structural injustices. We cannot respond adequately to these problems simply with more highly-developed medical technology, nor with more health care personnel or facilities. Rather, we must confront the underlying structures that will make adequate health care a reality for all our people. If we believe that the right to health care is implied in the very right to life itself, then we must act to create the social structures that will guarantee and protect this right. We must advocate legislative change: That will make health care financially accessible to all people by guaranteeing payment for health care services without coinsurance, deductibles, or high premiums; That will make health care physically accessible to all our people by encouraging a more equitable distribution of personnel and facilities; That will provide people with a sense of involvement and self-determination in the health care system by having broad citizen participation on all levels of planning and policy developments; That will make all forms of health care accessible to people, most especially forms of diagnostic and preventive care which can eliminate future suffering and great cost; That will provide the same caliber and quality of health care services for all people regardless of their economic or social status. For too long, these goals have been part of "the great American dream," ideals which have never been translated into reality. I am convinced that such changes can be brought about only by a significant program of national health insurance. Consequently, my second concern is to convey a strong sense of urgency that the Congress address the issue of national health insurance with seriousness and speed. In expressing this sense of urgency, I have in mind particularly the concerns and interest of the voiceless, the oppressed, the least powerful in our society. Physicians and health care professionals have concerns and interests regarding proposed legislation: they can, they will, they do voice those concerns and make themselves heard. Insurance corporations have concerns and interests regarding pending legislation: they can, they will, they do voice those concerns and make themselves heard. It is my concern as a religious leader to raise up the interests and needs of those who have so few to speak on their behalf. The provision of health care in the poorest communities of our country is not improving. Rising costs are making adequate health care less and less accessible to more and more people in our society. This brings me to my final point, which is that I sense a growing readiness on the part of all our people for a more comprehensive and equitable program of national health care. Recent opinion polls indicate that American citizens are even willing to pay higher taxes to achieve better health care, contrary to public opinion regarding government spending in other areas. I believe it will not be necessary to spend more money than we are currently expending in our wide array of public and private health care and insurance. Nonetheless, this expression of public opinion is a strong index of the readiness of the American people to move towards a comprehensive program of national health insurance. You have before you several bills and different approaches to a program of national health insurance. It appears to me that the Health Security Act (S. 3/H. R. 21) is the best basis for a socially just system of national health insurance for our country. No other bill provides as much coverage for as many people in as equitable a fashion as the Health Security Act. Only a comprehensive program of this type can meet the health care needs of all our people. I hope you will act with the urgency and readiness that is needed. In closing, I would thank you for your time and consideration, especially for holding these field hearings which make it possible for more of our people to be heard. Hon. DAN ROSTENKOWSKI, TENNESSEE DENTAL ASSOCIATION, Chairman, Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, Longworth House Office Building, Washington, D.C. DEAR SIR: The membership of the Tennessee Dental Association appreciates your Sub-Committee on Health coming to Knoxville, Tennessee to conduct hearings on National Health Insurance and related issues. It is most commendable the committee would give the time and effort for this procedure to obtain testimony on these vital issues at the all important community level. As the state organization which represents 1,600 members, we are not requesting time on your busy agenda. However, several of our members in the Knoxville area will be appearing to present information we feel certain will be of interest and value to the Committee. We do wish to document for the Committee the fact that the Tennessee Dental Association does concur completely with the policy statements on these issues presented to the Committee in Washington, November 18, 1975 by Dr. Paul Kunkel, Chairman, Council on Legislation of the American Dental Association. We have every confidence these positions will receive due consideration from the Committee in their deliberations. Sincerely, GIBBS M. PREVOST, D.D.S., President. ED. NOTE: A letter identical to the one above, dated March 22, 1976, was also received from: FAUSTIN N. WEBBER, D.D.S., President. STATEMENT OF TENNESSEE DIETETIC_ASSOCIATION, DOROTHY P. BEVINGTON, R.D., PRESIDENT I am Dorothy P. Bevington, a registered dietitian. I am a nutritionist with the American Diabetes Association, Middle Tennessee Affiliate and a nutritionist in private practice. Today, as president of the Tennessee Dietetic Association, I am speaking for the 476 registered dietitians in our state to strongly urge you to include nutrition counseling as a reimbursable service in a national health insurance policy. The American Dietetic Association defines nutritional care as "the application of the science of nutrition to the health care of people. Nutritional care is not complete without dietary counseling. Dietary counseling is the process of providing individualized, professional guidance to assist people in adjusting their daily food consumption to meet their health needs. The objective of dietary counseling is a modification of behavior. This objective is accomplished when individuals understand how to make wise food choices." Recently the Department of Health, Education and Welfare has published "Forward Plan for Health, FY 1977-81." Major health problems in the United States are outlined in this document with recommendations for solutions. The importance of nutrition to health appears in several sections of this plan. În Appendix II of this document is stated "nutritional care, including dietary counseling, should be integrated into the preventive, diagnostic and restorative health services of all the PHS programs for all family members." Dietary and nutritional factors have been strongly implicated in many diseases. For example, there is a strong relationship between obesity and such conditions as cardiovascular disease, hypertension, and the early onset of symptoms of diabetes. This is a concrete example of the indication for preventive nutritional care. Preventive nutritional care decreases the effects of poor nutrition as a major contributing factor in the above conditions, and is much less expensive than remedial care. Other health problems influenced by poor nutrition include low birth weight infants, birth defects, mental and physical retardation, anemia, and dental disease. Dietary modification is a major factor in recovery from certain illnesses or in lessening some of the factors contributing to long-term health problems. A good example of this is diabetes where diet is basic in management of the disease. With a well regulated daily regimen with a well planned diet suited to the individual, the diabetic can lead an active life with rare crisis and few hospitalizations. Poor regulation including improper diet leads to frequent hospitalizations, chronic |