| URGE STATE HEALTH DEPARTMENTS, STATE ECONOMIC
DEVELOPMENT BOARDS, CONCERNED STATE AND FEDERAL
AGENCIES, STATE PRIMARY CARE ORGANIZATIONS AND THE
PRIVATE SECTOR TO COME TOGETHER AND SUPPORT THE
DEVELOPMENT OF A SYSTEM OF AGRICULTURAL LABOR WE CAN BE
PROUD OF; ” HEALTHY HARVESTERS ”.

co

51
AS A PEDIATRIC SURGEON, CARE OF CHILDREN HAS BEEN MG@63-QF
Pho FStownL

- MY CAREER.

| WORRY ABOUT THEM AT ALL LEVELS AND AM ESPECIALLY

CONCERNED ABOUT THE FIVE MILLION WHO LIVE IN POVERTY.

52
1 HAVE A CONCERN THAT WE MAKE OUR SYSTEM WORK IN SUCH A
WAY THAT CHILDREN RECEIVE THEIR BASIC NEEDS IN THEIR OWN
COMMUNITY, BUT WHEN NEEDED, THE KNOWLEDGE AND SYSTEM
MUST EXIST TO SEE THAT THOSE WHO NEED IT FIND THEIR WAY TO

      
  

SPECIALIZED PEDIATRIC CARE.

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53
| AM EQUALLY CONCERNED ABOUT HOW FAMILY PHYSICIANS CAN
BURG Eo Mae |
ACQUIRE THE GCONTINGING KNOWLEDGE THEY NEED TO OPERATE

IN TODAYS ENVIRONMENT.

| KNOW THIS ANSWER IS NOT JUST OUR LEARNED JOURNALS. |
THINK IT IS PROBABLY SOME SORT OF INTERDISCIPLINARY HEALTH
EDUCATION PROGRAM RELYING HEAVILY ON AUDIO & VIDEO

TECHNOLOGY.

54
| ENCOURAGE THE AGENCY FOR HEALTH SERVICES RESEARCH AND
Veveror?
POLICY TO DO THE NECESSARY RESEARCH TO -S@ THE
KNOWLEDGE BASE FOR PROGRAMS TO MEET THE SPECIAL
INFORMATION AND CONTINUING LEARNING NEEDS OF RURAL

FAMILY PHYSICIANS.

ao”

55
THERE IS A GROWING CONCERN ABOUT THE SPREAD OF AIDS AND

SUBSTANCE ABUSE IN RURAL AREAS.
DR. JUNE OSBORNE, CHAIR PERSON OF THE NATIONAL AIDS

COMMISSION, SHARES THIS CONCERN AND HAS HELD HEARINGS IN

RURAL GEORGIA.

56
1 CAN’T PREDICT THE SPREAD OF AIDS IN THE RURAL AREAS, BUT
| KNOW WITH CERTAINTY THAT THE FRAGILE RURAL HEALTH CARE

SYSTEM HAS ALMOST NO TOLERANCE FOR ADDITIONAL PATIENTS.

HOW MANY CASES OF AIDS WILL IT TAKE TO BANKRUPT A

MARGINAL SMALL RURAL HOSPITAL ?

57
THE ANSWERS LIE IN AIDS AND SUBSTANCE ABUSE PREVENTION
EFFORTS, MORE DRUG TREATMENT SLOTS, AND SYSTEMS BUILDING
FOR HEALTH AND HUMAN SERVICES LIKE THOSE SPONSORED BY
HRSA’S PLANNING GRANTS FOR LOW PREVALENCE HIV STATES AND

COMMUNITIES.

58
| CAN’T LEAVE WITHOUT MENTIONING THE ADDICTIVE AND DEADLY

SCOURGE OF TOBACCO.

WE HAVE TURNED THE TIDE, BUT THERE ARE STILL AREAS OF

CONCERN: TEENAGE GIRLS IN GENERAL, RURAL MALE

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ADOLESCENTS AND SMOKELESS PRODUCTS.

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59
THESE ARE PUBLIC HEALTH ISSUES ALL OF US HAVE TO BELIEVE IN.

STROM ER
THERE MUST BE A PEW COMMITMENT TO PUBLIC HEALTH.

THE HEALTH SYSTEM WILL COLLAPSE IF WE DO NOT SUPPORT

DISEASE PREVENTION AND HEALTH PROMOTION.

60
| WOULD LIKE TO SEE A REVITALIZATION OF THE LOCAL HEALTH
DEPARTMENT, PERHAPS IN THE KIND OF FLEXIBLE AND

COOPERATIVE MODEL I PROPOSED FOR THE NHSC.

THE NEW LEADERSHIP IN HRSA (DR. BOB HARMON ) COULD BRING
THAT BACK AND REVITALIZE THE MORALE OF FEDERAL EMPLOYEES
AS WELL. WE NEED NEW DIRECTION AND POSITIVE PROGRAM

ACTION. lt HAVewT SESW oR stEAeO OF (7

YET!

61
IN MY VISION FOR THE 1990’S WE MUST ALSO HAVE SYSTEMS OF
HEALTH CARE THAT MEET NEEDS WITHIN THE CONSTRAINTS OF

EXISTING RESOURCES.

CONCURRENTLY THEIR MUST BE BETTER EDUCATION SYSTEMS,

ECONOMIC DEVELOPMENT, AND SUPPORTING INFRASTRUCTURE.

62
THESE ELEMENTS ARE INTERDEPENDENT AND THEIR LACK
CONTRIBUTES TO A CONTINUING CYCLE OF POVERTY. BUT THERE

IS HOPE.

KENTUCKY’S RECENT DECISION FOR STATE - WIDE EQUAL FUNDING

FOR EDUCATION IS A STEP IN THE RIGHT DIRECTION.

63
LONG TERM CARE FACILITIES DEVELOPED IN RURAL AREAS MEAN

MORE JOBS AND DOLLARS FLOWING TO THE COMMUNITY.

THAT’S ECONOMIC DEVELOPMENT COUPLED WITH HEALTH CARE.

64
PERHAPS STATES SHOULD GIVE PREFERENCE TO CERTIFICATES OF
AS
NEED FOR LONG TERM CARE BEDS IN RURAL AREAS 6&F ONE WAY

TO MEET THESE PROBLEMS.

pbs? OUR MODELS OF CARE MUST START WITH REALISTIC NEEDS
ASSESSMENT THAT RECOGNIZES THE UNIQUENESS OF EACH RURAL

COMMUNITY.

eid THERE MUST BE A PLANNING PROCESS THAT INVOLVES AND

EMPOWERS ALL OF THE COMMUNITY.

65
SUCH A PLAN MUST MAKE PROVISION FOR AT LEAST THE

FOLLOWING:

* MECHANISMS FOR COORDINATION BETWEEN HEALTH AND

SOCIAL SERVICES INSTITUTIONS.

* TRAINING OF COMMUNITY PEOPLE FOR EXPANDED AND
PARAPROFESSIONAL HEALTH ROLES.

* OFF - SITE PHYSICIAN surenvision/A GREATER USE OF
NURSE PRACTITIONERS, PHYSICIANS ASSISTANTS, MID — LEVEL
MENTAL HEALTH WORKERS, MULTI - COMPETENT TECHNICIANS

* GREATER USE OF LOW COST TECHNOLOGY ( E.G. FAX
MACHINES, P.C.’S )

* REGIONAL AND STATE - WIDE SYSTEMS OF COMMUNICATION,

REFERRAL, AND CARE.

66
ud (GLEVIDIOW SD MTOOT IY eR Tem En Ge
THE Basic HEaiTe CANE Prastsur Fate wor Mee
Oy enews th VEBRW S1E772 0d AHaw (hl CAME Gy,

WE’VE ALWAYS SAID WE NEVER WANTED EVEN A TWO-TIER SYSTEM, 4
OF FEALTH Ce RE pW AMERICH,

BUT WE HAVE IT ... AND A THIRD TIER, ALSO.

67
IN THE FIRST TIER .. THE BOTTOM TIER ... ARE UPWARDS OF
PERHAPS 30 MILLION AMERICANS -- ABOUT 13 PERCENT OF THE
POPULATION -- WHO FALL THROUGH THE CRACKS AND HAVE NO
HEALTH INSURANCE COVERAGE ... NO HIGH OPTIONS ... NO LOW

OPTIONS ... NO OPTIONS AT ALL.

THEY’RE NOT OLD ENOUGH FOR MEDICARE AND NOT POOR

ENOUGH FOR MEDICAID.

68
RECENTLY RELEASED FIGURES INDICATE THAT ONE OUT OF EVERY
EIGHT AMERICANS FALLS INTO THIS CATEGORY OF THE
UNINSURED. FOR BLACKS, THE FIGURES ARE WORSE, WITH ONE
OUT OF FIVE BLACKS UNINSURED. AND IN THE HISPANIC
POPULATION, ONE OUT OF EVERY FOUR PERSONS HAS NO HEALTH

INSURANCE

69
WHAT, THEN, DOES THIS "HEALTH CARE SYSTEM" OF OURS DO FOR
THE UNINSURED?

AS YOU KNOW, IN THE VAST MAJORITY OF CASES THE ANSWER IS
.. VERY LITTLE «- OR NOTHING. AND THEY ARE SUFFERING THE

CONSEQUENCES.
STUDY AFTER STUDY INDICATES THE CORRELATION BETWEEN NO

MEDICAL INSURANCE AND INCREASING HEALTH PROBLEMS.

THE HEALTH PROBLEMS OF THE LOWEST TIER, IF IGNORED BY

SOCIETY NOW, WILL BE BORNE BY SOCIETY LATER.

70
THEN WE HAVE A SECOND TIER.

THIS TIER RECEIVES A NARROW RANGE OF BASIC MEDICAL AND
HEALTH SERVICES WITH MORE OR LESS FIXED LEVELS OF
REIMBURSEMENT.

THIS IS LOW-OPTION COVERAGE ... MEDICARE AND MEDICAID
COVERAGE ... WITH THE PATIENT PAYING MANY COSTS OUT-OF-
POCKET OR WITH THE HELP OF SOME FORM OF SUPPLEMENTAL
INSURANCE, WHICH IS -- IN MY BOOK -- JUST ANOTHER KIND OF

OUT-OF-POCKET EXPENSE.

71
FINALLY, WE HAVE THE THIRD TIER, THE TOP TIER.

THE PEOPLE IN THIS TIER RECEIVE A FULL RANGE OF MEDICAL
AND HEALTH SERVICES. THEY ARE COVERED BY HIGH-OPTION
HEALTH INSURANCE AND ALSO HAVE A FEW DOLLARS LEFT OVER
TO PAY THE 15 OR 20 PERCENT DIFFERENCE BETWEEN THE ACTUAL
BILL FROM THE DOCTOR AND THE CHECK FROM THE INSURANCE

COMPANY.

72
FOR THOSE WITHOUT ACCESS, THE GOAL IS UNIVERSAL COVERAGE
TO BE ACHIEVED THROUGH COMPREHENSIVE REFORMS OF
GOVERNMENT PROGRAMS FOR THE POOR AND UNINSURED

COMBINED WITH RISK POOLING.

73
MEANWHILE INTERIM STEPS INCLUDE MEDICAID EXPANSION,
UNDER EXISTING LAW, AND TAX INCENTIVES TO ENCOURAGE

SMALL BUSINESS INSURANCE COVERAGE. FHESE—EAFFER—

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74
THE TIME IS RIGHT FOR CHANGE AND THE ELEMENTS EXIST:
- A MATURING RURAL HEALTH MOVEMENT
- A HEIGHTENED CONGRESSIONAL INTEREST

- STRENGTHENED STATE HEALTH DEPARTMENTS

75
«# STABLE COMMUNITY AND MIGRANT HEALTH CENTERS
- GROWING NUMBERS OF STATE OFFICES OF PRIMARY CARE
-COMMUNITY MOBILIZATION AROUND POTENTIAL RURAL HOSPITAL

CLOSINGS

76
| THE TIME IS NOW AND YOU HOLD THE KEYS *
GY IN CLOSING, | PLAN TO SPEND THE CURRENT PHASE OF MY CAREER
MAKING AMERICA AWARE OF ITS HEALTH PROBLEMS SUGGESTING
APPROACHES TO CONFRONTING THEM, AND GOADING THE

COUNTRY TO ACTION. YOUR GOALS ARE SIMILAR.

76
[| WILL NEVER BE A ”COUNTRY BOY”, BUT | WILL SUPPORT THE
EFFORTS OF MY "COUNTRY COUSINS”S IN THE NRHA AND BE

PROUD TO BE THEIR FRIEND.

——_

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