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President's Message (Evelyn Bender)
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Bylaw Change Adopted
New State Directors Listed
Look at Leasehold (Jim Koshi)
Health Care Study Commences
1991-1992 Calendar

Health Care Study Commences

At the 1990 LWVUS National Convention, members approved a new study on health care in the United States. Earl Fedje is the LWVHI chair of that study.

The focus is: Evaluate public and private mechanisms for delivery and financing of health care in the United States.

The scope is: Examine the current status of and evaluate public and private alternatives for delivery and financing of health care in the United States including coverage, cost, funding, "rationing," strengths and weaknesses.

Convention attendees had two opportunities to hear various perspectives on this subject. Saturday night speakers were Michael Dukakis, former Massachusetts Governor and Visiting Professor at the University of Hawaii and Dr. John Lewin, Director of the Department of Health.

Sunday's panel speakers were Ah Quon McElrath, Social Worker and lobbyist; Marvin Hall, President, Hawaii Medical Services Association; Lorraine Carlson, RN., Assistant Professor of Nursing at the University of Hawaii and Past President of the Hawaii Nursing Association; Richard Meiers, CEO of the Health Care Association; and Dr. John McDonnell, President of the Hawaii Medical Association.

Stressed throughout the talk was the fact that Hawaii has a health care program which exceeds most other states' efforts and as a national program is proposed, we must not let our program be diminished.

Governor Dukakis noted that the United States spends 12% of its gross national product on health and yet health care has now passed crime as a major concern of US citizens. He proposes three components to a national program: 1.) that universal access will guarantee everyone care, 2.) that preventative health care is needed; therefore, there must be a change in the way medicine is currently practiced. 3.) that there must be a change in the way people perceive the health care system; that decisions will need to be made on what will be spent and how it will be allocated.

Dr. Lewin spoke as a public health physician as well as department director. He said that this state has the opportunity to share [the success of our program] with the rest of the nation since our program has done well (public health statistics bear out our 17 years of health care). He noted, however, that health care of the Hawaiians is a tragedy.

Quoting Peter Drucker he urged that we look at things differently and expand our perception as issues are addressed.

Sunday's speakers echoed much heard Saturday. Each looked at health care from his/her own experience. Access to care was an ongoing theme.

Ah Quon McElrath presented an overview of current programs in place nationally. Title 8 of the Social Security covers the elderly; Title 9 covers the poor in America. The package is generous, she noted, with 42 options that states can provide. Hawaii has 24 options available. Military and their dependents have care provided through a network of hospitals and clinics with costs handled directly or through Champus. Poor women and children are served by WICH programs and there are services for the disabled and mentally ill, etc.

She noted that with worker's compensation and no-fault programs there are no controls on providers; premiums are determined by insurance companies based on individual and overall accident records. A long list of individuals, businesses and health workers illustrated the complexity of pinpointing areas that need addressing. McElrath reiterated the 12% of GNP figure and said that is $600 billion a year, yet 37million Americans have inadequate or no care at all.

Marvin Hall of HMSA said that in Hawaii there is a relatively small number of people who do not have access to health care versus the rest of the US. Cost is a major factor; he listed some reasons for increasing costs. These include: 1.) Inflation and an adjustment from previously low salaries; 2.) Technology which brings new drugs and equipment into use as we seek to provide the highest and best level of care; 3.) Cost-shifting to compensate for those not fully covered by medicare and medicaid to others; 4.) Aging, with the percent of those over 65 years growing rapidly (and using health care resources proportionately more than those younger); 5.) Public demand - we want everyone to have care; 6.) Malpractice claims stimulate defensive medical practice which adds 10% costs over actual needed treatment; and 7.) Excess beds and other factors.

Nursing is health care stressed Lorraine Carlson She noted that the nations' 2.4 million registered nurses look at human responses to actual or potential health problems and advance nursing solutions for them. She noted that nurses are positioned to help in a unicap approach, and through a mix of primary care, health promotion and various financial programs the long term health of the American people can be obtained.

Six factors were stated by Richard Meiers as relating to the costs of health care. He, too, felt that hard choices were needed to find a balance between acceptable costs and rationing of care. An aging population, in-patient versus out-patient care, technological abilities, personnel expenses as part of hospital costs, excess capacity of hospital beds and uncompensated care all contribute to the complexities found when looking at the subject.

Dr. McDonnell also noted that we have a good system in comparison to other states; the US has the best system (best medical care) in the world. He spoke of the "hassle factor" which frustrates health care providers and the need for tort reform. Physicians are supporting changes in the health care system and will increasingly do so if the two issues can be addressed.

Earl Fedje, moderator and chair of the state study committee, directed member questions to panel members and noted with appreciation their participation. Earl welcomes input from those who are willing to "chew" on this most complex subject. Reach him through the office- 531-7448.

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