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Folder Title:
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Clinton Library
DOCUMENT NO.
AND TYPE
SUB.IFXT/TITLE
DATE
RESTRICTION
001. letter
Personal (Partial) (1 page)
02/28/1993
P6/b(6)
002. letter
Address (Partial); Phone No. (Partial) (1 page)
03/21/1993
P6/b(6)
003. letter
Phone No. (Partial) (1 page)
02/18/1993
P6/b(6)
004. letter
Addresses (Partial) (1 page)
03/03/1993
P6/b(6)
005. resume
Phone No. (Partial) (2 pages)
n.d.
P6/b(6)
006. resume
Personal (Partial) (1 page)
n.d.
P6/b(6)
007. letter
Phone No. (Partial) (I page)
02/18/1993
P6/b(6)
008. resume
Address (Partial) (I page)
n.d.
P6/b(6)
009. letter
Address (Partial); Phone No. (Partial) (I page)
03/31/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
im782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bK6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning lhe regulation of
financial institutions 1(b)(8) ofthe I OIA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�HI
NORTHERN
NEVADA
MEDICAL
GROUP
INTERNAL MEDICINE
Catherine Goring, M.D.
Brad T. Craves, M.D.
Kirsten Lorenzen, M.D.
Lorrie M. Oksenholt, D.O.
Christopher Scully, M.D.
OB/GYN/INFERTILITY
Victor Knutzen, M.D.
Clarence Blea, M.D.
Ricardo Garcia, M.D.
Lester Ho, M.D.
Craig W. Klose, M.D.
Terrence McGaw, M.D.
*Robert G. Proctor, M.D.
PEDIATRICS
Berkley R. Powell, M.D.
REPRODUCTIVE
ENDOCRINOLOGY/
INFERTILITY
•Carlos E. SotoAlbors, M.D.
RHEUMATOLOGY
Christopher Scully, M.D.
PSYCHOLOGY/
FAMILY COUNSELING
*Jack Mayville, Ph.D., M.F.T.
MAMMOGRAPHY/RADIOLOGY
•Richard H. Ardill, M.D.
*Eugene A. DeBardelaben, M.D.
•Robert W. Kenton, M.D.
*J. W. Kraft, M.D.
*K. L. Learey, M.D.
FAMILY NURSE PRACTITIONER
lacqueline F. Webb, R.N., M.S.N.
OB/GYN NURSE PRACTITIONER
Laurie Smith, B.N., R.N.C., A.P.N.
Karen Wood, R.N.C., A.P.N.
PEDIATRIC
NURSE PRACTITIONER
Linda Cliff, R.N., M.S.N., C.P.N.P.
January 29, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Chairwoman o f t h e P r e s i d e n t ' s Task Force
on N a t i o n a l H e a l t h Reform
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Madam Chairwoman:
May I c o n g r a t u l a t e you on your appointment as
Chairwoman o f t h e P r e s i d e n t ' s Task Force on N a t i o n a l
H e a l t h Reform.
This t o p i c ,
l o n g overdue f o r
government and s o c i e t a l s c r u t i n y , may w e l l be t h e
s i n g l e most i m p o r t a n t domestic monetary i s s u e ,
o u t s i d e o f t h e economy, t o face t h e n a t i o n t h i s
decade.
As a member o f t h e medical community and.
w i t h a background i n t i m a t e l y shaped, by d i f f e r i n g
m e d i c a l systems, I would l i k e , t o o f f e r my s e r v i c e s
and those o f t h e m e d i c a l group I r e p r e s e n t i n t h i s
l e t t e r , t o you and your t a s k f o r c e .
Our m e d i c a l group i n N o r t h e r n Nevada has e s t a b l i s h e d
a model o f m e d i c a l care t o t h e poor as w e l l as t o
t h e w e l l i n s u r e d , p r o v i d i n g a range o f s e r v i c e s ,
w i t h t h e t w i n goals o f h i g h e s t g u a l i t y medical care
a t reasonable p r i c e s .
This model, c e n t e r e d m o s t l y
on m a t e r n a l c a r e , has improved pregnancy outcomes i n
N o r t h e r n Nevada t o such an e x t e n t t h a t we have
a t t r a c t e d and r e c e i v e d support from Governor Bob
M i l l e r and t h e H e a l t h Department o f t h e S t a t e o f
Nevada.
Dr. V i c t o r Knutzen, t h e founder o f t h e group, had a
South A f r i c a n and B r i t i s h background i n medicine,
h i s p a r t n e r s from t h e U.S., Canada, and A u s t r a l i a .
I t i s these i n t e r n a t i o n a l f a c t o r s t h a t have formed
t h e unusual c h a r a c t e r o f t h i s medical p r a c t i c e .
I
b e l i e v e we deserve c l o s e r s c r u t i n y f o r we share t h e
sentiment t h e P r e s i d e n t has expressed, namely t h a t
f r e e e n t e r p r i s e , government and t h e market p l a c e
can, and p r o b a b l y s h o u l d , shape what w i l l be a
u n i q u e l y American answer t o t h e q u e s t i o n of how t o
f u l f i l l our o b l i g a t i o n s t o t h e community - something
v i r t u a l l y a l l o t h e r c o u n t r i e s have addressed and
implemented i n one form o r another.
NUTRITION SERVICES
•Bonnie J. Vogler, M.A., R.D.
75 Pringle Way
'Independent Contractor
Suite 801
Reno, Nevada 89502
( 702) 688-5800
Affiliated with Reno Women's Center
FAX: (702) 688-5626
�January 29, 1993
Page two
I hope t h a t t h i s l e t t e r e n t i c e s your committee t o seek f u r t h e r
i n f o r m a t i o n about our c o n t r i b u t i o n t o t h e awesome m e d i c a l dilemma
t h a t i s c a u s i n g such g r i e f and d i s l o c a t i o n among so many people i n
t h i s c o u n t r y . We would be honored t o a s s i s t your e f f o r t s i n any
s m a l l way.
Respectfully,
ROBIN J . WILLCOURT, M.D.
Medical D i r e c t o r
Washoe P e r i n a t a l S e r v i c e s
VICTOR K. KNUTZEN, M.D.
Medical D i r e c t o r
N o r t h e r n Nevada M e d i c a l Group
N o r t h e r n Nevada F e r t i l i t y Center
RJW/VKK:aq
cc:
The Honorable Bob M i l l e r
Governor o f Nevada
Jerry Gripentrog
D i r e c t o r , Department o f Human
Resources
�•^m p
TARRYTOWN
INTERNAL
MEDICINE
ASSOCIATES
'
X h
March 25,
Mrs. H i l l a r y Rodham C l i n t o n
H e a l t h Care Reform Committee
The White House
Washington, D.C. 20500
€
1
Board Certified
In Internal Medicine
RICHARD B. FRIEDMAN,
1993
Dear Mrs. C l i n t o n :
M.D.
K N E H D T O A , M.D.
ENT .HMS
CHARLES F C R I R M.D.
.ARE,
SUSANNA S. WILKENS,
M.D.
BELINDA L. CASTOR,
M.D.
From a p r i m a r y care p h y s i c i a n ' s p e r s p e c t i v e , I cannot
e n v i s i o n a n y t h i n g s h o r t o f r a d i c a l r e f o r m as y i e l d i n g
m e a n i n g f u l change i n our c u r r e n t h e a l t h care system.
I
know you a r e s t r u g g l i n g t o balance t h e needs and d e s i r e s
of many i n t e r e s t s i n a d e s i g n i n g a r e f o r m package. I
b e l i e v e t h e enclosed e d i t o r i a l a r t i c u l a t e s t h e b a s i c
changes we need t o make t o d e l i v e r t h e most h e a l t h c a r e
t o t h e most people.
From o b s e r v i n g b o t h you and your husband from here i n New
Hampshire, I am c o n f i d e n t t h a t you possess b o t h t h e
courage and i n t e l l e c t t o achieve m e a n i n g f u l h e a l t h c a r e
reform.
Good l u c k .
Sincerely
Charles F. C a r r i e r ,
CFC/mrn
FOUR ELLIOT
SUITE
WAY
203
MANCHESTER, N H 03103
603-622-6700
M.D.
�r
40 .
THE BOSTON GLOBE •
health care
agrees they are large and rapidly becoming larger.
B Reahty 5: When there is a system with multiple
deciders and multiple payers without any one institution
or person being responsible for trading off total costs
EALTH CARE REFORM IS DIFFICULT:
and benefits, the results are going to be chaotic and exWe all know what the problems are, but we
don't want to face up to any of the obvious an- pensive. In health care we have just such a system and
the results are exactly what any organizational theorist
swers.
would predict - chaotic and expensive.
Basically we would like yet another patch
B Reality 6: There are almost 40 million Americans
"on the system so it will keep going without us having to
without health care coverage and those numbers are go'face reality. Hillary Rodham Clinton's task is difficult
ihg to get larger very rapidly. By moving abroad or by
"'sirite there may now be so many patches on the system
replacing full-timers with either part-time or temporary
^ that yet another patch cannot be designed. Reality at
workers, businesses can avoid health care spending.
Ib'rig last may have to be faced. .
Businesses are now doing so in larger numbers.
• Reality 1: Health care spending has nothing to do
Conversely if businesses have to pay for'health care
""with health. The United States spends by far the most on
costs, no business wants to hire older workers where
£ health care (14 percent of the gross domestic product
they might become liable for their health care costs dur-'versus 9 percent of the GDP in the next highest-spending retirement. Regardless of skill levels if you are uning country). Yet the United States is well down the
-'world's tables on any measure of health (19th in male life employed after 55 years of age, health care costs are
your principle handicap when it comes to being reem-^expectancy, hear the bottom among industrial countries
ployed.
.^Iri'infant mortality).
B Reality 7: Businesses cannot afford to pay for
:' •'
The United States could
health care in a global economy if their competitors in
spend a lot less and be healthier. If Americans want health, the rest of the world do not pay for health care costs.
Elsewhere health care is often paid for by taxes or other
they concentrate on prevendirect personal charges such as the Provident Fund in
tion, immunizations, poverty,
Singapore.
guns, illegal drugs and car acAbroad, health care is often not a business responsicidents. Doctor's and hospitals
bility. If American businesses have to put health care
-'kggBBBnHBBBH
have very little to do with'
costs in the prices of their products and this makes them
health. .
non-competitive vis-a-vis those that do not pay for health
B Reality 2: Some very large fraction of total health
care costs, Americans will simply go out of business with
care spending (40 to 60 percent depending upon which
study you believe) goes to individuals in their last year of the loss of both health care benefits and wages.
America cannot for much longer run a health care
"Tif£ The doctor says "terminal cancer," several hundred
thousand dollars are spent and the doctor was right The system where businesses are forced to pay the costs of
health care. Businesses can play a role in organizing the
patient dies. Other countries simply don't spend large
system, but the costs will have to come from wage deducsums .of money without a reasonable probability of suctions and not corporate contributions.
cess.
No one knows what Mrs. Clinton's task force will recHere Americans should remember the words of the
ommend, but workability of whatever she proposes is goAmerican Indian grandfather in the movie, "Little Big
Man": "Today is a good day to die." For every human be- ing to be easy to judge. Simply ask how many of these
seven fundamental realities she solves.
ing, there is a good day to die. Spending billions isn't goDoes the proposal understand the difference between
ing to change this reahty for even a single human being.
• Reality 3: The current malpractice system has got health and spending on health care? Are limits placed on
to go. The problem is not so much the direct malpractice how much can be spent in hopeless causes? Does she get
the lawyers out of the health care system? Does the sysinsurance premiums (although they are large) but the
tem have a single decision maker for each individual.
defensive medicine they force everyone to practice. Billions are spent on tests and treatments that would not be Have layers of paperwork been eliminated? Are those
not now covered, covered? Does America have a healthspent if doctors and hospitals knew that they would not
: spending system that leaves its industries globally combe sued.
petitive?
D Reahty 4: Multiple insurance systems have now
If she deals with all seven realities, give her an A + .
created a paperwork nightmare. Each doctor or hospital
has to have someone skilled in filling out all of the different forms that are required by all of the different payers. Lester C. Thurow is dean of the Alfred P. Sloan School of
,
Estimates of the costs of paperwork differ but everyone Management at MIT. .
LESTER G.THUROW
1
iAnqther patch
on the system
^qii't work
hi-13
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
A N D TYPE
001. letter
SU B.JECT/TITLE
DATE
Personal (Partial) (I page)
02/28/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - (•W U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e F O I A j
b(2) Release would disclose internal personnel rules and practices of
an agency 1(h)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA|
bid) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA)
National Security ClHssificd Information [(a)(1) of the PRA)
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PR A]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Kenneb h
Snell.
M.D.
•rv:
February
M r v=. H i 1 1 ^ r y Rodman
The W h i t e H o u s e
W-., i n g t on , D . C .
a--h
D^ar
Mr a.
28,
1^93
Clinton
CIinton,
I a m dc> 1 i q h t e d bhat your h u s b a n d
you
-si'''? i; o h e a d
the- reorganisation
of
I a m w r 1 1 i f i g t Li - o f f e r my s e r v i c e s , on.
a id,
.i n a n y w a y t h a t " T
T a (ii
year
i-,«ct i c S t *
y ears
i n that
i s P r e s i d e n t , and t h a t
our h e a l t h c a r e s y s t e m ,
a volunteer b a s i s , to
r eor g a n 1 2 5 t i o n
oil d i L o a r d c e r t i f i e d
C 1965II R a d i o l on i s t ,
d i a g n o s t i c R a d i o l o g y i n MaS3.au.b.LLSj5.t-tja-
- r j ' . l - i - •-rf
that time a senior
ri')T?in"C"&T o"f a g r o u p o f t e n r a d i o l o g i s t s , who d e c i d e d , I am
q iJ 11 e ^ LI )• : on t h e b a s i s b h a t t h e y c o u l d h i r e a y o u n g d o c t o r
f
3 h c.ut of r e s i d e n c y t o t a k e my p l a c e f o r a b o u t o n e - t h i r d
• j r my s a l \i y, t h a t I s h o u l d r e t i r e on d i s a b i l i t y . As a
'
of t i m e and w o u l d l i k e t o d e v o t e some of
I" U LI 1 L , [ h-jvi- l o t s
"
i t t o t h e t a s k w h i c h you h a v e , n o b l y , i f not w i s e l y ,
under taken.
:
Du.r i n g my p r a c t i c e y e a r s I s e r v e d o n s e v e r a l
committees
to
the present
d i s c u s s i o n .
One was
a
w h i c hi a • r e a p r o p ' . j s
r a d i o l o g i s t s
attempting
to develop
a l i s t
of
c omm11 t e e o f
procedures
a p p r o p r i a t e
for
a p a t i e n t
with
a
i" -vid i ' - ' j r a p h i c
•j i . t i n
" c l i 11:; f c o m p 1 a i n t " o r
p r e l i m i n a r y
diagnosis
upon
a i j iti i - z c i ci i i t o a h o s p i t a 1
A second committee,
working
with
B 1 u e C i- ' I ' S S / D l L.ie SI i i i a l c i , w a s c h a r g e d
with
e v a l u a t i n g
•n i ' j a t i o r ) i ci w h i c h
t h e E-.Lues h a d r e j e c t e d
a
r a d i o l o g i s t ' s
l'i a r g e s , a n d
the physician
wished
to appeal
t h e i r
.decision.
Tl-i i s
t a Jl
led
t * m> t r a v e l i n g
in t o BC/BS h e a d q u a r t e r s
for
.Stiver a l m o n t h s t o mon i t e r
cases where a payment
r e j e c t i o n
had
I J e e i "i m ad e b y a n u i - s e ,
and t h e y w i s h e d
another
opinion
before
send i n q the
r e j e c t i o n
n o t i c e
to the
p h y s i c i a n .
D u r i n g my y e a r s
i
i n t e r e=.t
in the
var iou
•c.iiu g o v e r n m e n t " g r o u p ' i
i inprove,
hc-w ( t i e d i c i n e
^track
by t h e n o t i o n
t
very
l i t t l e
under
t and
n pr a c t i c e ,
and s i n c e ,
I have had
an
s d e c i s i o n s
made by t h i r d - p a r t y
payers'
in a t t e m p t s
to a l t e r ,
and h o p e f u l l y
is p r a c t i c e d .
I have r e p e a t e d l y
been
hat
the d e c i s i o n s
seem t o be -based
on
ing of
medicine
or
p a t i e n t s
and
�c e r t a i n l y w i t h v e r y l i t t l e r e g a r d f o r t h e e f f e c t t h a t would
b e cau s e d i f t he new r u1e or r eq u i r e men t wer e ap p1 l e d
u n i f o r m l y t o s i m i l a r s i t u a t i o n s rather than j u s t t p t h e
p a r t i c u l a r p r o b l e m t h a t e n g e n d e r e d t h e change i n t h e f i r s t
p 1 ace„
For example; M a s s a c h u s e t t s i s p r e s e n t l y c o n s i d e r i n g a
s e t o f r e g u 1 a t i o n s f o r m a m m o g r a p h y. T h e r e i s n o q u e s t i o n i n
my mind t h a t mammography i s a good p r o c e d u r e , f r o m b o t h an
a c c u r a cy a n d an i mp or t an ce v i e w .
T h e r e i s n o q ue s t i on t h a t
t h o s e p e r f o r m i n g t h e procedures, b o t h r a d i o g r a p h e r and
r ad i o1og i s t , shou1d be e s p e c i a l l y t r a i n ed or t h at t he
e q u i p m e n t used s h o u l d be e s p e c i a l l y d e s i g n e d and w e l l m a i n t a i n e d . E<ut t h e r e t h e n f o l l o w s a r e g u l a t i o n w h i c h s a y s
"the
e x a m i n e r must be s u r e t h a t t h e p a t i e n t f u l l y u n d e r s t a n d s
111 e r e s u11 s o f t h e s t ud y, b e for e t h e p a t i e n t l e a v es t h e
f a c i 1 i t y.. " A t f i r s t a n d c u r s o r y g l an c e t h a t s o u n d s v e r y g o o d .
The p a t i e n t has j u s t u n d e r g o n e an e x p e n s i v e , and p o s s i b l y
uncomfor t a b 1 e t e s t , and i s n a t u r a l l y v e r y c u r i o u s and anx i o u s
a b o u t 11 "i e f : n d i n g . N o w c o m e s t h e v e r y b i g " H 0 W E V E R. " T h i e
L
p r a c t i c e o f w h i c h I was a p a r t , m a i n t a i n s an o f f i c e so1e1y
f or mammogr aphy,
1"he t echn ic i a n who does t h e i m a g i n g i s v e r y
good a t I")er j o b and i s per f ec 11 y c a p a b l e o f chec k i ng t he
f i 1ms and d e t e r m i n i n g i f t h e y a r e is a t i s f a c t r y f o r
interpretation..
P a t i e n t s a r e s c h e d u l e d one per h a l f hour
t h r o u g h o u t t h e day, and most days t h e s c h e d u l e i s f u l l .
S i n c e a 11 pa t :i. e n t s a r e r e f e r r e d f r o m o t h e r p h y s i c i a n s , i t i s
a s s u m e d t h a t a p h y s i c a 1 e x a m i n a t i o n was p e r f o r m e d . Tlie
t e c h n i c i a n d e t e r m i n e s t h a t t h i s i n f o r m a t i o n as w e l l as o t h e r
per t i n en t i n f o r mat i on such as q est at i ona1 and menst r ua1
h i s t o r y and any r e l e v a n t f a m i l y h i s t o r y i s on t h e
r eq u i s i t i on .
A t t hi e c 1 ose o f t he d ay t h e s t u d i e s ar e
a s s e m b l e d and d e l i v e r e d by c o u r i e r t o t h e n e a r b y h o s p i t a l
where t h e r a d i o l o g i s t s have s p e n t t h e day. The f i l m s on each
p a t i e n t a r e v i e w e d by a r a d i o l o g i s t , and t a k i n g i n t o
c o n s i d e r a t i o n any per t i n e n t f a c t s f r om t h e r e q u i s i t i o n ,
a
r e p o r t d : >: t a t e d .
L :
:
F' o 11 o w i n g t r a n s c r i p t i o n o f t h e r e p o r t , t h e
f i l m s and t h e r e p o r t a r e s u b m i t t e d t o a second r a d i o l o g i s t
w h o v i e w s t h e f i l m s , c o me s t o h i s own conc1u s i on, and t h e n
r e a d s t h e t r a n s c r i b e d r e p o r t . I f he a g r e e s w i t h t h e r e p o r t ,
i t i s sent out t o t h e r e f e r r i n g physician,.
I n almost a l l
c a s e s where a m a l i g n a n c y i s d i a g n o s e d , t h e w r i t t e n r e p o r t i s
p r e c e e d e d b y a t e 1 e p h o n e t r a n s m :i. s s i o n o f t h e f i n d i n g . I f
.
t h e r e i s d i s a g r e e m e n t as t o t h e f i n d i n g s , a d i s c u s s i o n ensues
between t h e t w o d o c t o r s , p e r h a p s i n v o l v i n g a t h i r d
r e d i o l o g i s t as an a r b i t e r , u n t i l agreement i s r e a c h e d . I f
t fi :i. s r e q u i r e s a r e t y p :i. n q o f a r e p o r t , t h i s i 5 d o n e a n d s e n t
out .
I am n o t f a m i l i a r w i t h a\ny ot her hosp i t a 1 or o f f i c e
where a 11 m a m m o g r a p h i c s t u d i e s a r e " d o u b l e r e a d " , b u t i t
worked f o r u s , and we were w i l l i n g t o spend t h e t i m e .
0b v i ous 1 y t h i s pr ac t :i. c e wou 1 d be s e v e r e l y hand i c apped :i. f t h e
new M A s s a c h u s e t t s r u l e were t o go i n t o e f f e c t . F i r s t l y , i t
w o u 1 d r e q u i r e a r a d i 1 o g i s t t o be p r e s e n t i n t h e o f f :i. c e a t
a l l t i m e s . S e c o n d l y , I see no p r a c t i c a l way in. w h i c h d o u b l e
r & a d i n q c o LI 1 d o c c u r ,.
:
�A n o t h e r major p r o b l e m w i t h making s u r e t h a t t h e p a t i e n t
" f u l l y u n d e r s t a n d s " t h e r e s u l t s o f her mammogram i s t h a t t h e
f i 1 ens ar e n o t easy t o i n t er pr e t „ I have s p e n t many hour s
?
a t t e m p t i n g t o e x p l a i n mammography f i n d i n g s t o s u r g e o n s , who
a r e 1 ] h o p e f u l l y above a v e r a g e i n i n t e l l i g e n c e and 211
f a m i l i a r with reviewing other x-ray f i l m s with r a d i o l o g i s t s
so t h a t t h e y have some n o t i o n as t o i m a g i n g p r o c e d u r e s and
t e r m i n o I o g y.
T h e t h oug h t o f t r y i n g t o e x p1 a i n suc h f i n d i n g s
t o p a t i e n t s, h a l f o f wh o m a r e b y d e f i n i t i o n b e1ow a v e r a g e i n
i n t e l l i g en ce, a n d wh o h a v e n o b a c kg r ou n d i n i mag i ng
t e c h n i que s, as w e l l a s b e i n g ner v ous and ap p r ehen s i v e o ver
t h e s u b j e c t under d i s c u s s i o n , b o g g l e s t h e i m a g i n a t i o n .
I w o u 1 d e s t i m a t e t h a t a n y s u c h a 11 e m p t w o u 1 d t a k e a t 1 e a s t
t h r e e t i m e s a s 1 o n g a s i t d o e s t o i n t e r p r e t t h e f i l m s. T h i s
w o u l d t h e n s e r v e t o c u t a r a d i o l o g i s t s p r o d u c t i o n by 3/4,
when I am g i v e n t o b e l i e v e we a r e t r y i n g t o r e d u c e m e d i c a l
c o s t s - I t a l s o o c c u r s t o me t h a t one c a n n o t , i n good
c o n s c i e n c e , i s o1 a t e m ammog r a p h y f r o m o t h er r a d i oq r a p h i c
s t u d i e s , so t h a t t h e same r u l e s t h a t a p p l y t o mammography
s h o u l d a p p l y t o b a r i u m enemas, g a l l b l a d d e r s t u d i e s ,
finger
x - r a y s, etc,, And why j u s t x r a y s t u d i e s ? S h o u I d n o t t h e
same r u l e s a p p l y t o t h e l a b o r a t o r y , and t o
e 1 ec t r o c ar d i og r ap h i c fa c i 1 i t i e s? As k you r c ar d i o 1 og i s t h ow
he f e e l s a b o u t a r u l e t h a t s a y s each p a t i e n t must " f u l l y
understand" t h e r e s u l t s before leaving t h e f a c i l i t y .
T h i r d1y, wh en any d o c t o r g i v e s any pat i en t a d i a g n os i s ,
t h e n e x t words f r o m t h e p a t i e n t a r e "what a r e y o u g o i n g t o do
about i t ? " I t i s p r e s e n t p r a c t i c e t h a t a " g e n e r a l i s t "
p h y s i c i a n o f some n a t u r e s e e s t h e p a t i e n t , o b t a i n s h i s t o r i c a l
i n f o r m a t i o n , does a p h y s i c a l exam, and t h e n , i f a p p r o p r i a t e ,
r e f e r s t he pa t i en t f or o t h er s t u d i e s , I a bor a t o r y, x r a y , e t c .
• nce he/she has t he r esu11 s o f t he v a r i o u s t e s t s , an op i n i o n
i s formed as t o t h e most l i k e l y d i a g n o s i s and t h e a p p r o p r i a t e
t r e a t m e n t i s p 1 a n n e d . "1" h i s i n f o r m a t i o n i is t h e n c o n v e y e d t o
t h e p a t i e n t a t a t i m e and i n a s e t t i n g where r a t i o n a l p l a n s
can be made. I t i s most d i s c o n c e r t i n g t a p a t i e n t t o have a
r a d i o l o g i s t t e l l her "you have a s m a l l c a n c e r i n your l e f t
b r e a s t " , and n o t be i n a p o s i t i o n t o answer t h e "what a r e y o u
g o i n q t o do a b o u t i t " q u e s t :i. o n .
Enough a l r e a d y on t h a t s u b j e c t .
I am p r e s e n t l y
living
i n New H amp s h i r e, b u t h a v e p 1 a n s t o tn o v e t o t h e P h o e n i x a r e a
i n m i d •- A p r i 1 - M a y . I have t i m e . T h a v e p a t i e n c e a n d n o
•
p a t i e n t s . I w o u l d l i k e v e r y much t o c o n t r i b u t e . May I ?
Sincerely
yours,
K e n n e t h B . Snel 1 , M„ D„
.
�CODER:.
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& information systems
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^unnecessary procedures
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drug prices
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prevention
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DOCUMENT NO.
AND TYPE
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03/21/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
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�GORDON C. G. THOMAS, M D
..
^3
March 21, 1993
Ms H i l l a r y Rodham C l i n t o n
Health-Care Task Force
1600 Pennsylvania Avenue, N W ,
..
Washington, D C 20500
Dear Ms C l i n t o n :
Although I am almost r e t i r e d , I are extremely concerned' about
the -health-care systeiB i n the U. S. Please note my 6/92 a r t i c l e i n
one o f the most c o n s e r v a t i v e papers i n the c o u n t r y . The W.S.J. , a n d
o t h e r p o l l s , show t h a t we a l l want changes f o r the b e t t e r . When
h a l f o f the Vermont doctors f a v o r a Canadian type systera, and they
are q u i t e f a m i l i a r w i t h i t , we should give i t our most serious
cons i d e r a t i o n .
At t h i s p o i n t I are begging and pleading t h a t you do not Jump
at any type o f managed o r H O p l a n . The U. S. deserves b e t t e r .
M
Although pushed so v i g o r o u s l y by the insurance coapanies and other
p r o f i t - m a k i n g groups, such as HMO's and b i g business, I do not bel i e v e you could f i n d any p h y s i c i a n , who would honestly e l e c t t o have
his own care through such a system. Why? We r e a l l y know the answer?.
The f i n a n c i a l i n c e n t i v e s are t o do less f o r p a t i e n t s , regardless ofthe i n d i c a t i o n s . Managed or l i m i t e d care i s g r e a t , unless one-gets
s i c k . Again I plead. Canadian and German systems are-proven, even
though not p l e a s i n g every one. We have a woman emergency room doct o r here-, who married a German and worked t h e r e t h r e e years. She
said: p a t i e n t s and p r o v i d e r s were very pleased w i t h t h a t system. I
beg.you t o t a l k w i t h her. England i s the p r i s e example o f the H O o r M
c a p i t a t i o n p l a n , which s t i l l gives second-rate care. One should noti'
e l e c t t o have a plan t h a t has most s t r o n g l y been proven a d i s a s t e r .
Again, we deserve b e t t e r . A small value-added t a x would end
the unconscionable t i e between h e a l t h and employment. A good, none a p i t a t i o n systera could and should be utilized» The b u r e a u c r a t i c
s i m p l i c i t y , along w i t h good cost c o n t r o l s , would give e x c e l l e n t careand s t i l l cost 150 b i l l i o n a year less than we are spending now.
!• would be happy, t o t a l k w i t h , meet w i t h anyone or help w i t h anything'-,
t h a t would help solve one o f our isost urgent problems.
Gordon G. G. Thomas, M D .
..
:
�THE UNION LEADER, Manchester, N.H. — Monday, June 1,1992
' Y O U R T U R N , ' New Hampshire
Health Care System in Absolute Chaos
guaranteed, the costs will-escalate.
Look what happened to college fees.
The Feds and other sources implied
years in medicine I have
- seen many changes. Polio is — that grants. and/or_loans would be.avail-_
able and all were urged to apply. In
gone... antibiotics came on
other words, colleges and universities
the scene, as well as the trancould increase fees without any conquilizers and antidepressants. There
cern about an individual's ability to
have been many developments in
pay. So, what happened? Skyrocketing
pharmacology, endoscopic procedures,
costs.
CT and other scans, one day surgery,
What about the recent race to build
plastic lenses to replace cataracts, anhundreds and hundreds of condos
gioplasty, open heart surgery, organ
without many commitments to buy, i.e.
transplants, etc.
keep building; buyers will show up to
In spite of all the wonderful developtake care of them. But, they did not.
ments, our health care system is in abCould there have been touches of
solute chaos. Costs keep skyrocketing,
greed causing some compromises in
whether hospital
business judgments?
bills, doctors' fees, r-, - -•v- '•'•^im^ :^rM
The explosion in medical technology
medical equipis tempting every facility to have as
ment, medicamuch of the expensive equipment as
tions, etc. Costs
possible. There are more and more test
now exceed the
procedures, treatment modalities, etc.
ability of many ininvolving increased staff and paperdividuals to pay,
work. The costs of which keep rising at
unless they are in
will, with the expectation that some inthe wealthy catesurance will somehow cover it.
gory. Insurance is
Health care is now an entitlement, as
supposed to more
it should be. This is the greatest counor less cover the
try on earth and our citizens should resituation. We all know that often this is
ceive needed care. The questions are:
absent or inadequate, or worse, unafHow do we do it, what type of plan is
fordable, as it is with 37 million people.
best, who will control it, how can costs
Each year in the United States we
be restrained, and, of course, how will
spend about $700 billion or 12 percent
it be paid for?
of GNP for health care, compared to 8
Paper-work or administration is estipercent in Canada. Yet, Medicare unmated at about 20 percent, which
fortunately does not cover the most
would be $140,000,000,000. Just imagcostly of all medical expenses of the eline, $140 billion a year, which is really
derly, i.e. chronic, severe invalidism. If
wasted money. To correct this, as much
someone goes into a nursing home and
as possible, we need a single paper sysis unfortunate enough to live a few
tem, as in Canada. The regular private
years, all family resources can be used
practice of medicine and the private
up, the spouse becoming destitute and
hospital systems should continue.
going on welfare. What a system the
The big change would be that all
government has derived for our latter
health care bills would be sent to a cenyears.
tral, or regional, government agency.
When something is essentially
By GORDON C.G. THOMAS
D
URING MY MORE than 45
m
Fee schedules would be developed, as
is done with Medicare. These should
be realistic, but not excessive. Every
year_qiJwo a blue ribbon commission
would have hearings and review all
fees. The system would cover all medical bills, hospital charges, nursing
home costs, group home care for various types of patients, home health
care, dental care and m'edications. A
national fee schedule is absolutely necessary, if the fantastic rises in costs are
ever to be contained. Peer review and
quality assurance programs would be
operating at all times, to insure good
care, as well as trying to prevent any
abuse ofthe system. We should avoid
any arrangements that would offer any
financial incentives for providing less
care for patients.
Whenever anything resembling the
Canadian system is mentioned, we
hear objections such as: we can't afford
it, the whole thing is beyond our ability
to carry it out, etc. If we are spending
12 percent of GNP now, and if we put
in a Canadian-type, one paper system,
the costs could drop possibly to 10 percent of GNP. In rough figuring, the
savings would be at least $100 billion.
—Dr. Thomas is a resident of Laconia
and at age 72, is in semi-retirement.
Opinions expressed in this weekly
column aren't necessarily those ef
The Union Leader. AH readers are
welcome to submit essays of up to 759
words for the editor's
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Please include a word or two about
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�AMERICAN MEDICAL NEWS/MARCH 22/29, 1993
Survey: Half of Vermont doctors back Canada plan
BERLIN, Vt. (AP) — Roughly half
of Vermont's physicians favor scrapping the current medical insurance system for one similar to Canada's, suggests an informal survey.
Vermont Physicians for National
Health Care said 49.9% of the 402
state-licensed doctors responding to its
mail survey said they backed a singlepayer plan. Just 10.7% supported managed competition, the modified multiple-payer system the Clinton
Administration appears to be pursuing.
But the president of the Vermont
State Medical Society says he doubts
the survey represented the sentiments
of a majority of physicians statewide.
"Their agenda is different from what
the State Medical Society's is," said
Edward Leib, MD. "Theirs is a membership that is more biased toward primary care and, I think, single-payer."
; Vermont (Physicians for National
Health Care is the state affiliate of the
"national organization lobbying for a
. single-payer system.
Lee Emerson, MD, a Brattleboro
physician who is conducting the survey, said he was not surprised by the
results "because I think physicians are
more Jn J favor of it than we usually
acknowledge." . - V' •• • \ *
Vermont lawmakers will have to
choose between single payer or a modified, more highly regulated system of
multiple insurers during their 1994 session, when the Health Care Authority
they created last year presents options
for each system. " '
Dr. Emerson said his group would
try to use its survey results to influence
r
:
the outcome of that legislative decision. " I think they [lawmakers] feel if
they did favor a single-payer program,
they'd have to get medical doctors in
line. I think that isn't necessarily true."
Vermont Physicians for National
Health Care released its survey during
a meeting at Central Vermont Hospital
promoting a single-payer system.
About 75 medical professionals turned
up for the meeting to hear a Canadian
physician explain her country's health
system and for Rep. Bernard Sanders
(Ind, Vt.) to make a similar pitch.
The group sent survey post cards
with return postage paid to 1,404 licensed doctors in Vermont. Four hundred twenty-one returned the cards,
but not all answered every question.
Dr. Emerson said he had not yet
determined whether the sample was
representative of the state's physician
population. Of the respondents listing
a specialty, 18.8% were family physicians and 25.1% internists.
Dr. Leib said that might be enough
to skew the survey results, because
those are the doctors most affected by
the insurance bureaucracy.
" " I think there are number of physicians out there who would favor some
form of single-payer," he said. But " I
think that group does not represent the
general membership of physicians in
the state."
The medical society opposes a singlepayer system but supports "a limited
multipayer system where we would not
have government controlling" insurance payments, Dr. Leib said.
�AMERICAN MEDICAL NEWS/JUNE 22. 1992
House Democrats say in survey
Single-payer, not play-or-pay,
best for health reform
Congress should 'move forward with reforms on
which there is agreement, rather than wait for any
Utopian solution that frankly may never develop.'
House Republican
By Harris Meyer
AMN STAFF
In a surprising split with party leaders, more House Democrats favored a
single-payer health reform solution
than a play-or-pay approach, a recently
released survey says.
In the poll of 98 congressmen by the
Democratic Study Group, 43% picked
a Canadian-style single-payer national
insurance system as their first choice
among five solutions; 11% chose it as
their second favorite. The play-or-pay
system pushed by Senate Democratic
leaders won first-place votes from only
27%.
Even more noteworthy, 36% said
they were likely to vote against a playor-pay bill, compared with only 15%
likely to vote against a single-payer bill.
The survey, though released last
month, was taken last fall. Scott Lilly,
executive director of the Democratic
Study Group, acknowledged that
House members' sentiment in the fastmoving reform debate is "evolving"
and might have changed since the poll
was taken:
The poll is, however, one of the few
available indicators of how Democrats
might jump. The study group said the
survey sample was representative of
the 270 House Democrats.
" I think single-payer is not as much
of a pipe dream as some people say,"
said Lilly, whose group is a research
organization for House Democrats. "1
was surprised to see that even most of
the Southerners were opting for singlepayer over play-or-pay."
The survey reflects Democratic disarray on health reform;. Democrats
hoped to capitalize on the politically
potent health reform issue to boost
their presidential chances, but find
themselves badly split between the two
approaches.
Leader Robert
Michel
Acknowledging the differences, | interest groups."
House Democratic leaders are pushing
Despite the show of support for sinfor passage of a stop-gap bill offering
gle-payer, there was, not surprisingly,
global spending limits and reform of
the current small-group private insurance market. But they don't have the
little agreement on how to finance it.
votes yet for passage, and certainly lack
A payroll tax paid equally by ema veto-proof majority.
| ployers and employees had the'most
The Republicans, meanwhile, have ,
gained momentum with a small-group :
insurance reform bill minus the controsupport — favored by 45% of the conversial spending caps.
gressmen as either their first or second
Congress should "move forward
choice. An income tax hike came in a
with reforms on which there is agreement, rather than wait for any Utopian
solution that frankly may never develdistant second, with only 22% listing it
op," House Republican Leader Robert
as one of their top two picks. The least
Michel (R, 111.) said at a news conferpopular choice was a system requiring
ence. Some prominent Democrats, like
Sen. Lloyd Bentsen (D, Texas), agree.
Under the leading single-player bill,
individuals to pay for coverage based
HR 1300, sponsored by Rep. Marty
on their level of insurance risk.
Russo (D, 111.), a tax-funded governSixty percent said it was "extremely
ment insurance system would cover evimportant" that a health reform bill be
eryone. Under the Senate Democratic
brought to the floor this year. The repleadership's Health America bill, all
resentatives favored a sweeping reform
employers would have to either proproposal over a modest one by a simivide coverage for their employees or
lar margin. Two-thirds preferred inclupay into a public plan that would offer
sion of long-term care, and three-quarcoverage. Both bills feature overall cost
ters wanted to fold Medicare into the
controls, though the Russo plan would
new system.
be stricter.
On medical malpractice, 43% said
Opposition to play-or-pay probably
they favored encouraging states to
is due to the burden it would place on
adopt liability system changes, while
small businesses that don't offer health
24% said the federal government
coverage, the survey report explained.
shouldn't play a role in this area.
Small firms have lobbied heavily
against the proposal. There hasn't been
as much lobbying against a Canadianstyle system because it's not yet seen as
a serious option, some say.
Russo, in a prepared statement, said
the survey shows that momentum is
building in Congress for "true" reform
legislation, and that congressmen "are
listening more to what their constituents are demanding and less to special-
�THE WALL STREET JOURNAL FRIDAY, MARCH 12, 1993
Seeking a Cure: Most Americans
Want Changes in Health System
•:HIt certainly lailea the 46-year-old retail
worker. When her employer was bought
; out by another company, her insurance
I premiums tripled pvernlghL Unable to
j afford the coverage, she had to drop it.
, Percentagestini.,*« ~ . ^ . . — . . . , • v.^^
Shortly thereafter, her teenage daughter
iUnacteptable
developed serious health problems, run- ning up huge bills that Ms. Owens can't
pay. She still has no medical coverage.
Eleanor Leopold, 48, also thinks the
U.S. health system stinks, even though her
health insurance covers 90% of her doctor,
dentist and prescription-drug bills. She'
worries that her coverage could vanish if
her husband, an (employee-relations manager, loses his job, or that it could be
onaquairti
drastically cut back if his employer falls oh
hard times. She wants the system
LlmlUioBivna
changed, and she is willing to pay higher
l-V:.^, - * r
taxes to change i t '
More Bovemnie-.
A Sweeping Consensus '
.' intha liealt
That kind of agreement between people
•v; y. • V? a i ^
at opposite ends of the coverage spectrum
reflects a sweeping national consensus. A
new nationwide Wall Street Journal/NBC
^ Liinils ooiite .
News poll shows that 7 % of the public
8
believes that the current health-care sysftem doesn't meet the needs of most
•LlmCtsonibe
Americans, and 74% say a complete overhaul is neededto.cover everyone and
control costs.
. Higher tnssraii
Moreover, the survey finds a surprising
willingnesstoaccept some sacrifices. Of
those surveyed, 6 % say they would be
6
willing .to pay higher taxes so that
T E W L SRE J U N L B NW POLL
H AL T ET O R A / C E S
N
everyone could get health insurance; 5 %
2
could accept limits on the righttochoose
their own doctors; and 4 % could even
6
How; Poll Was Conducted
accept higher Insurance deductibles and
The Wall Street Joumal/NBC News
co-payments.
poll was based on nationwide telephone
Americans believe" the system "needs
interviews of 1,503 adults (1,186 of them
major change, not just tinkering or work
registered voters) conducted Saturday
around the edges," conclude Robert Tee-.
through Tuesday by the polling organi; ter, a Republican,' and Peter Hart, a
zations of Peter Hart and Robert TeeI Democrat, who conducted the poll for the
ter.
: Journal and NBC.
The sample was drawn from 3 5
1
The survey results are good news for
randomly selected geographic points in
i President Clinton. They suggest that If he
the continental U.S. Each region was
. fulfills his promise to deliver a bold plan to;
represented in proportion to its populaguarantee universal access' to health care
tion. Households were selected by a
and curb therelentlessrise In medical
method that gave all telephone numPoll Shows Stunning Backing costs, Americans arereadytoaccept the
bers, listed and unlisted, an equal chance
possibly unpleasant tradeoffs.
of being included.
For an Overhaul, Giving Concerted Drive Needed :
One adult, 1 years or older, was
8
selected from each household by a proce; The President a Big Boost' areIndeed, Mr. Clinton's political advisers,
arguing that his health-care package is
dure to provide the correct number of
more likely to win public support if it is
male and female respondents.
seen as radical shift in
sense
Chances are 19 of 20 that if all adults
Support for Equal Treatment j that theapublic will havepolicy. Theyin a
confidence
with telephones in the U.S. had been
plan's chances of truly solving problems
surveyed, the findings would differ from
only if it appears to be a sharp departure
these poll results by no more than
By HILARY STOUT ~ :
from the current system. A package seen
2.6 percentage points in either direcStaff Reporter of THE W A H . STREET JOURNM.
tion. A limited number of questions
- MT. LAUREL, NJ-"We may have one as simply more of the kind of tinkering that
were asked of half the sample; for
of the best health systems in the world,", i has been tried before would be hard to sell,
these, the margin of error was 3.6
says Sandra Owens, "but it has failed us the advisers contend. But Mr. Clinton will
points. The margin for any subgroup
miserably.".
- :' still have to educate people about the
would depend on that group's size.
r
r
iS
H
Seeking a Cure
MostAmericansPledge
Sacrifice to Help Fix ;
The Health System •
:
�;
Cynthia Wynn, a 32year-old single
"The government has to take care for
mother of a four-year-old daughter, says
erhaul :
she can barely afford the $ 0 a month she those who don't have coverage, but if we're
20
talking about across-the-board intervenmust contribute to enroll in the health
tion, the government kjiows nothing about
maintenance organization her company
W>m\jmlcb$tsaadcowr:
ismp
.
the medical profession," Ms. Owens says.
offers. But she learned an even more
. mtyone withpin a tmpjeto amhaul oi painful lesson a few years ago when she
"The government's part should be making
it available to everyone who wants it,
was without any coverage-and her daughneeds it and cannot afford it."
ter was diagnosed as having diabetes.
Federal Role Disparaged
Ms. Wynn thinks the government
should pay for everybody's health care.
Richard Sooy, a 38-year-old mechanic
"That's a fairer way of doing it, so
who rates his current medical coverage as
everyone gets health care equally," she
A-plus, fears that the government would
says. She is opposed to paying higher taxes just mess things up. " I don't think the
for coverage-"people like myself, a single
government can handle it," he says. He
parent who only makes $15,000 a year,
vehemently opposes medical price controls
should not be taxed" - but less financially
and says the system should instead be
pressed members of the group say they
based on incentives for the medical profesT E W L SRE JOUHNAL/NBC NEWS POLL
H AL T ET
understand the need for higher taxes and
sion to treat uncovered Americans.
are willing, within reason, to pay them.
necessary trade-offs and forcefully explain
"Instead of penalizing people for
the intended benefits. However much
achieving in this free-enterprise system,
"I would pay more," Ms. Leopold says.
Americans clamor for change, they are
why don't we reward the medical profes"I personally would, but then my income
obviously confused about what they want
sion with tax breaks and tax cuts and tax
would stand it." Frank Giardinelli, a 35in health care, and their confusion could ,
incentives to give their time?" he asks.
year-old carpenter, says, "I say you either
prove perilous for the president.
have specific kinds of taxes or you raise
But such views are clearly in the minor"For Clinton, the devil will be in the
taxes, because to ignore the plight of
ity, the poll shows. An overwhelming 8 7
7c
'details," Mr. Teeter says. "As soon as you
someone else in society is, at least how I
of Americans favor government limitaget to the specific details of implementawas raised, immoral."
tions on doctor and hospital costs. And 6 %
3
tion, you will create a lot of opposition." An
say all employers, even small-business
A Sense of Vulnerability
object lesson is Congress's 1988 expansion
owners, should be required to provide
But another reason even people with
of Medicare to insure senior citizens, for a
health insurance to their employees - a
decent coverage are willing to entertain
moderate extra premium, against the cost
measure that President Clinton's advisers
sweeping changes is a lurking sense of
of catastrophic illness; something that
say he is likely to include in his plan.
their own vulnerability. "I'm working, and
looked wildly popular in theory turned out
Although the poll backs up the notion
I have pretty good coverage," Mr. Giardinto be wildly unpopular in practice, and
that many Americans understand tho
elli says. "But if I was out of work, I'd be in
angry seniors forced the law's repeal.
trade-offs that health-care reform might
a lot of trouble. My coverage comes
To further explore Americans' desire
entail, it also finds them willing to make
through a union; so, if I'm out of work a
for and reservations about health-care
those trade-offs. Of those surveyed, 5 %
6
certain time, I lose my benefits."
reform, the Journal asked Mr. Hart to
say the possible advantages - universal
To help pay for revamping the system,
bring together this week a group to discuss
coverage, no loss of benefits for changing
the nationwide Journal/NBC poll found
the issues - a group that included Ms.
jobs or becoming seriously ill, lower costs
overwhelming support for "sin taxes" on
Owens, Ms. Leopold and 1 of their neigh0
to the government and economy - outcigarettes, alcohol or other products conbors here in the New Jersey suburbs of
weigh the possible disadvantages - higher
sidered health hazards. Of those surveyed,
Philadelphia. Most of them were middletaxes, more government involvement, loss
7 % said they could accept a whopping $2
0
class working people, the vast and dispachoice for patients. And 3 % think the
3
increase in the tax on a pack of cigarettes;
rate group whose strong support the presidisadvantages would outweigh the advan8 % said they could accept a 50-cent in7
dent will need to push through his propostages.
crease in the tax on a six-pack of beer; and
als. Four of the 12 people had no health
The feeling that the benefits would be
8 % said they could accept a $1 increase in worth the problems was evident in the New
5
insurance; six had lacked any coverage at
the tax on a quart of liquor or wine.
some point in their lives. The group was too
Jersey group. "There was a sense that this
small to be a scientific sample, but the
Overall, 6 7 said it won't be possible to is not a something-for-nothing game," Mr.
7o
participants' concerns both echo and amHart observes. "These people are willing
provide health coverage for all Americans
plify thefindingsof the nationwide poll.
to make changes and adaptations either in
without raising taxes. In terms of benefits,
terms of what they are paying or what they
"What we could feel in New Jersey was
people want it all: The survey indicates
have to contribute or the way in which they
the sense of angst and uncertainty that
that strong majorities favor coverage not
receive health care."
people have when it comes to health care in
only for hospital and doctor fees but also
America," says Mr. Hart, who conducted
for nursing-home care, prescription drugs,
The one thing most of them - and most
the discussion. "Their difficulty is in
and dental and vision care, even if such
Americans - aren't wiUing to do is to do
reaching a single defined solution of how to
extended coverage would increase their
nothing. Asked his reaction if President
deal with the problem."
own costs under the program.
Clinton were to delay dealing with the
Both the poll and the discussion group
health-care problem until late in his term,
But people are ambivalent over the
suggest that, despite Americans' intense
Howard Myers, a 47-year-old administragovernment's role in the health system.
dissatisfaction with the overall health systor and therapist, responds with one word:
Although 71% are willing to accept more
tern, most of them are happy with their
"Impeachment."
government involvement, that doesn't inown medical care. According to the poll,
dicate that they favor a complete govern7 % are satisfied with the quality of health
4
ment takeover. Instead, 7 % say the sys0
care their families receive, and an identitem should be an amalgamation of public
cal percentage is satisfied with its availaand private insurers, with government
bility. Their biggest concern is cost: 5 %
6
regulation to control costs and insure
are very or somewhat dissatisfied with
how much they have to pay for coverage. j a minimum level of care for everyone.
!
1
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SORT:
General mail
.Personal stories
Other Health Providers
POSTCARD 1:
.Letter Campaign
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
REROUTE:
Casework
J^Physicians
Policy
.Scheduling
President
Other
POLICY AND PBRSONAT, STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
.unemployed/low income
.benefits
.providers
INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
.FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
a
1
��James .Atkinson IIIr-.-MsD
J. J a r r e t t ' C l i n t o n , M.D.
Administrator
Agency f o r Health Care P o l i c y and Research
A p r i l 30, 1993
U.S. Public Health ServiceDear.. Doctor J. Jarret " C l i n t o n ,
We are face^l w i t h the challenge of reforming American h e a l t h
care. How can we balance the inunediate need t o save money and
yet expand access to m i l l i o n s of uninsured? How can we improve
the u n f a i r service we now provide t o many Americans? Expanding
managed care i s under c o n s i d e r a t i o n .
1
Many p a t i e n t s fear change. Managed competition might change
t h e i r insurance, t h e r f h o s p i t a l , or t h e i r doctors. However, they
fear changing t h e i r doctors the most. Blue Cross and Blue Shield
of.New Jersey"recent 1y changed a l l three f o r some of my p a t i e n t s .
They are confused, a f r a i d , and angry. I f a company changes
insurance, or a person changes jobs or i s l a i d o f f , the doctors
might change. A pregnant woman might have a d i f f e r e n t doctor f o r
every t r i m e s t e r of pregnancy!
)
0 m
o
My p a t i e n t s gfrnn' ^T/"^ ^hHQf
because I work f o r a local
hospital/HMO ./^ut, ^ ^ ^ j ^ l pr '- - i ^ T " ^ •"' •
[inr-t-iwo
med R" 1 ne^
i k r a r r i c i p a t e i n Medicare and Medicaid. We a l l know
that indemnity plans l i k e Medicare are l o s i n g money. I
p a r t i c i p a t e i n four open panel HMO's. We know the HMO concept
seems to provide more care f o r less money, e s p e c i a l l y f o r
Medicaid p a t i e n t s . I t i s the gatekeeper concept that saves the
money yet expands access and maintains c o n t i n u i t y of care. I
p e r s o n a l l y don't b e l i e v e managed competition w i l l save money.
Any money saved w i l l go t o the "managers" or be wasted i n the
federal a d m i n i s t r a t i o n of hundreds of competing plans. I b e l i e v e
the Congressional Budget O f f i c e came t o the same conclusion.
3
1
-
4
,
Managed competition w i l l f i a t ^ r o v i d e more f a i r service.
.
They wTTI compete f o r the heai tny"; young, and employed. The
-^t
senior c i t i z e n w i l l s t i l l have to decide between food and
^=
medicine. Our nursing homes w i l l s t i l l provide impersonal •career*-'
for the r i c h "and poor wi th bankruptcy f o r the middle class. The",
unemployed, poor self-employed, or disabled w i l l s t i l l have t o
f i g h t a bureaucracy and wait to receive care. Providers w i l l
s t i l l waste b i l l i o n s of hours and d o l l a r s on unnecessary paper • -_
work. Germany and Canada may be q u i t e d i f f e r e n t , but t h e i r
"'
h e a l t h systems g e n e r a l l y work without managed competition. Why
reinvent the wheel? I f you would l i k e an a l t e r n a t i v e plan to
serve our f e l l o w Americans, please read on.
T
:
�My plan i s enclosed. While many of these concepts have
already been proposed, many are bold new ideas. For instance;
pay-or-play, l i m i t e d tax deduction, "smart cards", expanding the
RBRVS/DRG's to a l l payers, s i n taxes, and national drug
purchasing are already on the table. Conversely, my plans f o r
streamlining a d m i n i s t r a t i o n , senior nursing home care, pro-rated
premiums and co-pays, and national q u a l i t y assurance are q u i t e
new.
I have chosen the most important part of other proposals;
no f a u l t awards ( t o r t reform), c a p i t a t e d gatekeeper (managed
care), annual provider negotiations ( a n t i - t r u s t exemption and
f i x e d budgets), and universal coverage w i t h central c o n t r o l
(Canadian s t y l e national health insurance).
I represent myself and my p a t i e n t s . No one group w i l l l i k e
a l l my proposals but a l l p a r t i e s (except health insurers,
American T r i a l Lawyers, and pharmaceutical companies) might
accept the package. The a l t e r n a t i v e s of maintaining the status
quo or only expanding managed care are both e t h i c a l l y and
f i n a n c i a l l y unacceptable.
Please consider my proposal and I hope you can support
it.
Sincerely yours
James Atkinson I I I , M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
rW ****
SO*?
• /...
'
•'• '
-:' '-7. '
'
�James .Atkinson.-XII,
-
M.D.
-
Mrs. H i l l a r y Rodham C l i n t o n
Chairperson, Health Care Task Force
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Chairperson- Hi 1 l a r y C l i n t o n ,
As a p r a c t i c i n g p h y s i c i a n I share your concern f o r American
h e a l t h care and recognize the need f o r change. Medicine has been
in my f a m i l y f o r generations and I have witnessed great changes.
I beli'eve I have a good perspective to suggest what changes we
should now make. Health care i n the United States has'three main
problems; excessive cost, inadequate access, and i n e q u i t y . My
" i d e a l but a f f o r d a b l e " American h e a l t h care system i s summarized
below. Numbers i n parenthesis r e f e r to d e t a i l e d explanations
attached to t h i s l e t t e r .
Excessive cost i s the primary problem. Unless we can cut
costs and get more bang f o r the buck we can't expand access or
r e s t o r e e q u i t y . Health care costs can be d i v i d e d i n t o out-ofpocket expenses, h o s p i t a l type o r g a n i z a t i o n s , p r o v i d e r s i . e .
d o c t o r s , medications, equipment, t e s t s , senior care, and,
admini s t r a t i o n .
One payer c a l l e d Health Care America (HCAHl) would disburse
a l l f e d e r a l funds.
I n i t i a l l y , f e d e r a l and s t a t e insured persons
would be e n r o l l e d . ( F S I P ) ( 2 ) Other c u r r e n t t h i r d p a r t y payers
(TPP)(3) would coexist f o r employed persons under a "play or pay"
(4)law w i t h a l i m i t e d tax deduction ( 5 ) . Any company or person
could buy i n t o HCA w i t h a p r o - r a t e d income based premium ( 6 ) .
Each HCA member would be assigned a co-pay l e v e l based on
income ( 7 ) . Higher co-pays might be a p p r o p r i a t e . f o r e l e c t i v e or
expensive procedures ( 8 ) . .
A HCA medication, equipment, and t e s t i n g board (MET) (9)
would purchase these goods and services. Regional senior care
boards (SCB)(10), s i m i l a r to school boards, w i t h HCA, s t a t e , an
l o c a l funding, would manage the care f o r the aged and disabled.;*^
A n a t i o n a l nursing home board (NHB)(11) would set g u i d e l i n e s an<i^
negotiate rates.
A l l h e a l t h insurance companies (HCA and TPP) would pay
h o s p i t a l s or h e a l t h care organizations (HCO)(12) on a modified r"^
and n e g o t i a t e d (13) diagnosis r e l a t e d group (DRG)(14) scale. A l l "
American h e a l t h providers (AHP)(15), except HMO c a p i t a t e d primary
care physicians (16), would be paid by a m o d i f i e d and negotiated
(17) r e l a t i v e value scale (RVS)(18).
�A l l medical care would be reviewed by a n a t i o n a l q u a l i t y
assurance board (QAB)(19).
This board could see records, audit
HCA payments, and sanction p r o v i d e r s . A n a t i o n a l malpractice
review panel (MRP)(20) would review a l l v a r i a t i o n s from standards
of care and/or adverse r e s u l t s .
A l l Americans would carry a HCA i d e n t i f i c a t i o n card (21),
choose a primary physician (22), and cooperate w i t h record
keeping (23). That doctor would act as a gate keeper generating
r e f e r r a l s (24) and as a record keeper from a l l consultants. A l l
records would be t r a n s f e r r e d e l e c t r o n i c a l l y v i a modem (25). Names
and diagnoses could be shared by p r o v i d e r s , but only numbers and
codes would be sent to HCA or TPP (26)
Single payer purchasing power, l o c a l senior support,
c o n t r o l l e d and budgeted provider reimbursement, malpractice
reform, coordinated primary care, and a d m i n i s t r a t i o n streamlining
should save b i l l i o n s of d o l l a r s .
Freedom t o negotiate DRG and RVS payments, s i m p l i f i e d record
keeping and b i l l i n g , true peer review, f e e - f o r - s e r v i c e medicine,
and malpractice reform are t r a d e - o f f s t o American providers.
Nationwide coverage w i t h choice of doctor, employer or HCA
income based premiums and co-pays, and increased drug, d e n t i s t r y ,
and nursing home coverage w i l l r e s t o r e f a i r health coverage to
most Americans.
The HCA payment system might be expanded from FSIP etc. to
a l l Americans w i t h even greater savings, uniform access, and
t o t a l equity.
I would be happy to t r a v e l to Washington at my own expense
to discuss my proposals. Thank you f o r your concern w i t h American
health care and f o r reading my l e t t e r .
Sincerely yours.
James Atkinson I I I ,
cc: members of congress, et a l .
M.D,
�Health Care America (in detail)
Numbered paragraphs in this attachment explain in more detail each matching
item in my preceding letter.
(1) HCA (Health Care America) would be quasi-government agency managed by an
appointed board, independent of, but funded frou Congress with annual budgets.
Nine board members would be appointed by the president for four, eight, or
twelve year terms. Only the HCA agency could decide how to manage health care
and propose changes, not congress. Medicare, Medicaid, Chanpus, Veterans
Hospitals, Medigap insurance, and federal and state arployee health plans
would be replaced. The states would be free of the Medicaid millstone.
Further funding should be pro-rated such as a medical income tax or derived
frcm sin taxes. Those who are rich value l i f e more and those who abuse their
bodies deserve to contribute more. Veterans hospitals would become nursing
homes for Veterans under the same guidelines as senior care (10) below.
(2) FSIP (Federal and State Insured Persons) would include a l l those people
and their dependents who are employed by or retired from any federal, state,
and local government. This would include congress, a l l public school
enployees, as well as current members in the aforementioned HCA incorporated
plans. A l l those over 65, greater than 50% disabled, with 20 years military
service, handicapped, and recently injured (see MRP # 20) or unenployed would
automatically be enrolled. Including congress would ensure adequate funding.
No supplemental health insurance, l i a b i l i t y medical payments, or special
benefits would be allowed. Veterans would no longer fear losing their health
care with a base closing.
(3) TPP (Third Party Payers) would co-exist for a while. They would have
their own board, annual meeting, propose utilization criteria to the QAB, and
negotiate payments to providers (exempt from anti-trust law). However, cost
shifting might continue as providers would i n i t i a l l y seek out these patients.
Even H O s look for large groups to spread the risk. Health insurance would
M'
partially be tied to employment limiting job movement. Brployers would
continue to try to avoid coverage by contracting enployees and hiring
temporary workers. TPP would want to charge and employers would want to hire
based upon health risk. Currently, patients might have to change doctors
every year or travel far to participating specialists as their employer or
it's health insurance company shops around for the best deal. Some women
even have to change in mid-pregnancy. Expanding managed care w i l l only
increase this trend.
National guidelines for H O s should be established to avoid underM'
utilization or excessive provider financial risk (responsibility for hospital
b i l l s i f HMO not notified, large withholds, and huge penalties for referring
inadvertently to non-participating providers). Providers or groups of
providers should be allowed to negotiate their fees.(exerrpt from anti-trust)
�However, keeping TPP would keep millions of workers enployed. HCA
coverage should automatically be primary for the aged, disabled, injured,
handicapped, and unenployed, and their spouses and dependents. This should
encourage their enployment. Newborns without insurance would autanatically be
covered by HCA. The ridiculous burden of C B A payments on the unenployed
OR
would end. Allowing income based buy-in to HCA (see #6 below) would act as a
safety net.
HCA guidelines for provider payment (DRG/RVS), fair quality assurance,
malpractice reform, HCA identification "smart" cards, emphasis on primary
care, free preventive care, mental health coverage, and electronic b i l l i n g and
record keeping could be required of TPP also. This would save additional
money, provide better service, and avoid most of the provider "hassle factor".
(4) Play-or-pay should require employers to either pay for their enployees
health care or buy into HCA for each arployee not already covered by HCA. Any
contracted, temporary, or migrant worker should be covered. The enployer
portion of premiums should start on the f i r s t day of enployment whereas the
enployee portion should start after 90 days. I t should mandate pooled risk
sharing and no denial of coverage or higher premium for illness or health
risk.
(5) Health care tax deductions for employers or an individual should be
limited to 100% of the highest HCA premium. This would force the TPP to keep
coverage and rates competitive with HCA. Considering TPP would only cover
well working people and HCA would cover the sick and poor, HCA premiums should
be higher.
(6) HCA/FSIP premiums would be arbitrarily set for wealthy applicants. HCA
then establishes a sliding scale for those making less than five times the
federal poverty level plus cost of living raises. Those receiving less than
two times the federal poverty level (with cost of living increases) the
unenployed, injured, and recently disabled w i l l automatically be enrolled and
premiums waived for a set time. The re-enployed would be required to purchase
TPP or HCA coverage as an employed person after 1 year. Brployers would then
have to pay at least 50% of the HCA premium. Wealthy (five times the poverty
level) retirees or disabled would pay a maximum of 50% of the premium, with
HCA picking up the other half. The income base would be the lessor of the
current or previous year. No one would have to sell their house or wait
months to be eligible.
(7) HCA/FSIP co-pays would be pro-rated based on income over the federal
poverty level (with cost of living increases). A person with income five
times the poverty level might pay five times the co-pay of a poor person. The
income base would be the lessor of the current or previous year with urgently
reduced co-pays for the recently retired, unenployed, injured, or disabled.
These co-pays could apply to a l l services such as hospitalization, physician
care, prescriptions, and/or nursing home care. HCA should prohibit balance
b i l l i n g and avoid deductibles or co-insurance.
�8) Higher basic co-pays might be assigned to avoid certain services, up to a
maximum, i.e. 25$ for certain specialists, or 50$ for Emergency Services,
second opinions, braces or dentures. A "0" co-pay for a l l would be
appropriate for any maternal-child-health care, vaccinations, and screening
tests or physicals. HCA might also decide not to cover certain useless care
such as removing a wart from a bedridden patient. However, once a service or
substance is approved by the QAB as standard care or treatment, HCA must
provide coverage in spite of i t ' s cost, political concerns, or how new i t is.
(9) The MET (Medication, Equipment, and Testing) Board would negotiate
nationally for the best price for any product or service for HCA/FSIP members.
Each division of MET; pharmacy, equipment, or testing would propose broad
utilization guidelines for the QAB. Over utilization might generate a notice
to the beneficiary, the ordering provider, and the primary physician. The QAB
might then be requested to audit repeat offenders.
Sane QIC products and probably useful products should be covered. The
MET should not require generic substitution, therapeutic equivalent
substitution, or certain quantities. However, co-pays should be minimal for
generic, standard amounts of medications i.e. #100 furosemide and higher for
unusual amounts such as 10# furosemide, or brand name only, or less useful
products. Poor senior citizens would no longer have to decide between buying
food or medicine.
No product should be denied coverage i f considered standard treatment
regardless of cost, or newness. Products should be bought for chronic
conditions (i.e. wheelchair), not rented, with an incentive to return to a
senior center i f no longer needed. Only a provider signature and code number
should be necessary to order a test or piece of equipment. Documentation of
diagnosis, or severity of illness should not be required. Current rules
require a provider personally complete a two page form for a bandage or bag!
No person should have to drive more than a certain distance for standard
inexpensive test i.e. mairmogram. Routine testing should be done in the
primary physician's office such as a blood count, urineanalysis, or ECG.
Laboratory testing would be reimbursed the same, regardless of drawing station
except approved hone visits. Testing of disabled, uncooperative, or highly
contagious patients might be reimbursed higher. Names would be coded for
b i l l i n g to maintain confidentiality. Patients at risk for HIV infection
should not fear test disclosure.
Certain jut-patient testing (such as x-rays, vascular, biopsies, etc)
should have one encompassing test charge, not a technical and interpretive (or
pathology) portion. However, invasive same day procedures such as surgery,
lithotripsy, and colonoscopy should allow a separate DRG (HCO) payment. Copays might be higher for those of marginal benefit: i.e. oxygen for mild C P ,
OD
or i f extremely expensive such as MRI's.
(10) Regional SCB (Senior Care Boards) would manage a l l senior and nursing
home care similar to local school boards. Every high school district in the
country would elect a SCB. HCA, the individual state, and the local SCB would
each pay 1/3 of the cost. Each SCB would have authority to tax and issue
construction bonds similar to school boards. Hopefully, new nursing home
construction would add new jobs.
�Admission criteria would include severity of disability and years of
residency. Disability determination would be done by two geriatricians using
losses of Activities of Daily Living. Years of residency would apply to the
senior citizen and/or chosen next-of-kin. Each disabled senior citizen would
be entitled to support for preferably hone care, day care, or boarding care,
or nursing home care as the last resort.
Each S B district would define it's disabled population and provide
C
adequate care for each including residential care i f necessary. Although
purchasing existing beds within the district would be allowed, a l l the other
levels of care must be provided and national guidelines would s t i l l be in
effect. Bnpty beds waiting for hospital discharges would be appropriate.
Geographic bed roulette would end. Hopefully, residential homes, senior day
care, meals-on-wheels, nutrition centers, M T stations, and senior centers
E
could share some central facilities and transportation.
Residential and senior day care should be similar to heme care; no
l i a b i l i t y for injury and no restrictions to activity except to prevent
wandering in the streets. Driving, visiting family, shopping, and apartment
style living should be encouraged when appropriate. For those limited to the
f a c i l i t y ; washing clothes and making beds should be encouraged. Volunteers
would be strongly encouraged also. A l l of us could now relate to our own
local f a c i l i t y . Rehabilitation centers would be a separate wing or entity
with similar guidelines. Co-pays would again be graduated and based upon
incone. Conpare this to our current over-regulated, inpersonal nursing hone
care for the poor and rich with bankruptcy for the middle class.
(11) A national nursing hone board (NHB) would consist of 1/3 geriatric
providers, 1/3 nursing hone administrators, and 1/3 senior lay members. I t
would meet, propose "standards of care" and utilization criteria to the Q B
A
and propose rates to HCA. (therefore exempt from current anti-trust
regulations) Tri-annual meetings would take place with H A to negotiate rates
C
with disputes subject to binding arbitration.
(12) H O (Health Care Organizations) would include a l l those institutions that
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provide in-patient care (except senior care above) such as hospitals and some
out-patient care such as stand alone surgical and endoscopy centers. H O
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members could meet to propose guidelines for "standards-of-care" and
utilization review to the QAB, suggest capital outlays, and propose fees for
each D G payment (from HCA or TPP) to H O (therefore exenpt from current antiR
C
trust regulations). These negotiations could prevent H O S frcm arbitrarily
M'
deserting and bankrupting hospitals.
(13) Tri-annual meetings would take place between HCA and H O to negotiate D G
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payments and capital outlays with disputes subject to binding arbitration. No
lock-outs would be permitted under federal law.
�(14) D G (Diagnosis Related Group) payments are currently used by Medicare to
R
pay hospitals based upon the principal discharge diagnosis and some modifiers.
They have been very effective in streamlining hospital care, with less
testing, and a shorter length of stay. However, they would have to be
extremely nodified to adjust for younger (lower), more co-morbid conditions
(higher), and other inadequacies of the current D G system. Pediatrics and
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other specialties would be added. Bonuses might be added for lower
utilization and readmission rate, a good QA rating, and excellent patient
approval. Some out-patient care such as same day surgery, lithotripsy, and
colonoscopy would have a D G payment with an incentive for out-of-hospital
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care.
Discharge diagnoses and names of patients would be coded (to maintain
confidentiality) with dates of service and provider numbers sent
electronically to HCA. Only QAB representatives and not payers (HCA/TPP)
would have access to the medical records. HCA would pay each institution or
out-patient center monthly based on at least 90% of expected billings and
distribute credits or debits annually. No penalties would occur for
unintentional misscoding. Payment could not be denied i f a service was
rendered. Currently, Medicare requires f u l l signatures, exact information and
otherwise practices micro management.
(15) A l l AHP (American Health Providers) such as physicians, dentists,
chiropractors, opticians, nurse practitioners, therapists, etc. would meet
annually to propose guidelines for "standards-of-care" and proper utilization
of each specialty to the QAB, suggest educational outlays, propose under
served areas or specialties for additional HCA support, and propose the
conversion factor for RSV payments (from HCA and TPP) to AHP (therefore exempt
from anti-trust law).
(16) Capitated primary care physicians are paid per assigned patients and
therefore not on a RVS payment system. However, many of these same physicians
see patients not on their assigned H O l i s t and therefore should be paid on a
M
RVS payment scale for this care.
(17) Tri-annual meetings (alternating with H O and NHB above) would take place
C
between HCA and AHP to negotiate the RVS conversion factor, up to 3% of the
individual RVS fees, special support, and educational outlays with disputes
subject to binding arbitration. (See exenpt frcm anti-trust law above) No
strikes would be permitted under federal law.
(18) The RVS (Relative Value Scale) method of paying physicians was chosen by
Medicare (with physician participation) as a relatively fair method of valuing
each physician service. Previously, procedures were historically over-priced
and specialists were paid more than a general physician for the same service.
These RVS payments would have to be extremely modified to adjust for younger
patients (pediatrics) and non-physician services (dentists, chiropractors,
physician assistants, nurse practitioners, therapists). A l l services
considered standard care would have to have some reimbursement including
dental cleaning, E G interpretation, telephone calls to patients and families,
K
heme case management, and corpleting extensive forms.
�Bonuses should be added for primary care of the heme bound,
handicapped, and for service in an under served area. There should also be
financial incentives for low utilization, good QA. rating, and excellent
patient approval. HCA would electronically pay each provider at least 90% of
expected monthly billings. HCA would adjust credits and debits annually.
Monthly statements to HCA would l i s t coded patients, procedure or service
codes, and dates of service. No other information would be necessary except
i f audited by the QAB.
(19) A l l medical, nursing home, and hospital care would be reviewed by a
national QAB (Quality Assurance Board) made up of 1/4 physicians, 1/4 other
AHP, 1/4 H O and NHB representatives, and 1 4 legal/lay representatives. This
C
/
board would have offices in every major hospital and/or county. HCA would pay
50% of their budget with HCO, AHP, NHB, TPP, and MET each paying 10%. Each
provider (HCO, AHP, NHB, TPP) would propose standards of care and utilization
criteria to the QAB.
Beneficiaries (patients) would have their own board and propose
utilization criteria and a l i s t of patient's rights to the QAB. The QAB would
review, negotiate, approve, and publish these utilization criteria, standards
of care, and patient's b i l l of rights.
H A T P would have secret thresholds (similar to IRS) that might
C/P
generate an audit by the QAB.(i.e. an internist doubles his number of ECG's, a
dentist removes too many teeth, a patient has 2 gallbladder surgeries) The
beneficiary board, any state board of medical examiners, HCA, M B (below),
R
HCO, AHP, NHB, TPP could request an audit of a provider or beneficiary. No
individual could generate an audit except through his representative board.
This would prevent disgruntled enployees, angry patients, and jealous
providers from initiating fruitless audits. Possible assault would require
iirmediate review. However, a provider would be considered innocent until
proven guilty.
The QAB could copy any medical records, without notice, for review.
Those copied records would be held strictly confidential and only released
frcm the QAB with signed consent or by court order. Only a board certified
specialist (active or retired) in the same field (dentist to dentist, midwife
to midwife, neurosurgeon to neurosurgeon) could perform a QAB officer review.
A QAB officer would determine i f there was any violation of standards of care.
A QAB officer could enter any part of medical practice (Operating room, office
examining room) without notice to observe a practitioner.
The QAB board in turn could sanction any provider for over-utilization,
substance abuse, variance from standards of care, illegal activity,
intentional fraud, unethical behavior, etc. Sanctions should include education
and review of subsequent care. The punishment should f i t the crime; i.e.
over-utilization; underpayment, too many wound infections; a small fine,
substance abuse; detoxification and mandatory monitoring as a condition for
continued practice. A l l Q B review, decisions, and sanctions would be
A
absolutely confidential and except when initiated by the M P (below) or a
R
state board of medical examiners, non-discoverable. Beneficiaries could be
fined for abuse but never denied coverage. Any provider or beneficiary could
appeal his sanction through the courts. Currently; a mentally i l l woman could
accuse her physician of assault and ruin his practice before any t r i a l occurs.
8
�(20) The M P (malpractice review panel) would consist of 1/3 medical, 1/3
R
legal, and 1/3 lay representatives. Any conplaint of an adverse result or
negligence could generate a claim. Beneficiaries could directly f i l e a claim
without legal advice. Attorneys, the victims survivors, or the QAB could also
f i l e a claim on behalf of a victim. The QAB would be notified and would proceed as usual to copy records and provide "same specialty" review. The QAB
would determine i f there was any variation from standards of care and propose
any sanction to the provider. The M P would review the case, hear testimony
R
and only make one determination; i f an adverse result occurred (no-fault
concept). I f there was an adverse result the M P would suggest an appropriate
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coirpensation based solely on the severity of the loss.
No award either from the M P or a court of law should allow compensation
R
for medical care, punitive damages, or non-econcmic losses in excess of a set
amount. Medical care frcm an injury would automatically be covered under HCA
and punishment of any negligent provider would be determined by the QAB. M P
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conpensation would not include legal fees as legal advice would not be
necessary to receive compensation.
At this point the p l a i n t i f f or his survivors could review the QAB
records, and/or refuse the award and sue for greater compensation. Any
conpensation would then be put in an interest bearing escrow account. I f the
court ordered additional payment (guilty) the plaintiffs attorneys would not
be able to take any portion of the original conpensation or more than 50% of
the extra award. I f the t r i a l court found the award appropriate or excessive,
(not guilty), or i f the suit was later dropped or dismissed, the plaintiff's
attorneys would have to pay for the provider's legal fees.
Workman's conpensation, automobile and injury l i a b i l i t y payments for
medical care would be eliminated for a l l Americans as H A would become primary
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for any injury or disability. This would prevent practitioners frcm becoming
ambulance chasers as well.
(21) A HCA (Health Care America) identification card should be carried by a l l
Americans. Even those enrolled with TPP such as H O s would carry the HCA
M'
card. This "smart" card should carry the patient's name, code number, date of
birth, social security number, address, phone numbers at hone and work,
names, phone numbers, and addresses of the next-of-kin, primary doctor (and
his fax and modem numbers), an advance directive decision, and a organ donor
decision. The primary physician is in a good position to advise the patient
on the latter. A l l primary physician offices (given) and institutions
(purchased) would have equipment to encode and read this information. Other
providers would have to purchase their own readers but could not add
information. I f any medical information is included i t might be a problem,
drug, and allergy l i s t generated by the primary physician, (excluding
confidential information below #23) HCA/FSIP enrollment or TPP identification
numbers could be added to this.
�(22) Primary physicians are familiar with various medical problems and proper
use of hospitals and specialists, and capable of providing a history,
physical, and routine consultation.(i.e. child-pediatrician, adult-general
internist, or both-family physician) Each senior in residential care would
choose a primary physician. Primary care is much more cost effective than,
direct specialty care. Many specialists appropriately act as a patient's main
physician (such as an oncologist with a leukemia patient, or a nephrologist
with a dialysis patient). However, even in these situations, record keeping
and further referral or hospitalization should be discussed with the primary
physician. This would avoid the current expensive practice of multispecialty
groups inter-referring for minor new synptoms.
(23) The patient should assist with establishing and maintaining his medical
records. Fill-in-the-blank forms should be available in primary physician's
offices and institutions for both the H A "smart card" and for a conplete
C
medical history. The patient or his family could pick than up and conplete
than before their f i r s t v i s i t or on admission. The patient should remind a l l
other providers to forward subsequent records to the primary physician
electronically.
(24) The primary physician acts as a gatekeeper when he determines when and
where to refer his patients. (Except emergency and urgent hospital care when
he should be notified the next working day) This is a very effective but
practical method of controlling costs. Indemnity plans such as Medicare and
Blue Cross tried deductibles and 20% co-pays to discourage utilization.
Medicaid pays so poorly no provider wants the patient. Both of these methods
of cost control failed in spite of reams of regulations and prosecuting
"abuse". Sane H O s require phone calls, or limit the availability of certain
M'
specialists with tremendous stress on provider and consumer alike. Only the
primary physician gatekeeper concept has allowed f u l l access but controlled
costs.
(25) The primary physician would also function as the patient's medical record
keeper. A l l hospital suirmaries, specialists' reports, and emergency care
records would electronically be forwarded to the primary physician listed on
the HCA "smart" card. Then i f a patient changes doctors or moves he can
obtain his records from one location. The records would be divided into a
s t r i c t l y personal portion including alcohol use, sexual diseases and
preference, HIV status, psychiatric care and a general portion.
(26) Names and diagnoses could be shared among providers as long as electronic
connections to each provider were accurate and confidential. However, only a
Q B agent could see the actual record without a signed release. Names and
A
diagnoses would be coded for any other purpose such as b i l l i n g , research,
overutilization review.
10
��NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
J
fi
A S> (7£.
J>
<: •.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECT/TITLE
DATE
02/18/1993
Phone No. (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(H)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�/
.993
February
Mrs. H i l a r y R. C l i n t o n
j ^ h i t c House
Washington D.C
Dear H i l a r y ,
. . . '
"
".
'^
. : ;
,
.'.V-'r'y ' .
N
' '.
;
May I t e l l y r , how proud ^
^ '
0
< : J
; J^a,.*.:
S L ' s r i S « S : : ^ l ^ M - c ^ Ic^ooi
in 1939, have p r a c t i c e d . P e d i a t r i c and
and have heard . Ms M e j ^ ^ a p e a k
SAM
c a n ' t thank you a n d - ^ " - e n o u g h f o r a l l yo
have done f o r c h i l d r e n . .
Keep g o i n g ! ' :
.
v '
Affectionately,
E l l a -^"cummins, M.D.
(Dr. Bobby)
P.S. I f ever I can h e l p , please l e t . me know.
EJC:gl
.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
D
'.'•** ...
�March 1, 1993
Ms. H i l l a r y Rodham Clinton
Task Force on Health Care Reform
The Whi-te House
1600 Pennsylvania Avenue
Washington,
D.C.
Dear Ms. Cl -vnton:
,,
r
/
As a progressive physician (Georgetown M '68) I applaud the efforts of
* your task force directed towards the reform of our health care system.
I believe that most health care professionals will be willing to make
some sacrifices in order to solve this problem.
Although I have many thoughts on health care reform I want t o share only
one.
Americans seem to be addicted t o health care.
Any attempt t o
reduce health care spending, that does not address the demand side of
the equation is doomed to f a i l u r e .
A great deal of unnecessary services
. t.
are performed, p a r t i c u l a r l y for the elderly, and the motivation i s not
always greed on the part of the provider. I would l i k e t o see some
modification of the Oregon system.
Outcome analysis i s needed to
determine which services delivered under which conditions actually work
to the benefit of the patient.
• ;•
' *
Anything else should not be covered, and
:J.'
�really should not be performed.
This i s not rationing, i t i s as Dr.
Arnold Relman has said, simply good medicine.'
I wish you and your team good luck i n the next few months as you develop
your plan, and I look forward to learning the details.
Sincerely yours,
Lewis J.' Kampel , M.D.
�cXuiz
(Si/e
dissociates
Opllllialnjologi/
r«if) ''Wescotl tfjiive, Suite
SFLnungton, Jl. S
304
08S22-4605
'Helephone goS - 788-6472
G E O R G E H . K U R Z , M. D.
P A U L P H I L L I P S , M. D.
SFax QO8 - 788-6467
V I N C E N T F. S A R D I . M. D.
L A R R Y W E I S F E L D . M. D.
May 3, 1993
H i l l a r y Rodhair. C l i n t o n , Chairperson o f t h e
S p e c i a l Committee f o r H e a l t h Care Reform
The Whitehouse
1600 Pennsylvania Avenue
Washington, DC 20201
Re: H e a l t h Care Reform: P r e v e n t i o n and Education.
Dear Mrs. C l i n t o n :
The r o l e o f p r e v e n t i o n and e d u c a t i o n i n h e a l t h care cannot be overemphasized.
I f e e l t h a t a h e a l t h insurance p l a n s t r e s s i n g
p r e v e n t i o n c o u l d be a major f a c t o r i n c o s t containment i n t h e l o n g
r u n . A system t h a t rewards p r e v e n t i v e measures and p e n a l i z e s those
who f a i l t o heed t o recommended p r e v e n t i v e measures, a l t h o u g h
expensive t o s e t up and a d m i n i s t e r i n i t i a l l y , c o u l d have p r o f o u n d
l o n g t e r m b e n e f i t s i n a h e a l t h i e r p o p u l a t i o n and r e d u c t i o n i n l o n g
t e r m c o s t l y care o f v i c t i m s o f s t r o k e , h e a r t d i s e a s e , l u n g cancer,
etc. Accordingly I o f f e r t h e f o l l o w i n g suggestions:
A p i l o t p l a n s h o u l d be developed which s t r e s s e s p r e v e n t i o n by
r e q u i r i n g p a r t i c i p a n t s t o undergo a p e r i o d i c s t a n d a r d i z e d w e l l n e s s
assessment and covers t h e c o s t t h e r e o f ( i n c o n t r a s t t o many c u r r e n t
p l a n s which do n o t cover r o u t i n e p h y s i c a l e x a m i n a t i o n s ) .
Such
assessments s h o u l d be r e q u i r e d , say every f i v e (5) years f o r a d u l t s
age 18-49 and every two (2) years t h e r e a f t e r . They would c o n s i s t
of three p a r t s .
A.
An e x t e n s i v e medical h i s t o r y i n which t h e p a r t i c i p a n t
i n t e r a c t s w i t h a computer.
I n a d d i t i o n t o g a t h e r i n g d a t a which
would be used t o come up w i t h recommendations, t h e computerized
h i s t o r y would serve an i m p o r t a n t e d u c a t i o n a l f u n c t i o n .
I t would
r e q u i r e t h e p a r t i c i p a n t t o look a t h i s own f a m i l y m e d i c a l h i s t o r y
from which he might draw c o n c l u s i o n s about h i s own r i s k o f v a r i o u s
t y p e s o f diseases
such as h e a r t disease, cancer,
diabetes,
glaucoma. He would be asked about h i s e x e r c i s e program, smoking
and e a t i n g h a b i t s , frequency w i t h which he wears seat b e l t s , e t c .
�-2H i l l a r y Rodham C l i n t o n , Chairperson
Re: Health Care Reform: Prevention and Education
May 3, 1993
B.
A t e c h n i c i a n would take c e r t a i n standardized measurements
such as h e i g h t , weight, blood pressure, pulse, v i s u a l a c u i t y . The
t e c h n i c i a n would perform c e r t a i n t e s t s such as electrocardiogram,
u r i n a l y s i s , blood t e s t s .
The r e s u l t s of these measurements and
t e s t s would be entered i n t o the computer.
C.
Recommendations f o r reduced r i s k of l a t e r i l l n e s s might
derive from t h e data gathered. These would be reviewed w i t h the
p a r t i c i p a n t by a health care professional such as a primary care
physician
or p u b l i c health nurse.
Some, but not a l l
recommendations could be monitored f o r compliance. Examples are:
1.
The obese could be t o l d t h a t they must get r i d of
75% of t h e i r excess pounds beyond t h e i r i d e a l weight
by t h e time of t h e i r next assessment.
2.
Heavy smokers: q u i t smoking. P a r t i c i p a t i o n i n a program
t o help t h e i n d i v i d u a l accomplish t h a t goal should be a
covered item.
3.
Immunizations should be brought up t o date.
covered by the p l a n ) .
4.
Exercise program, e s p e c i a l l y f o r those w i t h a sedentary
l i f e s t y l e and family h i s t o r y of heart disease.
5.
Wear seat b e l t s while d r i v i n g .
One observation by a
p o l i c e o f f i c e r of absent seat b e l t s a t t h e time of a
minor t r a f f i c v i o l a t i o n would be s u f f i c i e n t t o document
non-compliance.
6.
Alcohol and drug abusers r e f e r r e d f o r r e h a b i l i t a t i o n
(again a covered s e r v i c e ) .
7.
Persons w i t h blood pressure l e v e l s or blood l i p i d l e v e l s
t h a t put them a t high r i s k f o r heart a t t a c k or stroke
would be advised t o reduce those l e v e l s t o lower the r i s k
by d i e t a r y change, exercise programs, and/or medication.
8.
Diabetics would be advised t o have an annual examination
by an ophthalmologist t o access any need f o r treatment of
d i a b e t i c retinopathy a t an early stage h o p e f u l l y t o
prevent serious v i s u a l impairment t h a t might r e s u l t from
the diabetes.
(Their cost
�-3H i l l a r y Rodham C l i n t o n , Chairperson
Re: H e a l t h Care Reform: P r e v e n t i o n and Education
May 3, 1993
9.
As g u i d e l i n e s are developed f o r v a r i o u s s c r e e n i n g s w i d e l y
recommended as b e n e f i c i a l i n t h e e a r l y d e t e c t i o n o f cancer, such as
p e r i o d i c mammography, such s c r e e n i n g s would be recommended and
would be covered by i n s u r a n c e .
F a i l u r e t o f o l l o w t h e recommendations would r e s u l t i n p e n a l t i e s
e i t h e r i n t h e form o f s t i f f i n c r e a s e s i n h e a l t h i n s u r a n c e premiums
or an i n c r e a s e i n t h e co-insurance payments r e q u i r e d o f t h e
p a r t i c i p a n t f o r medical care.
The r e l a t i v e s e v e r i t y o f t h e
p e n a l t i e s c o u l d be based on e p i d e m i o l o g i c s t u d i e s o f t h e r e l a t i v e
r i s k s o f c o n t i n u e d o b e s i t y , c o n t i n u e d heavy smoking, e t c . Repeated
f a i l u r e t o c o r r e c t t h e c o r r e c t a b l e could r e s u l t i n repeated
i n c r e a s e s i n h e a l t h i n s u r a n c e premiums a t each p e r i o d i c w e l l n e s s
assessment. On t h e o t h e r hand s u c c e s s f u l l y m a i n t a i n e d r e d u c t i o n o f
r i s k f a c t o r s c o u l d be rewarded by a r e d u c t i o n o f premium o r
r e d u c t i o n i n c o - i n s u r a n c e payment r e q u i r e d by t h e p a r t i c i p a n t f o r
his h e a l t h care.
I would l o v e t o see a s e r i e s o f w e l l n e s s assessment c e n t e r s
e s t a b l i s h e d i n much t h e same way as we have motor v e h i c l e
i n s p e c t i o n s t a t i o n s s c a t t e r e d across our s t a t e w i t h t h e aim o f
maintaining
safety
on t h e highway, o n l y a t a much more
sophisticated level.
Such a p l a n would say t o those w i t h poor h e a l t h h a b i t s t h a t , u n l e s s
t h e y a r e w i l l i n g t o change, i n l a t e r years t h e y a r e s t a t i s t i c a l l y
l i k e l y t o c o s t t h e system f a r more t h a n t h e i r share.
Therefore,
t h e y w i l l need t o pay s i g n i f i c a n t l y h i g h e r premiums f o r t h e i r
i n s u r a n c e o r s i g n i f i c a n t l y h i g h e r co-payments f o r t h e i r b e n e f i t s .
I doubt t h a t any humanly d e v i s e d system can ever be t o t a l l y
T h i s I f e e l would be a reasonable s t a r t .
"fair."
The o p i n i o n s expressed
i n t h i s l e t t e r a r e my own and n o t
n e c e s s a r i l y t h o s e o f t h e U n i v e r s i t y o f Medicine and D e n t i s t r y o f
New J e r s e y .
Sincerely yours.
2*
George H. Kurz, M.D.
C l i n i c a l P r o f e s s o r o f Ophthalmology
U n i v e r s i t y o f Medicine and D e n t i s t r y o f New Jersey:
Robert Wood Johnson Medical School
GHK:wtc
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
SUBJECT/TITLE
DATE
03/03/1993
Addresses (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
,im782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - 1? U.S.C. 552(b)l
PI National Security Classified Information |(a)(l) of thc PRA]
P2 Relating to the appointment to Federal office [(a)(2) of Ihe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe I ()IA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CC: Senator B i l l Bradley
,P6/(b)(6)
Senator Frank Lautenberg
Gateway 1, Room 1510
Newark, NJ 07102
Richard
Ziminer
• P6/(b)(6)
^
Norman H. Edelman, M.D.
Dean, Robert Wood Johnson Medical School
675 Hoes Lane
Piscataway, NJ 0885.1-5635
Robert D. Reinecke, M.D.
W i l l s Eye H o s p i t a l
900 Walnut S t r e e t
P h i l a d e l p h i a , PA 19107
�Beth
r
Cardiac '
Transplant ^
PyOgraffl
~—
-^-^^—^
TECHNOLOGY WITH COMPASSION
Newark Beth Israel Medical Center • 201 Lyons Avenue at Osborne Terrace • Newark, New Jersey 07112
March 1, 1993
Ms. Hillary Rodham Clinton
West Wing - White House
1600 Pennsylvania Avenue
Washington, D C.
Dear Ms. Clinton:
Approximately one month ago I sent a copy of my curriculum vitae and a letter expressing
an interest in working with you and the other distinguished members of your health care task
force. A copy of that letter is herewith attached. I am disheartened that neither you nor a
member of your staff has so much as acknowledged the receipt of my letter nor my offer of
assistance.
As you can see from the attached letter, it was my concern that the health care task force
would be comprised of well-known, highly-respected individuals, but would not include the day to
day providers of care. The article in this Sunday's business section of the New York Times
strongly suggests that I was correct. While I recognize that the members ofthe Jackson Hole
Group are not your only advisors, that group is heavily weighted against the physicians. Many
physicians feel that the American Medical Association does not represent their interests. It is for
this reason that membership in that association is so low. Likewise, Dr. Todd, the executive vice
president of the association, as a non-practicing physician cannot understand the problems we all
face. Although 1 am certain that he believes otherwise, he is wrong. Academics, writers,
consultants, and representatives from the pharmaceutical industry are important participants, but
no more important than the physicians and nurses who treat America's sick.
I am not politically "connected." T do not know how to get through to you, other than by
writing a letter such as this. To be honest, it is not clear to me that anyone is interested in the
opinions ofthe most important players in this crisis - the physicians. Again, I ask that you
seriously consider my request to work with the iadministration in planning health care for the
future. As a physician and attorney who practices in inner city Newark, I am well versed with the
problems facing us.
There are individuals "but there" who are sincerely interested in helping. I am one such ah
individual. Please do not ignore my offer of assistance. My insights into the problems and
solutions may prove quite valuable. I look forward to hearing from you in the near future
Should you wish a second copy of my curriculum vitae (resume), please feelfreeto call and we
will forward or fax it to you.
Thank you for your reconsideration in this matter.
Sincerely yours,
. Mark Jay pucker, M.D:, J.D , F A C C , F.C.L.M
Director, Cardiac Transplantation Program
Assistant Professor of Medicine
University of Medicine and Dentistry of N.J. - New Jersey Medical School
Medical Director
Surgical Director
Heart Failure Program
o
•
o
Mark Jay Zucker. M.D.. F.A.C.C.. Assistam Professor of Medicine
Uiszlo Fuzexi. M.D.. Clinical Assistant Professor of Surgery
Hillel S. Kibncr. M.D.. F.A.C.C.. Professor of Medicine
•
«
e
(201)926-7205
(201)926-7325
(201)926-7X90
Transplant Coordinator
o
Sandra L. Bausback-Ahallo. R.N.
»
(201) 926-721 I
AITilkile of University of Medicine ;mc! Dentistry of New Jersey • Member ol' United Jewish Federation of Metro West
�Transplant ^
P r o g r a m
**^~
—
—
—
T
E
C
H
H
O
L
O
G
Y
WITH COMPASSION
Newark Beth Israel Medical Center < 201 Lyons Avenue at Osborne Terrace < Newark, New Jersey 07112
>
»
January 27, 1993
Mrs. Hillary Clinton
West Wing - White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mrs. Clinton:
Let me take this opportunity to congratulate you on your recent appointment. Ac you
undoubtedly know, reforming the healthcare system in America cannot be described as a
minor task. Undoubtedly, members of many nationally recognized organizations have
stepped forward to offer their services to you. While many of these individuals may be
highly respected and well recognized, they are frequently isolated from the day-to-day
interactions with the "system". To ensure that all groups are fairly and accurately
represented, it is necessary to include on your healthcare task force individuals, such as
myself, who practice high-tech inner-city medicine and deal with the realities of our
healthcare system each and every day. As you can see from the enclosed curriculum vitae,
I am a well trained physician as well as an attorney. I have participated actively in revising
the healthcare plan in New Jersey. I am a member of thc Board of Directors of the New
Jersey Affiliate of the American Heart Association as well as the New Jersey Organ and
Tissue Sharing Network. I would be honored to have an opportunity to work with you and
the other distinguished members of the task forces and subcommittees that will ultimately
restructure the American healthcare system.
Please be assured that the physicians are as unhappy with the present system as are the
politicians and public constituencies. Reformation is a challenging but necessary task. I ask
that you seriously consider my request to assist you in one way or another. I know that
yjM! wi!! find my active participi:lion to be worthwhile zivJ. piafi&He.
Thank you in advance for your consideration in this matter.
Sincerely yours,
Mark J. Zucker, M.D., F.A.C.C.
Director, Cardiac Transplantation Program
Assistant Professor of Medicine
UMDNJ - New Jersey Medical School
Medical Director
Surgical Director
Heart Failure Program
Transplant Coordinator
•
•
c
o
Mark Jay Zucker, M.D., F.A.C.C, Assistant Professor of Medicine
Laszlo Ftnesi. M.D.. Clinical Assistant Professor of Surgery
Hillel S. Rihncr. M.D.. F.A.C.C. Professor of Medicine
Samlra L. Bausback-Ahallo. R.N.
Affiliate of University of Medicine and Dentistry of New Jersey
•
e
e
e
o
(201) 926-7205
(201) 926-7325
(201) 926-7890
(201)926-7211
Meinhcr of United Jewish Federation of Metro West
�CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
OENRRAL SORT:
POSTCARD 1:
.Personal stories
.General mail
.Letter Campaign
Other Health Providers
P O S T C A R D 2:
.Offers to help/Employment
FORM LETTER:
Letterhead
REROUTE:
Casework
.Policy
'hysicians
Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
. C O V E R A G E (II)
working families
unemployed/low income
benefits
providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
.medical equipment
fraud & abuse
.FINANCING (VII)
. M E N T A L H E A L T H (EX)
L O N G - T E R M C A R E (X)
.PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Oara k E l i z a L e t k A l l e n , M D
j^cJ^r
^
+w
d^as.
ere-
C^or,^,
�P E D I A T R I C C A R D I O L O G Y A S S O C I A T E S cfr N E W M E X I C O
ST. J O S E P H S Q U A R E
7 1 5 G R A N D A V E N U E . NE
— •
S U I T E 2 0 7 . A L B U Q U E R Q U E . NM 8 7 1 0 2 . ( 5 0 5 )
848-3700
February 4, 1993
1
WILLIAM BERMAN, JR.. M.D.
R A Y M O N D R. FRIPP, M . D .
STUART A . R O W E , M . D .
STEVEN M . Y A B E K , M.D.
Hillary Rodham Clinton
Coordinator, Federal Office for
Health Care Delivery and Insurance
White House
1600 Pennsylvania NW
Washington, DC 20006
RE: Proposed input regarding federal health care programs
Dear Director Clinton:
I am writing to ask you or the member of your organization who reviews letters such as this
to consider accepting my input and recommendations regarding the developmenLof-an
health care delivery and/or insurance program.
^=^±z===^ •
My name is Bill Berman. I am a doctor, currently living in Albuquerque, New Mexico, and
I have enclosed my CV for review by anyone who cares to document the details of my
background.
Briefly, I grew up in the midwest, kl^tTLouiSj^ssf^bri^was bom at Ft. Riley, Kansas
when my father was in the semce^ttended'mrvard CoTl&gk, Washington University
School of Medicine, and did my pediatricttaining^Lthe-Umversityof California in San
Francisco. Following a two year period of service in the TTnitpH Statpg Pnblir alth
SeryiceJLfcontinued training in the field of pediatric cardiology and cardiovascular
physiology at the Cardiovascular Research Institute of the University of California. I have
held academic positions ai the Pennsylvania State University in Hershey and the University
of New Mexico in Albuquerque. I have done sabbatical work at Yale, received four NIH
funded research grants, am the director of the division of Pediatric Cardiology at the
University of New Mexico, am the former secretary-treasurer of the Society of Pediatric
Research, and since 1986 have been engaged in the private practice of pediatric cardiology
in Albuquerque and throughout the state of New Mexico.
Hp
I practice in a poor state whe/e 50%pf my patients are on federal and/or state financial
assistance. I was, from my perrod~of entry into medical school in 1965 through 1985,
involved in academic medicine with heavy responsibilities in teaching, training and
research. Since 1986 I have been preoccupied with the delivery of medical care in an under
populated rural state. I think I have, if not a unique, a broader medical perspective than
most because of my involvement in a variety of medical settings throughout my period of
training and practice.
DIPLOMATES OF THE AMERICAN BOARD OF PEDIATRICS AND SUB-BOARD OF PEDIATRIC CARDIOLOGY
�Page 2
February 4, 1993
Hillary Rodham Clinton
I have opinions (? prejudices ?) regarding the issues of health care delivery in rural and
urban settings; the advantages and disadvantages of "managed care"; the potentially
destructive as well as constructive aspects of medical "competition", and a number of other
issues which I am sure are under consideration by you and your task force during the
development of a national approach to health care delivery and financing. As one might
guess from what I just said, I believe the delivery and distribution of health care must be
integrated into any reimbursement system and it is this primary objective I would love to
have the opportunity to discuss with you or a member of your staff.
If a grass roots approach such as this one is in any way, shape, or form attractive to you or
your task force, I would be happy to provide more explicit information about specific
medical care issues. If not, I am glad I function in a system where I have the opportunity to
write a letter such as this.
All my best wishes and good luck in your gargantuan task.
Sincer
Willfaj n Berman Jr., M. D.
Adjunct Professor
Pediatrics (Cardiology)
Pediatric Cardiology Associates of New Mexico
WB:LT
enclosure
ADDENDUM: As references regarding my background and qualifications, I would
respectfully offer the following: 1. Jeff Bingaman, United States Senator, State of New
Mexico. Jeff and I were college house mates together. We have more than occasionally
been in touch in New Mexico and in Washington over the past several years and I think he
would be a qualified professional reference for me. 2. Bowman Cutter, economic advisor
to the President, currently officed in the White House. Bowman and I were roommates at
Harvard and have stayed in touch over the years. Recently, Bowman and I discussed in
modest detail the issue of health care reform and its economic consequences. Bowman
would also be an accurate professional reference for me. 3. Steve Fiance, Democratic
committee person in the State of New Mexico and manager of the gubernatorial campaign
for Bruce King during his last election. Steve and I grew up together in St. Louis and have
remained close friends over the years. He is an avid participant in all democratic political
issues in the Santa Fe, New Mexico area. Steve knows me as well as anyone in my life. He
would not only provide a reference for me, but together we can also most likely come up
with an extemporaneous rendition of almost any song by the Platters, Jerry Butler, Everly
Brothers, Gordon Lightfoot etc.
�CLINIC LOCATIONS:
ADMINISTRATIVE O F F I C E
1812 Candelaria N.W.
Albuquerque, N.M. 87107
(505) 768-5465
2001 N. Centro Familiar S.W.
Albuquerque, N.M. 87105
(505) 768-5400
1316 Broadway S.E.
Albuquerque, N.M. 87102
(505) 768-5450
ALBUQUERQUE
1259 Highway 85
Los Lunas, N.M 87031
CENTRO FAMILIAR DE SALUD
Bernie Sanchez, Board President
FAMILY HEALTH CENTER
Luis Rey Gonzales, M B A
Executive Director
2001 N. C e n t r o Familiar S W / Albuquerque, New Mexico 87105
(505) 768-5400 (Administration)
(505) 865-4618
Edward Lamon, M.D.F.A.A.P.
Medical Director
2001 N. Centro Familiar S.W.
Albuquerque, N.M. 87105
(505) 768-5440
2127 Los Padillas Rd., S.W.
Albuquerque, N.M. 87105
(505) 768-5480
7704 2nd St., N.W.
Albuquerque, N.M. 87114
(505) 768-5475
February 10, 1993
Mrs. Hillary Rodham Clinton
Medical Health Care Reform Committee
White House
Washington, D.C.
Dear Mrs. Clinton:
First of all, I wish to congratulate you and Mr. Clinton for your recent victory.
I am very pleased that such swift attention has been given to medical health care reform
and I support your efforts.
My area of interest is in bridging traditional and alternative medicine. My goal
is to participate in establishing a series of Medical Health Care Centers in which both
of these disciplines could come together. I believe that by focusing on the causation,
prevention and treatment of disease, much could be done to reduce the costs of health
care.
I am available as a consultant in evaluation, implementation and research of
Alternative Medical Practices.
Sincerelv.
Milton G. Godine
�V
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
c
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. resume
SUBJECT/TITI.E
DATE
Phone No. (Partial) (2 pages)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jin782
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)
Freedom of Informalion Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOI A)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) nf the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CURRICULUM VITAE
Milton G. Godinez, M.D
•,.P6/(b)(6)
My goal is to participate in bridging traditional and alternative medicine. I am interested
in Native American Healing practices and energy medicine. I would like to participate in
creating a series of Medical Health Centers to incorporate a new model for medical care.
Included in, this new model are education and research.
Vital Statistics:
Experience:
3/1/92 - Present: Albuquerque Family Health Center, 2001 N. Centro Familiar S.W.,
Albuquerque, New Mexico 87105. (505) 768-5440.
1/1/92 - 12/31/92: Health Source, La Mesa Medical Center, 7000 Cutler N.E., E-6,
Albuquerque, New Mexico 87110. (505) 884-3039. The center specializes in'Energy
Medicine, Transformational Medicine, bridging traditional and alternative medicine.
9/1/91 - 2/31/92: ACL Hospital, Acoma Pueblo, New Mexico. (505) 552-6634.
7/1/80 - 8/31/91: OB/GYN Assoc. Ltd., 8200 Constitution PI. N.E., Albuquerque, New
Mexico 87110. (505) 292-0444.
Education:
Undergraduate - University of New Mexico, Pre-Med, B.A, - 1972.
Graduate - University of New Mexico, School of Medicine, M.D. - 1976.
Post-Graduate - Kaiser Foundation Hospital, Los Angeles, California, OB/GYN
Internship -1977.
Kaiser Foundation Hospital, Los Angeles, California, OB/GYN Residency - 1980.
�Milton G. Godinez, M.D.
P6/(b)(6) . .
References:
Donna L. Denning, M.D.
Center for Health Awareness, 120 Aliso Dr. S.E., Albuquerque, New Mexico 87108.
(505) 266-8876.
Ralph Luciani, D.O., Phd.
The Albuquerque Clinic, 2301 San Pedro Dr. N.E., Albuquerque, New Mexico 87110.
(505) 888-5995.
Angelique Cook-Wilcox, L.A.C.
Health Source, 7000 Cutler N.E., E-6, Albuquerque, New Mexico 87110. (505) 884-3039.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
5
3
..-.-.v
..- . .-. •• • / » •
. •>:x-'--.'; -. -y.'V.
�/ \
March 15th, 1993
Hillary Rodham Clinton,
Health Care Reform Task Force
The White House , .
Washington, D.C.
Dear Ms. Rodham Clinton,
It is refreshing for me to see a change of direction in Washington and
I hope many of our pressing social and economic problems will be
addressed. I am completely supportive of the steps you have taken so far. I
have some areas that your task force should explore. I hope my input is not
too late. Your task is formitable, and you will need all the help you can
get!
^
I am a- gomrnuDUy oriented emergency physician who believes that a
synthesis of emergency medicine and public health disciplines will yield a
great deal of useful information for managing our health care - delivery
problems. I have rich "front line" experience every working day with our
health care crisis. I have come to see the emergency department as a
window on our communities whose neglected role is to provide
information about the status of our people and of the health care system
as a whole.
The Emergency Department is the "safety net" where the ill effects of
our out-of-control social and medical problems are managed. Examples are
substance abuse and its many casualties of all types, personal and
domestic violence, lack of access to primary care physicians, medical and
administrative inefficiencies which together form a microcosm of our-^
condition. We have become the Primary Care Clinic for our society.
Thus, I am responding to your request for input and ideas, some ofg|^
which are the product of two years of unpublished research. I hope that mj^p
observations may be of use. They fall into two categories, as follows:
A) Observations made by myself over time in various Emergency
Departments and recommendations which may help stop the
financial hemorrage.
r
r
�Page Two
B) A recommendation that the Federal Government, as part of its
technology initiative, develop the technological tools needed
to control the flow of medical and health related information
and therby provide the tools needed to control and optimize our
health care system . It represent the kind of bold
interdisciplinary initiative that I believe is needed to "get a
handle" on our health care crisis. The proposal converts some
of the resources available from our two National Laboratories
and our close knit, but diversified, medical and academic
community into a Federal Medical Informatics Laboratory
based at the University of New Mexico. An analysis of the
benefits of the DynaMedics Provider Interface is also included.
My C V . and my partner's C V . are enclosed as an addendum at the end
of this document. I am prepared to volunteer my services to you in any
capacity you need. I believe I have the network, the "front line" experience,
the insight, and motivation to help you develop these areas. My special
organizational talent is in working between and within institutions,
building bridges, identifying common interests and "key" people. I would
be honored to help.
Respectfully Yours,
Haywood HalF
cc. Senator Jeff Bingaman D-NM
Representative Bill Richardson D-NM
�List of Twelve
Recommendations from an
Emergency Physicians Point of View
1) Promote a Single Party Payer System
Of course, the insurance industry will fight tooth and
nail. Managed competition may not work in rural, underserved areas
and may not result in administrative streamlining. Working a few
hours each day in a federal hospital or clinic (as in Costa Rica)
seems like a good system.
2) Federal Medical Informatics Laboratory as a part of the
Technology Initiative
The technology must be developed to control the flow of
medical and health related information, which will be the key to
controlling and transforming the health care system. An all out
effort will have to be made to develop Medical Informatics (the use
of computer and information sciences to streamline and re-engineer
the flow of medically related information) as useful tools for
providers (especially primary care), and for health care systems
monitoring. Administrative and clinical practice are tremendously
inefficient and can be streamlined with the right tools, (see next
section)
3) Reform Medical Education and Training
A) Encourage the Community-Based, Problem-Oriented
Primary Care Curriculum pioneered by the University of
New Mexico School of Medicine.
B) Integrate Public Health, Primary Care and Medical and
Post-Graduate Medical Curricula. Schools of Public
Health and Medical Schools are generally found
completely separated physically and intellectually
(probably the core of the problem). I have tried to develop
and integrate an MPH program into our Medical School
(with some success).
�C) People going into Medical School should expect to come
out of the medical training as primary care physicians.
After 5 years of primary care practice and if there is a
need, they should be allowed to subspecialize. (This will
make better primary care physicians, and make
specialists who better understand the context in which
we must provide health care).
D) Reactivate and re-energize the National Public Health
Service Corps. Use it to attract and retain primary care
and public health oriented physicians. Make primary care
medical education affordable so that physicians do not
try to recover the cost of their education on the
population by subspecializing and charging high fees.
4) Make Primary Care the Center of our Health Care System.
Probably 75+% of physicians should be doing Primary Care (the
situation is reversed). Although technologically facinating, the
preeminance of speciallists is destroying our health care system and
undermining our health. Develop effective use primary care midlevel providers (Nurse Practicioners/ Midwives and Physician
Assistants).
5) Incorporate Emergency Departments as a Feedback-Control
Mechanism for the Health Care Reform Process
Our health care system is out of control and from a "systems"
point of view an effective feedback and control mechanism must be
established. Since all of our health care dysfuntions spill over into the
Emergency Department, we need to develop the emergency departments of
our country to fill this function. Using an Emergency Medicine version of
Community Oriented Primary Care (melding clinical Emergency Medicine
with Public Health approaches) powerful tools can be developed to keep an
eye on the Medical and Social "Bottom Line". Such a Feedback-Control
mechanism would generate powerful epidemiologic, health services
administration, and clinical research data, for health promotion as well as
medical human resource assessment. It would provide the tools for
medical, administrative and public health initiative impact analysis.
�6) Focus on Emergency Departments during the transition
phase from a speciallist oriented health care system to a primary
care oriented health care system.
The uninsured, underinsured, and the many people who can't
find a primary care doctor presently use the Emergency Departments
as their Primary Care Clinics. By having combined Emergency and
Urgent Care Centers with a shared "triage" area, we will
immediately "off load" our overextended Emergency Departments,
and provide more appropriate, cost effective care for the "at risk"
population. As our primary care capabilities expand, we will need to
place these patients into a primary care network and use waivable
co-payment to discourage frivolous use of the Emergency
Department.
7) Improved Medical Control in Nursing Homes
A large resource drain is directly the result of poor
medical control in nursing homes. Because most nursing homes do
not have active Medical Directors, or even "mid-levels" (nursepracticioners or physicians assistants), trivial medical problems
are sent to the local Emergency Departments by people with minimal
assesment skills. This means a two way ambulance trip and and an
Emergency Department visit ($500 is not an ureasonable estimate
for even the most trivial problem).
8) Reform Pre-hospital Care
Innapropriate Ambulance patients "short circuits" our normal triage
system making it harder to treat seriously ill or "salvagable" patients.
Perhaps as much as 50% of ambulance transfers are innappropriate.
ParaMedics should be allowed to not transfer people by ambulance who do
not even remotely have an emergency problem. Strictly enforced
"Certificate of Need" declarations should be signed by all physicians
receiving ambulance patients (define need as to whether the patient had
reasonable cause). Patients without this certification by physicians
should be billed directly, regardless of third party payer status. Repeat
offenders should go to an orientation class provided by Emergency Medical
Technicians. Emergency Medical Systems released from the buden of non-
�4
emergency transfers should be involved in highly visable, community
centered safety and health promotion activities.
9) "Sin Tax" on alcohol and tobacco to cover the actual cost to
society.
You seem to be on this track already. Congratulations for your
courage!! I agree that those people who drink alcohol and smoke tobacco
should not have their massive health care and other direct and indirect
cost subsidized by the rest of us. A tax to cover the amount of cost to
society is only fair. The Center for Disease Control has released
information that 95% or more of the cost of substance abuse is due to
tobacco and alcohol alone.
An example of the problem is the major drain on our system by the
"hopeless" alcoholics who are often found "down and out" and repeatedly
brought by ambulance to our Emergency Departments (often 50 to 100
times a year) where we become a very high priced "drunk tank". They often
spend 8-12 hours per visit (total cost including ambulance: $750 to
$1,000 per visit!!).
10) Reform Narcotics Policy
Other substance abuse issues need to be addressed. There are many
people who routinely request drug treatment and I am unable to find
facilities for them. Drug abuse is a major vector for the spread of AIDS,
and is probably the major factor in property (and increasingly) violent
crime. Drug related arrests are a major resource drain on our legal
system, so much so, that our criminal justice system may collapse. A
radical solution is required (although politically may be difficult). A
combination decriminalization of the casual use of narcotics, treatment
on demand, drug use prevention initiatives, government regulated supply,
registration and taxation of "recreational" drug users, heavy civil
penalties and enforced treatment for "problem users", harsh criminal
penalties for drug dealers may be the kind of approach needed. Clearly,
those things that re-enforce the psychology of despair (unemployment,
lack of opportunities disenfranchisement) need to be addressed. Such a
program would have as its strongest opponents the drug cartels since they
would have the most to loose.
�11) Reform the Disaster Management System
The command and control of medical and public health responses to
disaster is a disaster in itself. It should be coordinated and administered
by the Public Health Service. The National Disaster Medical System (NDMS)
command and control must be streamlined and demilitarized as much as
possible. The political use of disaster response teams is reprehensible.
A) Presently, disaster response requires activation through FEMA,
the VA, DOD, PHS, and the State Department to name a few
which makes it very political, unweildly and ineffecient.
B) In many situations (international and inner cities, for
example) a humanitarian response with a military facade
may be insensitive and counterproductive in the long run.
Community-based PHS reserve medical personel should
make up a large number of the response teams.
12) Increase Active AIDS Prevention and Intervention
Initiatives
If an AIDS "czar" is to be considered, I can think of no one more
qualified than Jonathan Mann, M.D.. As you may know, he spearheaded the
United Nations AIDS effort (and may have been too successful!). He is
presently at Harvard, I believe. The most effective vector control will be
health education, access and use of condoms and clean needles.
New Mexico, I believe, has much to offer to develop some of the areas
listed above. If you wish, I can help you put together fact finding
committees in the areas of Emergency Medicine and Health Care Reform
and to consider the development of a Federal Informatics Laboratory in
New Mexico. There are excellent resources across academic, private, and
governmental sectors that need horizontal integration (which a federal
initiative could provide) to develop these interdisciplinary areas. I have
good contacts here in these areas, as well as ideas about how to develop
them. I believe that our community has the right balance of critical mass
and informality to make such development projects feasable. I am, and
will be, always, at your disposal.
Haywood Hall MD
n
�Advanced Medical Computer Applications
Laboratory Mission Statement
(Proposed)
The Advanced Medical Computer Applications Laboratory, will be
based at the University of New Mexico School of Medicine, Center for
Community Medicine and Public Health. It's purpose is to stimulate and
support non-proprietary research and development of management
information systems, developing data exchange standards, systems
integration, provider interface and medical system re-engineering as it
relates to health care services. The outcome will be to develop government
run medical computer systems and technologies which will provide the
needed tools for health care management in the United States.
It will be a consortium of the following New Mexico Institutions: The
University of New Mexico, The Computer Research Laboratory at New Mexico
State University, Los Alamos and Sandia Lational Laboratories (technology
transfer and technical support), Lovelace Medical Center (HMO), Lovelace
Scientific Resources, the State of New Mexico Health Department, the Public
Health Service/Indian Health Service, and the Veterans/Kirtland Air Force
Base Hospital with support from the Center for Disease Control, and the
National Institute of Health.
OPJECTIYEiS
1) To make health care systems more productive, to increase the
quality of care by providing portable, easy to use, point of contact computing
to health care practicioners and to develop productive pen-based computer
systems and to set new standards in applied medical computing.
2) To bring these provider-based computers into a government
administered local area network that will streamline and re-engineer the
flow of medical systems information, thereby reducing administrative
overhead
3) To develop and promote the concepts of computer assisted
management of the patient encounter and use its National Medical Computer
Systems as a tool for monitoring, development, and transformation of U.S.
health care systems.
4) To create an environment of cooperation, innovation, and
technological advancement, with the same type of urgency and focus as the
Manhattan Project, that will meet the challenges of an evolving health care
system and to provide the tools to convert a chaotic health care system into a
rational, well managed, high quality health care system for all.
�2
5) To provide a means to convert New Mexico's largely military based
economy to productive civilian use.
STRATEGY
1) University of New Mexico School of Medicine provides the open
academic environment available at a major university and medical
coordination with a special focus on Primary Care and Emergency Services
settings. The project will build on the many existing innovative activities of
the University and New Mexico.
2) Los Alamos and Sandia National Laboratories in collaboration with
the Computer Research Center will provide the technological and engineering
support for the project, therby providing a means to redirect the military
industial complex to social and economic needs.
3) Lovelace Medical Center provide its Health
Maintenance
Organization management expertise, and its outpatient clinics as
development sites for the project, Lovelace Scientific Resources will provide
its technology development and assesment skills to the project.
5) The Center for Disease Control Field Office and NIH input will ensure
that medical and health services data generated by the systems developed
will provide useful epidemiologic, clinical research, and health services
administration information.
6) Other agencies input will be developed as needed.
I feel I can help you organize this project, if the administration throws
its weight behind it. I will accept a transient organizing role, with your
assistance and supervision, if this is needed to make the project successful. I
am also willing to sign over any rights on the work I have done on this
project so far, which might result in financial enrichment.
Our Health Care System, Computer Technology, and Economy are in a
state of flux, which provide opportunities for innovative horizontal solutions
to our critical social health problems. But timing is essential.
�Benefits of the DynaMedics System
1) Decreases the time physicians spend documenting by
allowing the practicioner to "document as you go". Physicians may
spend as much as 30% of their time documenting, thus, this system
should allow the physician to see more patients or to spend more
time with the patient.
2) Provides "problem oriented templates" for historical and
physical findings therby prompting the physician not to omit
important medical and medico-legal information. This feature
assures that standards of care are met and should decrease the
number of lawsuits.
3) Provides easy to use , intuitively obvious, graphic user
interface, which will for the first time put truly portable computers
in the health care workers hands. Computers are everywhere around
medical practice except at the point of contact between the physician
and the patient. Modern medical computer systems spend a
tremendous amount of manpower and resources
retroactively
reconstructing
this encounter.
4) Automatically assists the physician in selecting the
appropriate billing codes (ICD-9 and CPT) and makes sure that all
documentation supporting billing is done. Coding is now done by
coders who are not medically trained, and have to select the
(supposed) appropriate billing codes based on often incomplete and
illegible hand written charts. This feature should reduce
transcription and translation errors, administrative overheads, and
third party audits.
5) Provides a list of diagnostic possibilities (differential
diagnosis) based on information selected in the history and physical
templates. This feature should increase the chance that the correct
diagnosis is made.
6) Provides problem oriented flow diagrams to assist the
physician in working
up the patient. It suggests pertinent laboratory
and diagnostic studies based on medico-legal standards and third
payer re-imbursement patterns. This feature should assure that
standards of care are being met in the most cost effective manner.
�7) Imports encapsulated medical record from patients previous
encounters, including problem lists, medications, etc. Also able to
export same to hard copy, to hospital computer, or to Fax to
insurance companies or other physicians. In an integrated system,
this feature circumvents many of the problems with traditional
medical records access and makes available the important bare facts
from previous encounters, therby increasing the quality of care. The
hard copy feature allows the system to be used in a modular fashion
and provides additional back-up.
8) Allows orders and prescriptions to be done directly from the
pen-based computer and automatically informs in-house pharmacy
and materials management of items used. It also generated a bill for
those items. Further streamlines the flow of medical information and
provides superior inventory control. Prescriptions are derived from a
software based formulary which gives the physician prescribing
information, cost indexes, suggested substitutions, etc.
9) Automates customized discharge instructions, giving
problem and diagnosis based instructions, information on prescribed
drugs and treatments, and follow up information. Able to generate
discharge instructions in Spanish. Decreases time physicians and
nurses spent on developing written discharge instructions and
provides a vastly superior and more detailed output.
10) Functions as the physicians "personal organizer" , keeping
track of appointments, patient status, etc.
11) It would provide administrative information to physicians
and administrators for practice analysis such as peak flow ,
frequency of problems/diagnoses, acuity scales, monitoring of patient
flow times, etc. Essential for Quality Assurance and Control
12) Able to assist the physician an Continuing Medical
Education. The system will keep track of what kinds of cases have
been seen by the physician thus is able to periodically provide a list
of problems not recently encountered which the physician is
nonetheless still required to maintain proficiency in. Using the
�template database, the system can present simulated problems for
the physician to work on. With the emerging multimedia capabilities,
the system will be able to hook up to a teaching workstation and
manage a realistic simulated patient. Will provide a mechanism to
keep practicioners current who are isolated from medical centers.
13) Especially well suited for Managed Care Systems
incorperating Total Quality Management techniques such as HMO's,
PPO's, etc. All templates, flow diagrams, and major software
algorhythms will be customizable. This feature allows medical
administrators to closely monitor physician activity and to "program"
changes in physician/patient
interactions through quality
assurance/improvement
committees making algorhythmic changes in
the software. It also allows for changes in medical practice to be
incorporated.
14) Able to assist in epidemiologic analysis in large integrated
systems. The system could provide biostatistical analysis to problems
seen by physicians, and thus give early clues to epidemiological
events ( ie. early outbreaks of epidemics). Summary information
could be sent to the state health department and the Center for
Disease Control for further analysis
15) Will bring the overwhelming amount of information that
primary care practicioners have to manage under control. One of the
causes of overspecialization is the need many in medicine have to
have a good grasp information relevent for practice. The system
proposed will provide major solutions in this area.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
6Y
.•. .. J . . . ..
•
•v
�Withdrawal/Redaction Marker
Clinton Library
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AND TYPE
006. resume
SUBJECT/TITI.E
DATE
Personal (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
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PI
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IM
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b(2) Release would disclose internal personnel rules and practices of
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h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
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personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
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financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
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Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CURRICULUM VITA
Haywood: Hall
Personal
M.D.,
Information:
Professional
Associations
(past
&
present)
American College of Emergency Physicians
American College of Physicians
Member, Greater Albuquerque Medical Association
Member, New Mexico Medical Society
Licenses
and
Certifications:
* New Mexico Medical License
#247-87
* State Pharmacy License
#9751
Drug Enforcement Agency Number:
• pe/tbxef*
Certifications:
•
Education
* MD
and
o0(o
Medical Control Emergency Physician, Bernalillo
current
Advanced Cardiac Life Support, current
Advanced Trauma Life Support, not current
Pediatric Advanced Life Support, not current
Professional
County,
NM
Training
Degree, Baylor College of Medicine, Houston Texas 1982-1986
Honors In Community Medicine, Cardiology, Pulmonary,
Anesthesiology, and Emergency Medicine
* Completed Internal Medicine and Emergency Medicine Residency
Programs
with 9 months
of advanced
critical
care training
Including
3 months as Medical Intensive
Case Unit Fellow,
University
of New Mexico.
1986 to 1991
'
Board
BA
Eligible In
Internal
Degree, Cum Laude,
New York, Graduated
Medicine
and
Emergency
Biology, Brooklyn College,
1981. Entered with G.E.D.
V
/
^
^r-
Medicine
City
University
.
of
.--
�Page Two
Current
Employment
and
Appointments:
* Adjunct Assistant Professor, Departments of Emergency Medicine and
Community Medicine, University of New Mexico School of
Medicine
* Medical Director, Emergency Department, Clovis High Plains
Hospital, Clovis, New Mexico
* Medical Director, Region III Emergency Medical Services, Emergency
Medical and Primary Care Bureau, State of New Mexico
* Team Physician, New Mexico Disaster Medical Assistance Team,
National Disaster Medical System (NDMS)
* Emergency Staff Physician, University of New Mexico Hospital
* Emergency Staff Physician, Lovelace Medical Center, Albuquerque,
New Mexico.
* Emergency Physician, Memorial Medical Center, Los Cruces, New
Mexico
Past
Clinical Experience:
*Over 5000 hours in Emergency Departments around the State of New
Mexico Including Farmington, Gallup, Espanola, Grants, Roswell,
Belen, Holloman Alrforce Base, Klrtland/VA Emergency Center,
Presbyterian Hospital
(Albuquerque)
Paraprofesslonal
Activities
* Organized and incorporated the DynaMedics Medical Computer
Corporation to develop integrated penbased Computerized
Patient Records systems computers. 1991
* Initiated the Masters In Public Health program at the University of
New Mexico.
Wrote the original development proposal which
emphasized an Interdisciplinary approach. Organized and served
as a member of the MPH executive committee. Co-chaired the
Internatlona/RuralBorder/Cultural
Health MPH
subcommittee.
Coordinator between the MPH Program and University Graduate
School. Continues as community organizer for the development of
UNM Public Health Programs.
* Technical advisor to the Dissemination Unit of the World Health
Organization Collaborative Center for Community Based
Medical Education. Helped develop their present computer
capability in Desk Top Publishing.
* Developed and directed the Medical Spanish program for residents,
medical students, faculty, and staff of the University of New
Mexico Medical Center funded under the Robert Wood Johnson
Foundation Social Medicine Grant.
�Page Three
* Founded the New Mexico House Staff Association 1989. Edited the
New Mexico House Staff Association Newsletter. Successfully led
Interns, resident, and fellows in wage and working condition
disputes in 1991.
* Founded the Intercultural Health Organization, 1988.
Resulted In
the development of the Housestaff Association, changes in the
Internal Medicine residency program to a more outpatient
/primary care orientation, the Medical Spanish Program, the
Masters In Public Health (MPH) initiative, and a student health
service for 18,000 Technical-Vocational Institute (TVI)
students.
Research and Publications:
* "Community Oriented Learning for Emergency Medicine Residents "
Academic Emergency Medicine, 1990, Vol 2, No.
* "Problem-Based Learning for Emergency Medicine Residents"
Academic Emergency Medicine, 1990, Vol 2, No.
* "Controlled Vocabulary, Narrative Comments, and Novel Syntax in
the design of a computer-based Patient Record System" K
Rosenberg MD, H Hall MD, D Coultas MD, in progress
* Pharyngeal-Tracheal Lumen Airway Study. UNM Dept. of Emergency
Medicine
* "Effect of written orientation materials on patient satisfaction in the
Emergency Department" In progress
* "Community Oriented Primary Care: Public Health and the
Emergency Physician." in progress.
* Research assistant, Estrogen Receptor Study, Baylor College of
Medicine, 1982
* Research assistance Rlbavlron Drug Study Baylor College of
Medicine, 1982
Extra-Currlcular
Activities
and
non-medical
work
experience
* Traveled extensively throughout southern Mexico and In Jamaica,
West Indies and observed health care delivery in a variety of
settings.
1982-1986
* Organized and participated in mural project for Ben Taub Hospital's
pediatric clinic waiting rooms, treatment rooms, and on the
pediatric ward, Houston, Texas 1983-1984
* Officer of Rlverrun, the Brooklyn College's literary arts magazine
1979 to 1991
* Organized a cultural festival at Brooklyn College 1979
* Traveled with my wife, my father and mother and sister to China,
India, Turkey, Germany, and England during the summer of
1 978.
�Page Four
* Employed by the English Department and the Department of
Educational Services as a tutor In English, Biology and
Anthropology at Brooklyn College.
Trainer and administrator
of peer tutors.
* Worked as a meter reader, piano tuner, and taxlcab driver in New
York City prior to obtaining a General Equivalency Diploma
(GED) 1972 to 1976
Special
*
*
*
*
*
Interests
Interdisciplinary studies, social ecology and social change/evolution,
process Inovatlon and information re-engineering,
Health care provider centered, point of contact computer applications
to solve broad based problems in clinical medicine, medical
economics, health care delivery, public health and medical
education.
Development of Emergency Medical and Primary Care Services in
rural and underserved areas.
Medical Anthropology. Interested in the provision of health care
services In multicultural
environments.
Music.
Played percussion, keyboard and guitar since 1967, as well
as some composing and arranging.
References
Larry Gordon, MA, (505)
277-3312
Visiting Professor of Public Administration,
University of New Mexico,
Former Secretary of Health and Environment,
State of New Mexico
Scott Obenshaln, MD
(505)
277-2321
Assistant Dean, Professor of Pediatrics, UNM School of
William
Wiese, MD
(505)
277-3253
Chairman, Department of Community Medicine,
UNM School of Medicine
President, U.S. Public Health Association
Paul Roth, MD
(505)
272-5062
Chief of Staff, University of New Mexico Hospital
Chairman, Department of Emergency Medicine
Commander, New Mexico Disaster Assistance Team,
National Medical Disaster System
Tom Becker, MD, PhD
(505)
277-5541
Faculty, Internal Medicine
Epidemiologist & Medical Anthropologist
Former Epidemiologic Intelligence Officer,
Center for Disease Control, Atlanta, GA.
Medicine
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Kevin Marcus Rosenb
Persona
Information
Undergraduate
Education
University of California at San Diego
B.A. in Biochemistry / Cell Biology conferred June 1983
MCAT scores: Biology 99.9% Science Problems98%
Physics 98%
Chemiitry
97%
University of Catifornia at Irvine, School of Medicine
Medical Degree conferred June 1988
Postgraduate
Education
Honors
Grants
Awarded
Professional
Activities
Work
Experience
University of New Mexico, Albuquerque
Internal Medicine internship: 24 June 1988 to 22 June 1989
Internal Medicine residency: 1 July 1990 to present
Graduated cum laude, U.C. San Diego (CPA 3.75)
National Dean's List / Third College Academic Honor List / Provost's Honor List
Canyon High School's Oatstanding Science Achievement award
David Jay CFambee Memorial Fellowship grant, 1982
U.C. San Diego Chancellor's Associates grant, 1982
Member American Medical Informatics Association (1991-present)
Member American Medical Association (1989-present)
Member New Mexico Medical Association (1989-present)
Member Greater Albuquerque Medical Association (1989-present)
Member California Medical Association (1983-88)
Member of California Medical Association's Committee on Computers in Medicine (1984-85. 1985-86)
Member UC Irvine Admissions Committee (1983-85)
Co-director and founding member of UC San Diego Peer Health Advocates (1981-1983)
1991-prcs
1989-pres
1988
1984-86
1983
1979
1979
1978-79
1977-79
Designing and implementing a computerized medicalrecordsystem for DynaMedics, Inc
Locum Tenens Emergency Room and Urgent Care Physician, over 4000 hours
Extending and documenting expert system shell at the National Library of Medicine.
Statistical analysis using statistic and graphic languages and custom programs.
-v
Wrote computer program to print contents of a color graphic screen for Anadex Printer, Inc."%
Wrote computer program to control multi-theaterticket-sellingand accounting system for
Pacific Theaters, Inc.
•^F
Pharmacy clerk.
.31;;.
Computer hardware and software technician for Microcomputer Business Consultants, Inc*,,
Wrote majority of Canyon High School's computer programs that analyze and record results of
the experiments for their chemistry and physics courses.
�Research
Experience
1991
University of New Mexico, May 1992 to June 1993
Designing and implementing a computerized record of the patients seen at the
Multidisiplinary clinic. The system will store the patients' medical problems and
medications, using the Unified Medical Language System's standarized codes.
1988
National Institutes of Health, 7 March to 15 May 1988
Participation in Computers in Clinical Medicine lecture series and research in medical
artificial intelligence. Designed and implemented an expert system that reasons with a
hybrid of criteria tables and production rules. The program can display its reasoning
governing how it reached its conclusions. It can also display videodisc images of
requested physical findings as well as dial MEDLINE and display the latest references in
the literature concerning those findirigs. The program is comprised of 24,000 lines of
computer code. The system, named CTX, will replace the current expert system at the
AI/RHEUM clinical test centers.
1987
Wrote program for S.P.E.C.T. scanner to calculate liver, spleen, and bone marrow scintillation
ratios. Program used on all liver/spleen scans done at UC Irvine Medical Center.
1985- 87 Data collection, manipulation, and statistical analysis using SPSSX for large and small-scale
clinical studies:
• Clinical and laboratory associations with spontaneous bacterial peritonitis.
• Characterizing liver tissue with:
• Liver/spleen/bone marrow ratios of Tc99 sulfur-colloid distribution
• Frequency-demodulated ultrasound imaging
• AM Ultrasound attenuation using zero-crossing technique
• AM Ultrasound attenuation using narrow-band technique
1986
Solved equations and wrote simulator for model of hepatic blood flow after portosystemic
shunt. Verified with laboratory model and clinical data.
1984-87 Studied computed tomography and requisite sub-disciplines. Wrote and evaluated a complete
CT. simulator. Data collection of a phantom object is simulated and beam hardening, photon
statistics, scatter, and random noise can be specified. Images are reconstructed using several
algorithms and then statistically and visually compared to the phantom image. Incorporated
and evaluated the novel application of B-spline approximation to the convolution computation
in CT reconstruction.
1986- 87 Wrote a comprehensive library of image processing programs for digital filtering, contrast
enhancement, edge detection, areas of organs, image statistics, etc.
1982
Special
Skills
Extracuiricular
Activities
San Diego Veterans Administration Nuclear Medicine Laboratory. Studied numerical analysis
and wrote a computer program to find the best-fitting polynomial for a set of data points by
least-squares minimization.
Extensive computer programming experience; writing hundreds of programs in more than a dozen
computer languages, almost all are computer, natural, or applied science related.
Skills in multimedia programming, electrical engineering, physics, and cognitive sciences.
Playing guitar, bass, keyboards, vocals with informal groups. Song writing, composing, and recording
using a computer to control multiple synthesizers and drum machines.
Readings in mathematics, physics, cognitive science, philosophy, natural sciences, anthropology, history.
Ham radio operator (technician class, call letters are WD6ERB)
Bicycling; skiing; dancing; camping;films;theater; travel.
�Bibliography
Published
1.
Rosenberg KM, Duerinckx AJ, Hoefs JC, Kanel G, Ferrari L, Aufrichtig DA, Cole-Beuglet C. Estimation of
acoustic attenuation in liver: Difficulties with a narrow-band estimator and the importance of fat. (Abstract).
(Presented to 11th Symposium on Ultrasonic Imaging and Tissue Characterization, Washington DC, June 3
1986)
2.
Rypins EB, Rosenberg KM, Sarfeh IJ, Houck J, Conroy RM, Milne N. Computer analysis of portal hemodynamics
after small diameter portacaval H-grafts: Vie tlieoretical basis for partial shunting. Journal of Surgical Research
42:354-61, 1987. (Opening presentation of Annual Meeting of the Association for Academic Surgery,
Washington D.C, November 5-8,1986)
3.
Duerinckx AJ, Aufrichtig DA, Rosenberg KM, Hoefs JC, Ferrari LA, Cole-Beuglet C. Tlie importance of fat in
the estimation of acoustic attenuation in liver with a narrow-band estimator. (Presented at the 31st AIUM Annual
Convention, Las Vegas, Nevada, Sept 16-19,1986)
4.
Martinez JE, Ming R, Rosenberg KM, Becker T, Strickland R. Inflammatory bowel disease in Native Americans
and Hispanics: How common is it? Gastroenterology, May 1989.
Poster
1.
Martinez JE, Ming R, Rosenberg KM. Inflammatory bowel disease in Native Americans and Hispanics: How
common is it? American College of Physicians, Albuquerque, New Mexico. Dec 5-7,1989.
In Press
5.
Duerinckx AJ, Rosenberg KM, Hoefs JC, Aufrichtig DA, Cole-Beuglet C, Kanel G, Lottenberg S, Ferrari L.
In-vivo acoustic attenuation in liver: Correlation with histology and blood tests. Ultrasound in Medicine and
Biology.
6.
Duerinckx AJ, Hoefs JC, Cole-Beuglet C, Ferrari LA, Rosenberg KM. Estimation of acoustic attenuation in
diffuse liver disease: Difficulties with tlie zero-crossing technique. Journal of Clinical Ultrasound.
7.
Hoefs JC, Kutch J, Utrick R, Kanel G, Donner B, Runyon B, Bridges R, Ocariz J, Meth E, Rosenberg KM,
Braunstein P. Precise quantitation of the abnormal sulfur-colloid distribution by liver- spleen scan with SPECT
analysis in patients with liver disease: Functional and histologic correlation. Hepatology.
Submitted for Publication
8.
Hoefs JC, Kanel G, Cole-Beuglet C, Aufrichtig DA, Lottenberg S, Donner B, Rosenberg KM, Ferrari L,
Friedenberg RM. Frequency demodulated ultrasound: Detection of hepatic fat and differentiation from hepatic
fibrosis. Hepatology.
9.
Ocariz J, Hoefs JC, Kanel G, Bridges R, Udkoff R, Rosenberg KM, Braunstein-P. Liver-Spleen Scan with SPECT
analysis: A Precise Method of Staging and Following the Progression of Viral Hepatitis.
10. Orcariz J, Hoefs JC, Kanel G, Bridges R, Udkoff R, Rosenberg KM, Braunstein P. Liver-spleen scan with SPECT
analysis in tlie progression and prognosis of primary biliary cirrhosis, primary sclerosing cholangitis and secondary
sclerosing cholangitis.
11. Wang F, Udkoff R, Braunstein P, Bridges R, Orcariz J, Kanel G, Rosenberg KM, Hoefs JC. Quantification of
sulfur colloid distribution in liver-spleen scanning by SPECT analysis.
Unpublished Manuscripts
12.
Rosenberg KM. An expert system using criteria table reasoning with tlie Al/RHEUM knowledge base: Tlieory,
implementation, guide for users, and guide for programmers. National Institutes of Health - National Library of
Medicine, 1988.
13.
Rosenberg KM, Sankar PV. Computed tomography reconstruction using B-spline approximation of convolution
filtering on a personal computer.
In Preparation
14.
Hoefs JC, Rosenberg KM, [plus investigators from clinical centers). Spontaneous bacterial peritonitis and
analysis of tlie Ascities International Diagnosis Society's questionnaire results.
�CODER
HEALTH CAKE TASK FORCE SORTING SHEET
s ate
INPUT DATE:
GRMRRAT. SOPT-
POSTCARD 2:
General mail
Personal stories
Other Health Providers
POSTCARD 1:
Letter Campaign
.Offers to help/Employment
>
.Physicians
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
President
Other
POLTCY AND PF.RSOISTAT, STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
unemployed/low income
benefits
.providers
.INFRASTRUCTURE/WORKFORCE (IH)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
.manpower issues (training)
.unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VTI)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
women's health
Jmmunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
13 oX
•
,
'-7.
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
007. letter
DATE
SUBJECT/TITLE
Phone No. (Partial) (I page)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
im782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b ( l ) National security classified information 1(b)(1) of the I OI A|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
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h(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning thc regulation of
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b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the F O I A |
National Security Classified Inrorniation 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Alert / y ^ r i M ^ ^ w
^H-^il^
-.Shisf,^
;^^n>^<
4
February 18, 1993
Ms. Hillary Rodham Clinton jVe/btffo[
Dear Ms. Clinton
P6/(b)(6)-.
I am writing in support of serious health care reform. I bope^your task
force can design the changes so sorely needed. Furthermore, I support strongly
President Clinton's Budget proposal that he specified in his State of the Union
Address to die Joint Session of Congress on the evening of February 17, 1993. I
agree with the president that we will all need to sacrifice to avoid the economic
disintegration of the nation.
I understand that this budget plan represents only a first good step. Another
good step would be a modest increase in the minimum wage, which should
increase our tax base without significantly decreasing jobs, according to recent
economic research.
kpow
However, no plan will work without sweeping health care
this fromfirst-handexperience, for I am a physician. 1 practict )ediatric£/in
Albuquerque, New Mexico. In the last five years, I also worked extensively with
the children of pgor, uninsured families in California. I have seen a four year-ol
child near death with diphtheria, later requiring a pacemaker and tracheostomy
tube for life, from a disease easily preventable by early immunization. I have
seen children and teens with permanent brain damage from measles encephalit}
regret to say also that I have seen scores of premature infants bom permanent
disabled, drug-addicted, and underweight to mothers who had no access to
prenatal care.
/
I agree with President Clinton that all infants and children£ai!£L^ttfts-fbr
that matter) should have free and unfettered access to complet^nmunization^It
is not only cost-effective in the long run, but it makes basic pubUcTieaTlli cUmmon
sense. The same holds true for prenatal care. It is far more costly in economic
and human terms to ignore the care of pregnant women, only to pay for the
astronomical cost of neonatal intensive care and lifelong: custodial costs for the
substantial fraction of babies bom with bad outcomes because of a lack of
'
preventive care and education.
�This suggests a broader point. Any health care reform must center
itself on the paradigmatic change that preventive and primary care is
the emphasis and centerpiece of any health care system. That primary
care can be delivered by physicians, nurse practitioners, and supervised
physician's assistants at a reasonable cost. In contrast the outrageous
reimbursements for procedure-oriented, surgical, and subspecialized care can be
reduced by two- or three-fold at a substantial savings to our society, still leaving
the average orthopedic surgeon with a "paltry" approximately $150,000 per year
annual income. Two caveats must be understood for this to be true. First, the
burden of immense malpractice insurance premiums and potential medical
liability would have to be eased by significant tort reform. Second, the structure
of medical reimbursement would need to be altered, so that a physician and
associated staff for adequate care of the patient, as opposed to per procedure,
according to its length, complexity, and "what-the-traffic-will-bear" going rate.
If this system is not altered, then there will always be incentive to do more
procedures at more cost for borderline indications justified under the mystery of
medical expertise.
All patients should have a primary provider. That provider can act as the
agent for primary care, health promotion, and the gatekeeper for subspecialty
and surgical referrals. Choice of primary providers is essential in any publicly
or privately coherent health care system. Free access and self-referral to
subspecialty or surgical care leads to inappropriate consultation, potential
duplication of services, and overuse of limited resources. To avoid unnecessary
bottlenecks, basic mental health, family planning, and women's health services
should either be considered primary care or open to free(non-referrred) access.
The cost of medical equipment and hospital supplies also need drastic cuts.
There is no true "free market" for these items. The costs are universally inflated
and the demand is captive. Medical supplies have hit the level of defense
procurement for price astronomically beyond the cost of production and a
reasonable margin of profit. The patient or the third party payor has little choice
but to pay the price once the necessity of the involved procedure, medication, or
equipment is ascertained. Because a proprietary drug or vascular catheter is the
best choice to improve health or save a life is not sufficient reason to extort the
maximum possible price from the payor. However, this extortion is the norm in
medical supply pricing and hospital billing. Cost controls and honesty in pricing
are needed, yet will still supply the pharmaceutical, medical and surgical
equipment, and health technologies a sizable profit(albeit not the record-breaking
profits of present years.) One caveat is that a significant tax credit or support
must be maintained for research and development in these industries to stimulate
the continued pursuit of improved health care. Perhaps a disincentive of some
�sort could be provided to reduce the massive budgets for marketing,
advertisement,and promotion of these products, so that these funds could be
channeled back to R&D and quality control. The horde of "detail men" that flood
doctor's offices and hospitals could be eliminated without much harm to the
public. The ethically questionable meals, trips, conferences, and outings
sponsored or wholly paid for by these corporations for health care personnel and
administrators could be curtailed or eliminated.
Many other vital issues need to be tackled in detail. Long-term care must
have a comprehensive plan. No longer can Medicaid be the ad hoc payor for
custodial and prolonged nursing care by impoverishing individuals and their
families. Creative community and in-home options for this care can be supported
with greater quality and decreased cost. Also, the huge bulk of health care bills
generated by top-heavy, paper-heavy administrative system must be pared down
and simplified.
Finally, we need an explicit national health policy. At the present time, we
have implicit health rationing on the ability to pay or find reimbursement. In
other words, we pay billions of dollars each year for the intensive care of the
extreme elderly or the extremely premature infant(<28 weeks or <600 grams)
regardless of whether there is any reasonable prognosis for recovery, returned
function, survival, or quality of life. We do so simply because we provide no
alternate decision; by practice, all possible intensive care is provided to all
patients without discretion in all but the most extremely futile circumstances. By
abdicating any societal priorities to heath care, we pay for these exorbitant, futile
or ill-advised treatment and leave no money or means to pay for the greater
benefit of preventive, primary, or prenatal care. Our present unnamed ad hoc
medical rationing system shows no long-range thinking. We pay for extreme
things of little utility now, thereby depriving manyfold more people of the care
needed to prevent these extreme andftitileevents in the future, thus multiplying
costs by a huge amount and deriving little qualitative benefit. We must set our
health care priorities, then live by our societal decisions. The Oregon experiment
with "rationing" was laudable, but doomed to uninterpretable results because of
its position couched in an otherwise unchanged and contrary national health care
system. Ideally, we should set up a National Health Policy Board with an
independent status like the Federal Reserve Bank, so that tough decisions about
health priorities both for public and private payors and about health resource
utilization can be made without the immediate vascilladons caused by electoral
politics. This board should be made of people with experience and expertise in
health care and health policy, but no immediate vested interest in the decisions
made.
All in all, all Americans must be provided basic health care, but profound
�reform of the health care system and business must occur simultaneously. This is
the next step after the passage of President Clinton's well-designed budget
package.
Sincerely,
Paul H. Kalz, M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�EVE A.
N, M D
..
^
February 21, 1992
Mrs. H i l i a r y R. C l i n t o n
The White House
Washington, D.C.
Dear Mrs. C l i n t o n ;
I am w r i t i n g you t o o f f e r any assistance I may be able t o
provide. I am a physician who f o r the past four years worked
i n the corporate medical department o f a major n a t i o n a l
insurerer,- I was responsible f o r p o l i c y making i n areas of
claims payment. At the present time I am medical d i r e c t o r 'df
a union t r u s t fund. We are a HMO and PPO, although some of
our members are also covered under an indemnity plan. I have
also provided advice t o the t h i r d p a r t y a d m i n i s t r a t o r paying
claims.
I am aware t h a t you have f i n e consultants t o advise you, however,
I might be able t o add the dimension of someone who a c t u a l l y
i s i n v o l v e d i n the p r o v i s i o n o f services and who i s f a m i l i a r
w i t h how claims are paid as w e l l as what providers a c t u a l l y
bill.
Enclosed i s a copy of my resume.
I t i s , however, incomplete
since my present p o s i t i o n i s not l i s t e d . This i s , Medical
D i r e c t o r , 1115 Employees B e n e f i t Funds, 761 Merrick Avenue,
Westbury N.Y. 11590.
4
�f
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
'JO
V
C • J~^f"JfJ / • - S ft/ f
- .•
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. resume
DATE
SUBJECT/TITLE
n.d.
Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER T I T L E :
[Physician Letters] [loose] 12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
IM
b ( l ) National security classified information 1(b)(1) o f t h e FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of thc FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(K) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA|
National Security' Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�EVE A. KLIPSTEIN, M.D.
p6/(b)(6)
00%
Telephone
; : -;:,
SUMMARY
Physician with excellent management skills and a vast knowledge of medicine and how it applies to
the area of health insurance. Responsible for building a claims unit that served as a resource to a
leading national insurer. Participated in the development of a Long Term Care product and
subsequent underwriting, marketing, and benefits determinations.
PROFESSIONAL EXPERIENCE
METROPOLITAN LIFE INSURANCE COMPANY
Corporate Medical Department
1987 - 1992
Medical Director and Officer-in-Charge of Claims (1990 -1992)
Associate Medical Director (1988)
Assistant Medical Director (1987)
Responsibilities include the Management of a unit which consists of fifteen professionals and support
staff. Service Group Health Claims,,Group National Accounts, Personal Health Insurance, Long
Term Care Insurance, the Corporate Legal Department and Actuarial.
Specific accomplishments include:
• Developed cost-containment systems used by Managed Care Medical Directors and nurses
resulting in 23% reduction in payment of claims.
..
• Developed internal definition of medical necessity and experimental/investigational procedures
and services. Supervised and organized Company-wide guidelines and criteria for handling
relevant claims. For example, surgical site lists, experimental/investigational lists, etc.
• Responsible for development of a system to enable medical personnel and claims approvers
to handle claims in a cost effective manner which is uniform and consistent.
• Wrote guidelines in conjunction with group claims operation for medical directors, nurses and
senior claims approvers to properly adjudicate claims.
• Designed protocol and criteria for transplants and other significant medical issues resulting
in cohesive, time sensitive responses.
• Worked as Medical Director of a team to develop a long term care product. Continued to
provide underwriting and benefits support.
•
Interacted with the provider community (medical associations, physicians, etc.) in cost
containment issues.
Interacted with the benefits administrators and medical directors of customer companies such
as Johnson & Johnson, American Airlines, and General Motors in an effon to develop claims
policies specific to their needs.
�EVE A. KLIPSTEIN, M.D.
PAGE 2
ALBERT EINSTEIN SCHOOL OF MEDICINE
and MONTEFIORE MEDICAL CENTER
1986 - 1987
Anesthesia Residency
CIGNA
1982 - 1985
Associate Medical Director
Worked in health insurance, disability insurance, and re-insurance underwriting. Represented HIAA
and worked with HCFA reviewing studies for which they had contracted on physician payment
reform and prospective payment systems. Duties were primarily in re-insurance underwriting.
PRIVATE PRACTICE in PEDIATRICS, Manchester, CT
1971 - 1980
EDUCATION
AB
MD
Intern
Resident Pediatrics
Smith College
New York University School of Medicine
Montefiore
Mt. Sinai Hospital, New York City
1961
1965
1965 - 1966
1966 - 1967
PROFESSIONAL ACTIVITIES
Board Certified in Insurance Medicine.
Hartford County Medical Association, Hartford, CT.
1975 - 1986
Board of Directors; Chairwoman of several committees. Chaired committee for underwriting
applicants for our malpractice insurance carrier; served on the committee that screens suits.
�i
ALBUQUERQUE ANESTHESIA CONSULTANTS
H.-n-mmiC. Rcngcr. Ph.D.. M.D.. P.A.
VVilli.nn |. Brvn, Pli.D.. M.D.. I'.A.
March 3, 1993
Mrs. H i l l a r y Rodham C l i n t o n
The W h i t e House
P r e s i d e n t ' s Task F o r c e on H e a l t h Care Reform
1600 P e n n s y l v a n i a Avenue, N.W.
W a s h i n g t o n , D.C.
20500
Dear Mrs. C l i n t o n :
I am a member o f PHYSICIANS WHO CARE. I am d e e p l y c o n c e r n e d a b o u t
access t o q u a l i t y
h e a l t h care
f o r a l l Americans.
Equally
i m p o r t a n t , I f e e l s t r o n g l y t h a t p a t i e n t s s h o u l d be a b l e t o choose
t h e i r p h y s i c i a n f r e e l y , n o t f r o m a c l o s e d p a n e l p r o v i d e r l i s t o f an
HMO.
I r e s p e c t f u l l y r e q u e s t t h a t y o u a l l o w D r . R o n a l d Bronow,
P r e s i d e n t o f PHYSICIANS WHO CARE, t o p r e s e n t t o y o u a p l a n f o r
r e f o r m i n g h e a l t h c a r e . He w i l l e x p r e s s t o y o u o u r s t r o n g f e e l i n g s
t h a t m e d i c a l d e c i s i o n s s h o u l d n o t be based s o l e l y on c o s t o r
c o r p o r a t e p r o f i t , as i s t h e case i n most managed c a r e h e a l t h p l a n s .
Please g i v e these views your utmost c o n s i d e r a t i o n .
Sincerelv
vours,
/A
"
Hartmut
Rengjpffc, P h . D . ,
M.D,
HR:mb
SIII'L',<:I-Y C r m . i ol AlbuquririiH' • 1720 VVyomim; N . E . • AllHiqucrquc. New Mexico !i71 VI • (fiOfi) 2!J2-!>2<'n
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
B6X 93
S,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. letter
SUBJECT/TITI.E
DATE
Address (Partial); Phone No. (Partial) (I page)
03/31/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e F O I A j
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) o f t h e F O I A j
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe F O I A j
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of thc F O I A j
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance wilh restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�EDGAR,SIMON
ABOMlA
M.D
n
.P6/(b)(6)
Maivh 31. 1993
HJ1IJI\- Rodham Ctimon.
Chiinr.ui. F*rti.idcri\ T a s l f-'otce on N'diiiuul hcilih Rct'orm
Tlte V-liiic House, 'ft ashmfion. D C.
Dear Mrs Cl:r.:onI applaud ytwr conurutmcm ro rcsti-JClining thc htalih i-»r^ indmir*. It ii gTanlymg lo know lhai a PrciiJc.i!
Hnally realiied ihai
ihis counry Con no kirgci cnniinui; on the pulii whioi ha( led u', in -Jeady mcreaic in tht hoditi fare i-onip<incnl of ihi G I U M Sluiimal
PrnduLT
Ac-^irdiniiK. I would greaily tppii-Liait- u if yoi: would rcvicM [he enclosed lencr diisrl L O W 10 Dr. Gcor»- Whcail). Mcdir»J
Di:cciur of Uic Surioik Coumy Dcparjuint of Social Services in Hauppaupc. Nev, Voik Please *11o*- me lo sumrrunze its cimtrnii.
Tlic Cji-isifuphii: New Y o r i Siztr He*lih Insurance Plan, with in apptoprijie check sysiem. d c K no; rrquire any nan-up nr phme-in
penod. vinujllvrliuiiaaic. all p=pcrwurt and allows ibt r m i m u n i iavinp; by all taxpayer. In addition, a p.TUiive balance ol ihe
caiaiunphic (mid is mjinuiiied jea-'ly by grajua] incrciisc tn pre-esublishe*; prenuumi. Litetine eovejage ii provided tor bom lhe
uninMjretJ ai * e l l di ihe undennsutcJ, ^iili fiaud ^ndjor ahuse heiog elimiaaifd or ci leaii reduced to a drtrjmcniefl mt.vmum by Ihe
cheeL fcysiein. wilh the toi^iJ b-mk. and audoal by paiierui *jid provider*
The sy^iem I am micijhiinp is dciigncd to eveniuallj reiiuce and hupcfully elinunaie the Medicate and Medicaid budgei The general
public will leani [o become aware uf lhe coil and lean huw lo cunrro! excessive- e^penditurei. Pfrveuti»c medicine will be stressed ai
a *-s> oi ultmuiely bringing all expenses down to r.n acceptable level Or.ipeiition by priiaie p ™ tiring ph\ siciam, liojpruii cLniL-s.
HIP. etc.. thruush the managed conipemion coocepf. njll alio iciuh in subtumial iivingi and [In: impcailiun of cuM coni/ol tncctwnisnn It is anticipaicd thai et^pleyers wili volunurily [mj ihe prrmiuors associaicd with ihe Cj^sirophic Fund, [haeby resulting in
portabiliry of policies. For all new employees it is no lonser wcessary thev AIS id ready equally Ltsutrd, ihciffoic helping cieaie new
jobs. (ImMgin*- len million workinj; tiixpnycnp pacing S3OO0.O0 by 6-1-93 and i h i real by 4-I5-9J nnd 5-31-94, plus payrocni
f r « n all new c c i p l u t r u • n d uneanplojtrd worktrs. tod payments rrom Medicarx and Medicaid Tor lhe poor and boniekas.)
! have tried to ftcieni a generj] overview rif z program I am convinced will save money, co^er neryane, SOINC our 1 legal immigrant
1
pmbleni. main!tin p-Jtienl freedom uf choice, and control mulpociice insurant^: premiums Included for your irvicw. jr.formuiion and
reierem-e. is a deiiilcd cornpiHu>n of Prnidem Clinton's proposal ind lite Caiastrophif Ne*- Yoifc Insunuicr I'bn I havi- postuiaied.
I 'incerely
tnanl yc.i tn: yimu time and contirieraiion,
su^t.'. »T)UI<1 Lite ii miller •.•aie.'ni advisemem.
JHQ | am confideni that you wjl) sw [lie advanuj.-es with my propisal.
I anxiously snail youi positue response to thii
and as
\c\izi.
Sincerely.
./
:V.-/.
Edgar Simon A h o o U M.D.
encs.
Donna Shale I.i. Secretary of H:alih and Hunian S m i c e i
IViet i m a n i . M.D . Ph.D.. Direcior of Health. Columhu-.. Otno
Senwor Orrin G. Hjtch
S e n a i n - F d w a i J M kLnncdy
Scnno; Daniel P Moynitun
Rhodd H Kjrpatfcm. C u n s u n m Union ofilte U S.
D:.Ji«!yn E l J m
Mi. Maiio Mcntthmi. New York Siatc Meditjl Scf ieiy
Dawd Ajinutuiaio. M.D., AnicriL-an AL-adcmv of Pediamcs
Donald
r.roinisch. M.D.. ClLiirmjn. D q x . of Pediaaic*. Naisau County Medical Cenicr
Amiricins ai age t;? ha-c a -13 pciceni clwntr uf necdins lonp-lcrm care. ECCIHTJIDP to Djvid E. Huphes, senior vice presidem for
lonj-ienn care el L I S U M . a major insurer based in Pori;ind. M.:
The earlier you buy ihe policy ihe bener, bt-cause you lock in a lev el prcmiuin foi life. For example. Mi. llufihes. uho is ^5. pay^leu
than HOO a year Fur hii 73-year-old moiner. (lit premium iiS17O0. "Youcnni aflurd It; wail," said Mr. SlrauiS "It » a wonderful
buy « 55. II"? nill a relaiivelj ood buv at &0. Ai a»e ti5 arid Lp. iis stans to get crpeniive."
E
THli NEW Y O R K T I M E S . S U N D A Y . M A R C H 14, 1 » 3
' It rs tine to end (he diifrscerijl double standard in health u r c "
...If you ajc uoi allowed m pay equitable health care ihrnnjh ihr incnnic lat... (ahoul S3000.00. . foi a life-nme of family or individual mpavcr... Y O U W I L L A L W A Y S H A V E ' D O U h L F S T A N D A R D IN H E A L T H C.AR^" - i h e i r is m puperwurk.
�,.1*^
•1
-
EDGAR SIMON ABONIA. M D.
/ f'*
"t"
March 31, 1993
Mrs. Hillary Rodham Clinton,
Chairman, President's Task Force on National Health Reform
The White House, Washington, D.C.
Dear Mrs. Clinton:
I applaud your commitment to restructuring the health care industry. It is gratifying to know that a President has finally realized that
this country can no longer continue on the path which has led us to steady increase in the health care component of the Gross National
Product.
Accordingly, I would greatly appreciate it if you would review the enclosed letter dated 1/29/93 to Dr. George Wheatly, Medical
Director of the Suffolk County Department of Social Services in Hauppauge, New York. Please allow me to summarize its contents.
The Catastrophic New York State Health Insurance Plan, with an appropriate check system, does not require any start-up or phase-in
period, virtually eliminates all paperwork and allows for maximum savings by all taxpayers. In addition, a positive balance of the
catastrophic fund is maintained yearly by gradual increase in pre-established premiums. Lifetime coverage is provided for both the
uninsured as well as the underinsured, with fraud and/or abuse being eliminated or at least reduced to a documented minimum by the
check system, with the local bank, and audited by patients and providers.
The system I am articulating is designed to eventually reduce and hopefully eliminate the Medicare and Medicaid budget. The general
public will learn to become aware of the cost and learn how to control excessive expenditures. Preventive medicine will be stressed as
a way of ultimately bringing all expenses down to an acceptable level. Competition by private practicing physicians, hospitals, clinics,
HIP, etc., through the managed competition concept, will also result in substantial savings and the imposition of cost control mechanisms. It is anticipated that employers will voluntarily pay the premiums associated with the Catastrophic Fund, thereby resulting in
portability of policies. For all new employees it is no longer necessary they are already equally insured, therefore helping create new
jobs. (Imagine ten million working taxpayers paying $3000.00 by 6-1-93 and the rest by 4-15-94 and 5-31-94, plus payment
from all new employees and unemployed workers, and payments from Medicare and Medicaid for the poor and homeless.)
I have tried to present a general overview of a program I am convinced will save money, cover everyone, solve our illegal immigrant
problem, maintain patient freedom of choice, and control malpractice insurance premiums. Included for your review, information and
reference, is a detailed comparison of President Clinton's proposal and the Catastrophic New York Insurance Plan I have postulated.
I sincerely thank you for your time and consideration, and I am confident that you will see the advantages with my proposal, and as
such, would take it under careful advisement. I anxiously await your positive response to this letter.
Sincerely,
rt*:
ia,
igar Simon Abonia, MX).
encs.
Donna Shalala, Secretary of Health and Human Services
Peter Somani, M.D., Ph.D., Director of Health, Columbus, Ohio
Senator Orrin G. Hatch
Senator Edward M. Kennedy
Senator Daniel P. Meynihan
Rhoda H. Karpatkin, Consumers Union of the U.S.
Dr. Jocelyn Elders
Mr. Mario Menghini, New York State Medical Society
David Annunziato, M.D., American Academy of Pediatrics
Donald S. Gromisch, M.D., Chairman, Dept. of Pediatrics, Nassau County Medical Center
Americans at age 65 have a 43 percent chance of needing long-term care, according to David E. Hughes, senior vice president for
long-term care at UNUM, a major insurer based in Portland, M.^.
The earlier you buy the policy the better, because you lock in a level premium for life. For example, Mr. Hughes, who is 45, pays less
than $400 a year. For his 73-year-old mother, the premium is $1700. "You can't afford to wait," said Mr. Strauss. "It's a wonderful
buy at 55. It's still a relatively good buy at 60. At age 65 and up, its starts to get expensive."
THE NEW YORK TIMES, SUNDAY, MARCH 14, 1993
"It is time to end the disgraceful double standard in health care."
...If you are not allowed to pay equitable health care through the income tax... (about $3000.00,... for a life-time of family or individual taxpayer... YOU WILL ALWAYS HAVE "DOUBLE STANDARD IN HF.ALTH CARE" -.there is no paperwork.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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[Physician Letters] [loose] [12]
Creator
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 3
Is Part Of
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Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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3/16/2015
Source
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42-t-12092992-20060885F-Seg3-007-001-2015
12092992