07/28/10 — Expert answers questions about health care reform

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Expert answers questions about health care reform

By Phyllis Moore
Published in News on July 28, 2010 1:46 PM

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Dr. Pam Silberman, president and chief executive officer of the N.C. Institute of Medicine, speaks Tuesday night at Wayne Community College on "How Will Health Care Reform Affect You and Your Family?" The free 90-minute forum was sponsored by the Wayne County Board of Health and included a question-and-answer segment. Watch the video here.

At this point, questions about the national health reform plan far outnumber the answers.

Since the bill came out March 23, there has already been "a lot of activity" and likely more to come, said Dr. Pam Silberman of the N.C. Institute of Medicine, who spoke on the subject Tuesday night at Wayne Community College.

Hosted by the Wayne County Board of Health, the 90-minute public forum drew an estimated crowd of 100, said Patty Pfeiffer, the college's division chair of allied health/public services.

"It was an excellent turnout," she said afterward. "I think the questions were very appropriate, people were seeking information."

Dr. Silberman attempted to break down the plan into manageable segments, likening health care to three legs of a stool -- the most critical components of the system comprised of costs, quality and access to care.

According to the N.C. Institute of Medicine, she said, there is a growing population of uninsured -- 1.4 million non-elderly in the state of North Carolina alone during 2008. With the economic downturn, she estimated that figure rose to 1.75 million, or 21 percent, in 2009.

Among the efforts of the proposed plan is to try to expand the number of physicians and health professionals into rural areas and communities that are underserved, Dr. Silberman said. Beyond that, it will be critical to make health care more affordable to more people so that they'll buy into it.

Before that can happen, she said, it will be important to make sure the plan works. She cited mental health reform, which has drawn much attention in recent years over its implementation and seeming short-sightedness.

"The real problems with the mental health system, part of it is that when we changed our mental health system, we did it overnight across the state," she said. "We didn't test it to see, 'Will it work? Then we'll expand it further.'

"That's what this bill basically does. ... Before we change our whole delivery system, we want to test it to make sure it works. We don't want to create an all-new system to see if it works."

Health reform, as it is being laid out, could actually provide "better coverage" than most people currently have in their regular insurance, Dr. Silberman said.

Keith Stewart, a Fremont pharmacist, raised a question about access to care as it relates to residents being able to purchase insurance, especially when some doctors' offices are closed to new patients.

"Is there anything in the bill that addresses physicians and other health care shortages?" he asked.

"Yes, there's several things that deal with access to providers," Dr. Silberman said. "There's money for health professionals to get into underserved areas. There's also money in for training nurse practitioners and physicians' assistants and also to expand safety net services."

Comparisons were drawn to health reform introduced long ago in other countries such as Great Britain, which one audience member said had "failed in many of the areas that we're talking about."

"The way I understand it is they used to have hospital districts and now they're going to pay primary care trusts," Dr. Silberman replied. "What they're talking about in Great Britain sounds a lot like what we're at the forefront of in North Carolina."

But it illustrated the fact that the U.S. is not alone in its efforts to respond to concerns about adequate health care, Dr. Silberman said. Nor is this the first time that the subject has been introduced.

President Harry Truman discussed it in the 1940s, as did Presidents Richard Nixon and Bill Clinton during their terms, she said.

It's not only a universal topic, Dr. Silberman said, but a very personal one.

"All of us have such a major stake in our health care system and all of us are afraid of what it means to us," she said. "But it doesn't mean that our system is perfect and it doesn't mean that it can't be improved."

The latest plan is not without controversy, she noted -- for some, it doesn't go far enough, for others it is going too far.

"Lots of people complain about it because it's not a very efficient model and you have so many pieces," she said. "But it builds on what we have done."

One of the most prominent issues among the audience related to the senior segment of the population. Several indicated they are already subscribers to, or nearing eligibility for, Medicare.

What does the new plan offer them besides an annual physical and preventive measures? And are those over 65 essentially being "pushed to the side?" one asked.

"I wouldn't say you're pushed to one side because you have health insurance coverage," she said. "You're getting better prescription drug coverage. You don't get as many benefits from the bill but you already have more than what most people have."

Chuck Stone, director of North Carolinians for Affordable Health Care with the State Employees Association, maintained the legislation will help bring the county's cost in health care under control.

"If we do not have that in the year 2017, and I will only have been eligible for Medicare four years by that time, Medicare will go broke," he said. "Even private companies will not be able to afford coverage. And again, we will not have Medicare.

"We have got to get costs under control. .. This legislation will benefit all people on Medicare, extend the life of Medicare by 10 to 12 years and I think that's a very important benefit that needs to be added in."

Eugene Holloman of Sleepy Creek, who retired almost 16 years ago from the insurance business, called the community forum helpful in understanding more about the national reform.

"There's a lot of information," he said afterward. "I appreciate what I learned but there's a whole lot that we really don't know. .... I'm more informed, but I still feel like the elderly people have been left out and that's the one reason I was here."

Kathy Johnson, a nurse practitioner with WATCH, which serves underinsured and uninsured in Wayne County, said she was more familiar than most as she has read the plan "from cover to cover."

"I thought (the presentation) was excellent," she said. "People have strong feelings both for and against the reform bill, but I think it's a first step. It will really provide coverage for more people."

Stone expressed gratitude to the Board of Health for sponsoring the event in Wayne County and to Dr. Silberman, whom he called a "guru" when it comes to understanding the issues of health care in the state and how the reform legislation will benefit citizens.

"There's still many regulations being written every day," he said. "Quite honestly, we don't know all the answers to the questions. There's a lot of development still to be done. What we have got is the best framework. Now within our state, we have to cover that framework, put the heart into it.

"We have got a lot of work to do but we can make North Carolina a healthier state and see that people get the health services that we need."