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L.C. - V.I.P. Correspondance
PHOTOCOPY
PRESERVATION
03/21/94
13:26
001
CLINICIAN
REPORTING ON THE LATEST ADVANCES IN MEUICINE
TO:
Ms. Karen Finney
Press Room
Office of the First Lady
FROM:
Mr. Thomas Yackeren, RPA
Clinicians Publishing Group
DATE:
March 21, 1994
Dear Karen:
I was happy to hear that you have received our questions and are working on them.
All of us are very excited that Mrs. Clinton has agreed to the interview.
As we discussed this morning, I would like to replace question #3 which began,
"Current healthcare legislation sets aside $200 million for graduate nurses. " with what
we believe is a clearer, more accurate and better worded question.
New question
The Clinton plan of September 1993 called for a doubling of the supply of physician
assistants and nurse practitioners in its workforce plan. Does the Health Security Act
insure sufficient funding for educational programs to achieve this goal? Specifically,
current healthcare legislation sets aside $200 million for graduate nurse education. The
Clinton proposed budget contains $400 million to cover a variety of health professions,
primary care physicians and PA training in addition to programs for minorities and
nurses. With the demands for PAs at an all-time high and PA programs, particularly
those just starting up in need of funding, why are PA educational programs not eligible
for GME funds?
Karen, I apologize for amending the interview, but this question is important enough
for us to feel the need to get the wording right. Hopefully, now that it is a more
accurate question, it will be easler to answer.
Once again, thank you for all of your assistance. Our original deadline was April 4th,
but if it makes it easier for you (particularly since I'm responsible for slowing you up),
April 8th would be acceptable as a new deadline.
If you have any questions, please call me.
Clinicians Publishing Group
Sincerely yours,
4 Brighton Road
Ix IVC.
Clifton, New Jersey 07012
(201) 916-1000 Fax (201) 916-0021
CLINICIAN
REPORTING ON THE LATEST ADVANCES IN MEDICINE
Mrs. Hillary Rodham Clinton
March 3, 1994
The White House
1600 Pennsylvania Ave
Washington DC 20500
Dear Mrs. Clinton:
Last May you addressed the Mirabella group with a discussion on Health Care
reform. You said "In order to have universal health care coverage for all
Americans that emphasizes primary and preventive health care, we need
more...nurse practitioners and physician assistants who will be on the front lines
delivering it."
First, let me thank you for taking on this immense task of making health care
affordable and accessible for all Americans. Secondly, thank you for recognizing
that nurse practitioners and physician assistants are vital ingredients in
American health care delivery.
By agreeing to be interviewed by Clinician Reviews - - the leading nurse
practitioner and physician assistant journal (circulation 46,000) - you now have
the opportunity to expand on your earlier comments.
We have carefully prepared questions that were developed by PA and NP leaders
from around the United States. Your response to them will help to clarify just
where we fit, and how we can help you pass this historic legislation.
If possible, we would like your responses by Monday, April 4th; the interview is
scheduled to run in our May issue. Please let me know if that is unattainable or
if you have any questions.
Thank you again, Mrs. Clinton, for your time, support and service.
Warmest regards,
The
Thomas F. Yackeren, PA
Vice President
Clinicians Publishing Group
4 Brighton Road
Clifton. New Jersey 07012
(201) 916-1000 Fax (201) 916-0021
Clinician Reviews Interview with Mrs. Hillary Rodham Clinton 3/94
1. Mrs. Clinton, thank you for consenting to be interviewed by us and for your
interest in nurse practitioners (NPs) and physician assistants (PAs). I'm sure our
readers appreciate that you are taking time to speak with us.
What is your view of how physician assistants and nurse practitioners will be
used in a reformed health care system? As a follow up, do you consider PAs and
NPs as a short term or long term solution? For example, are we being used as a
"stop-gap" measure until more primary care physicians can be trained?
2. The Health Security Act does not specifically provide for a federal pre-
emption of restrictive state practice acts for NPs and PAs, such as incomplete or
total lack of prescription privileges, or inadequate reimbursement. What is being
addressed, considered or done to remove these and other obstacles to NP/PA
practice? Will these actions, designed to lower practice barriers, affect both PAs
and NPs equally? If not, why not?
3. Current healthcare legislation sets aside $200 million for graduate nurse
education, and $400 million to cover primary care physician and PA training, in
addition to programs for minorities and nurses. With the demand for PAs at an
all time high and PA programs, particularly those just starting up, in need of
funding, shouldn't PA education also be eligible for GME funds at a level
significantly greater than the currently authorized $9 million? What can PAs do
to make this a reality?
4. To many practicing NPs and PAs, tort reform has not been adequately
addressed in the Health Security Act. Defensive medicine causes many clinicians
to over-order diagnostic tests and x-rays etc, that needlessly drive up health costs.
How will the legal system, as it pertains to our day-to-day practice be reformed?
5. Many clinicians also worry that strict price controls on pharmaceuticals will
significantly decrease money that drug companies spend on the research and
development of new products thereby damaging not only our preeminent
leadership status as the world leader in pharmaceutical research, but also more
importantly, patient care. Should we be worried?
6. PAs and NPs are concerned that health care reform can backfire on them. For
instance, a local medical society bands together to form a regional purchasing
alliance representing all local doctors in the area, and tells their members doctors
that services by PAs and NPs will no longer be reimbursed. Is this a possible
scenario, and if so, how can it be prevented?
7. In view of the opposition we have occasionally seen from special interest
groups, how can NPs and PAs position themselves to be an integral part of
health care reform? And, along those lines, how can PAs/NPs help the
administration bring about health care reform?
8. Mrs. Clinton, once again we are very appreciative of your time and interest.
Are there any other comments or thoughts that you would like to share with
America's physician assistants and nurse practitioners?
Thank you very much.
03/21/94
13:26
001
CLINICIAN
REPORTING ON THE LATEST ADVANCES IN MEDICINE
TO:
Ms. Karen Finney
Press Room
Office of the First Lady
FROM:
Mr. Thomas Yackeren, RPA
Clinicians Publishing Group
DATE:
March 21, 1994
Dear Karen:
I was happy to hear that you have received our questions and are working on them.
All of us are very excited that Mrs. Clinton has agreed to the interview.
As we discussed this morning, I would like to replace question #3 which began,
"Current healthcare legislation sets aside $200 million for graduate nurses. with what
we believe is a clearer, more accurate and better worded question.
New question
The Clinton plan of September 1993 called for a doubling of the supply of physician
assistants and nurse practitioners in its workforce plan. Does the Health Security Act
insure sufficient funding for educational programs to achieve this goal? Specifically,
current healthcare legislation sets aside $200 million for graduate nurse education. The
Clinton proposed budget contains $400 million to cover a variety of health professions,
primary care physicians and PA training in addition to programs for minorities and
nurses. With the demands for PAs at an all-time high and PA programs, particularly
those just starting up in need of funding, why are PA educational programs not eligible
for GME funds?
Karen, I apologize for amending the interview, but this question is important enough
for us to feel the need to get the wording right. Hopefully, now that it is a more
accurate question, it will be easier to answer.
Once again, thank you for all of your assistance. Our original deadline was April 4th,
but if it makes it easier for you (particularly since I'm responsible for slowing you up),
April 8th would be acceptable as a new deadline.
If you have any questions, please call me.
Clinicians Publishing Group
Sincerely yours,
4 Brighton Road
Ion Wachere
Clifton, New Jersey 07012
(201) 916-1000 Fax (201) 916-0021
MAR 2 I 1994
CLINICIAN
REPORTING ON THE LATEST ADVANCES IN MEDICINE
Mrs. Hillary Rodham Clinton
March 3, 1994
The White House
1600 Pennsylvania Ave
Washington DC 20500
Dear Mrs. Clinton:
Last May you addressed the Mirabella group with a discussion on Health Care
reform. You said "In order to have universal health care coverage for all
Americans that emphasizes primary and preventive health care, we need
more nurse practitioners and physician assistants who will be on the front lines
delivering it."
First, let me thank you for taking on this immense task of making health care
affordable and accessible for all Americans. Secondly, thank you for recognizing
that nurse practitioners and physician assistants are vital ingredients in
American health care delivery.
By agreeing to be interviewed by Clinician Reviews - the leading nurse
practitioner and physician assistant journal (circulation 46,000) - you now have
the opportunity to expand on your earlier comments.
We have carefully prepared questions that were developed by PA and NP leaders
from around the United States. Your response to them will help to clarify just
where we fit, and how we can help you pass this historic legislation.
If possible, we would like your responses by Monday, April 4th; the interview is
scheduled to run in our May issue. Please let me know if that is unattainable or
if you have any questions.
Thank you again, Mrs. Clinton, for your time, support and service.
Warmest regards,
Piomar Vice Thomas President F. Yackeren, 7. John PA
Clinicians Publishing Group
4 Brighton Road
Clifton, New Jersey 07012
(201) 916-1000 Fax (201) 916-0021
"Clinician Reviews" Interview with Hillary Rodham Clinton
#1:
I'm thankful for this opportunity to share some thoughts
with you -- our nation's nurse practitioners and physicians
assistants. First, let me say how grateful our nation is to all
of you for the critical role you play each day in providing
health care to our fellow citizens.
Today, we stand at a unique moment in history. In the
coming months, we have an opportunity to accomplish what our
nation has never done before -- provide health security to every
American.
To successfully reform our nation's health care system, we
must look to those who are on the front lines of health care
delivery. Physician assistants and nurse practitioners are
important contributors to affordable, quality health care in this
country. The services that PAs and NPs provide represent long
term solutions for a health care system that must be reformed if
high quality, affordable health care is to be available to each
and every American.
Because the services that PAs and NPs provide are so
important, the President is committed, through his approach to
health care reform, to ensuring that all health care providers
may work to the full extent of their professional training.
#2:
The President's proposal, the Health Security Act, does
override restrictive state laws for NPs and PAs. The Act
provides that "[n]o state may, through licensure or otherwise,
restrict the practice of any class of health professionals beyond
what is justified by the skills and training of such
professionals." Health care providers -- like PAs and NPs --
deserve the right to use their training fully, and we as a nation
cannot afford, in both human and economic terms, to forego the
quality, affordable primary care that you deliver.
We firmly believe that to achieve successful health care
reform, we must empower our NPs and PAs; we must remove
inappropriate barriers to practice and allow you to work to the
full capacity of your professional training.
#3:
The President's proposal reflects his commitment to training
our nation's physician assistants and nurse practitioners. The
Act allocates $400 million annually to support programs to train
additional numbers of primary care physicians, physician
assistants and nurses. Also from this funding source, money will
be available for other important programs: developing model
professional practice statutes for NPs and PAs, supporting
efforts to remove inappropriate barriers to practice, and
promoting the full utilization of the professional education and
clinical skills of NPs and PAs.
Additionally, under the President's proposal, $200 million
is authorized annually to both train health care workers for more
advanced positions -- such as technicians, nurses and physician
assistants -- and to support quality and workforce improvement.
#4:
Defensive medicine does both drive up health care costs and
reduce the quality of care. The President's approach to health
care reform addresses the need for medical malpractice reform in
a number of ways.
The Health Security Act establishes an alternative dispute
resolution process to resolve malpractice claims in a fair,
efficient, timely and affordable way. An individual may bring a
case to court only after participating in this process. Also
under the Act, attorneys' contingency fees are limited to one-
third of an award, and states may further limit these fees. The
President's proposal also prevents claimants from recovering
damage awards more than once for the same injury. Finally, the
Act permits damages to be paid over a period of time. These and
other proposals in the President's approach address the important
need for malpractice reform.
#5:
Our challenge in health care reform is to preserve
innovative research and high quality patient care while
controlling escalating costs. We chose not to include price
controls on pharmaceuticals in the Health Security Act for many
of the reasons that you mention. The President is committed to
preserving and strengthening the high caliber of medical research
we enjoy in our nation. Through the President's approach to
health care reform, support for research will be expanded,
emphasizing preventive research.
The Health Security Act establishes an Advisory Council on
Breakthrough Drugs. This Council will advise the Secretary of
Health and Human Services on the reasonableness of launch prices
for new drugs. The determination is based on a wide range of
factors, including prices of other drugs in the same therapeutic
class, cost information supplied by the manufacturer,
manufacturing requirements and research costs, and improvements
in quality of life offered by the new product. The Council does
not have the authority to mandate a reduction in the price of a
new drug. We believe, however, that the Council will play a
critical informational and advisory role. The Secretary of
Health and Human Services has limited authority to exclude a
newly marketed drug from Medicare coverage, if negotiations to
determine a rebate fail.
#6:
I'm happy to clarify this -- the scenario you depict simply
is not possible under the President's approach to health care
reform. In the President's proposal, regional alliances act as
purchasing cooperatives through which people will choose a
quality health plan from a range of choices. The purpose of
alliances is very simple -- to give bargaining power to small
businesses and individuals. Today, the deck is stacked against
small businesses and individuals. Small businesses are paying
35% more than big businesses for the same insurance, and
individuals pay even more. These consumer-controlled alliances
give people and small businesses more consumer clout.
As state agencies or non-profit agencies, alliances will
each have a board -- that resembles a corporate board of
directors -- made up of representatives of consumers and
employers. Alliances may not be formed by "all local doctors in
the area," as you suggest.
A group of doctors may well ban together to form a
qualifying health plan, but the regional alliance would offer
consumers in the area many plans from which to choose. All plans
offered by the alliance must meet state certification standards
and must offer all of the benefits specified in the comprehensive
benefits package outlined in the Health Security Act. It is very
important that the benefits package specifies services to be
provided, rather than categories of providers. Since health
plans compete for consumers by offering high quality care at a
reasonable price, they will have strong incentives to contract
with nurse practitioners and physician assistants to provide some
of the services in the benefits package. I believe that NPs and
PAs will play a critical role in health care delivery of the
future.
#7:
As NPs and PAs, you know better than most what works in our
current health care system, as well as what is badly broken.
Every day, you see the tireless dedication and talent of our
workforce and you witness miraculous technology literally saving
lives. At the same time, you see a health care system that is
available to too few of our citizens -- you see the millions upon
millions of Americans who are uninsured or underinsured, who do
not get the health care they need, or who receive care only when
they develop serious, often costly, illnesses. The President is
committed to changing this -- to preserving and strengthening
what is right with our system, and correcting what is wrong. We
are committed to achieving real health security -- guaranteeing
private health insurance coverage for all Americans. The support
of PAs and NPs is important if we are to achieve this critical
goal.
#8:
I'd like to underscore what is at stake with health care
reform. We all have so much to gain, because until every
American has real health security, none of us truly has it.
Through health care reform, the President is committed to
achieving guaranteed private insurance for every American, to
expanding our choice of doctors, to outlawing unfair insurance
practices, to preserving and stregthening our Medicare system,
and to ensuring that all Americans have a comprehensive package
of health benefits guaranteed to them at work. With the help of
our nation's PAs and NPs, I believe that we can and will make
this a reality.