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Ronald Reagan Presidential Library
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This is a PDF of a folder from our textual collections.
Collection: Blackwell, Morton: Files
Folder Title: Department of Health and
Human Services (2 of 6)
Box: 6
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WITHDRAWAL SHEET
Ronald Reagan Library
Collection Name BLACKWELL, MORTON: FILES
Withdrawer
RBW 3/21/2011
File Folder
DEPARTMENT OF HEALTH AND HUMAN SERVICES (2
FOIA
OF 6)
F06-0055/07
Box Number
6
POTTER, CLAIRE
10
DOC Doc Type
Document Description
No of Doc Date Restrictions
NO
Pages
Note
1
LETTER
DUKE TO MORTON BLACKWELL RE.
1
ND
B6
DEPT. OF HEALTH AND HUMAN
SERVICES
Freedom of Information Act - [5 U.S.C. 552(b)]
B-1 National security classified information [(b)(1) of the 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 FOIA]
B-4 Release would disclose trade secrets or confidential or financial information [(b)(4) of the FOIA]
B-6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA]
B-7 Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA]
B-8 Release would disclose information concerning the regulation of financial institutions [(b)(8) of the FOIA]
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.
RICHMOND TIMES DISPATCH, THURS., JUNE 21, 1982, P. A-9
AnOunce of Prevention
Saves Taxpayers Billions
By Nick Thimmesch
WASHINGTON - The American economy
annually on exercise and equipment, cor-
goes slow these days, but the health
porations and private organizations are
care business doesn't. The nation's health
increasingly active in promoting wellness.
bill will likely hit $320 billion this year. If
Some 500 businesses now spend about $2
this inflation in health-care spending isn't
billion annually on physical fitness pro-
stopped, it will reach an incredible $1 tril-
grams, and conclude they pay off. Prema-
lion by 1990.
ture deaths cost industry more than $25
The nation, and especially the taxpayer,
billion and 132 million lost workdays a
can't afford this cost-escalation madness.
year. The American Heart Association es-
Besides, there's a good argument that
timates that industry pays $700 million a
throwing billions at medical treatment
year to recruit replacements for heart at-
doesn't necessarily improve the health of
tack victims.
the citizenry.
One of the more interesting and respect-
The Reagan administration seems bound
ed wellness groups is the American Self-
and determined to check the rise in health-
Health Association, whose members pay
care costs. Now, there are two ways to
$35 a year for a continuing flow of informa-
keep a pot from boiling over: Put a lid on it,
tion about rules for healthy living, a de-
and turn the fire down.
tailed personal health profile and use of a
Self-Health toll-free number to call with
The former is called "health cost con-
questions about self-health programs.
tainment," and involves a complicated set
of deregulatory actions and incentives
Filling out the profile questionnaire in-
geared to make the health care system
volves answering rather personal ques-
more competitive. The second approach -
tions about life style and family history,
turning down the fire - is, as Secretary of
and is probably not recommended for by.
Health and Human Services Richard
pochondriacs. The idea is for the member
Schweiker puts it: "Make wellness instead
to know what illnesses his or her family is
of sickness our top priority."
susceptible to and to adopt a life style that
can forestall those illnesses.
Call it wellness, preventive medicine,
self-health or whatever, there's no question
"We're not for everybody," said Dr. Le-
that if people take care of themselves, they
roy A. Pesch, president of this self-health
won't be constantly running to the doctor
group. "Nor are we an alternative to the
br entering hospitals - an undertaking
medical system. We just feel it is better to
sometimes as expensive as buying a Jag-
enjoy the 99 percent of life you spend out-
uar.
side of hospitals or away from doctors,
than to focus on illness."
STUDIES BY THE University of Califor-
nia on 7,000 adults showed that if people
EVERY STUDY I've seen shows that the
follow seven hallowed rules for healthful
more medical service you make avail-
living, they will prolong their lives and
able to people, the more they use it -
save themselves, their employers and the
particularly if insurance or the govern-
federal government big bucks. If a 45-year-
ment pays for it. People want to eat up
old man lives up to three of the following
medical care like popcorn and probably
rules, he can expect to live to 67, but if he
become illness-minded in the process.
practices six or seven, he'll likely make 78.
Consequently, the federal bill is stagger-
The same age women can add up to seven
ing. This year, the feds will spend an esti-
years to their lives by the same measures.
mated $82 billion on health care, up 16
The rules:
percent from 1981. Medicare and Medicaid
Seven to eight hours daily sleep.
alone cost $66 billion, or 26 percent of
Regular breakfast.
Schweiker's budget. And if unchecked, will
Keep weight normal.
reach $190 billion by 1990.
Occasional snacking only.
"So it could go bankrupt by the end of the
Regular vigorous exercise.
decade," Schweiker says. "We've got to
Don't smoke.
take short-range measures to cut these
Moderate use of alcohol, if at all.
costs, and work toward a long-range reduc-
"Until recently, the health establishment
tion in medical spending through the well-
leadership wasn't very interested in the
ness program."
wellness approach," Schweiker told me.
There's a "No Smoking" sign on Schwei-
"But in the last two years, there's been a
ker's desk. And every lunch hour, he puts on
radical change in their attitude. They've
his jogging suit and runs 2½ miles on the
gone from a focus on sickness to wellness.
mall where tourists pay no attention to him
Instead of me having to crack the whip
because he is lost in an army of joggers.
over my own department, they're out
Schweiker shed 25 pounds by jogging and
abead of me.
cutting out desserts.
"We've had a consequent shift in funding,
He's also big for cutting salt from the
too - $4 billion now at the National Insti-
diet, taking more vitamins and urging peo-
tute of Health for research prizes for out-
ple to get a second opinion when a doctor
standing students in this field, and we're
recommends surgery.
trying to motivate people through adver-
I've never seen Schweiker looking
tising."
better.
Besides the $30 billion Americans spend
© 1982, Los Angeles Times Syndicate
American
Self-Health
Association
President's Luncheon
July 28, 1982
American Self-Health Association
Morton Blackwell
Special Assistant to the President
Old Executive Office Building
Washington, DC
ASHA
James P. Low, CAE
President
Low & McManis, LTD
LeRoy A. Pesch, M.D.
1201 Connecticut Avenue, NW
President
Suite 300
Washington, DC 20036
Carol B. Benjamin
Managing Director
James M. MacLeod
Director of Public Relations
American Red Cross
National Capitol Division
2025 E Street, NW
Washington, DC 20006
Hugh McCahey
Manager, Association Division
Chamber of Commerce of the U.S.
1615 H Street, NW
Washington, DC 20062
Michael McGinnis, M.D.
Deputy Assistant Secretary for Health
Health and Human Services
200 Independance Avenue, SW
719-H
Washington, DC 20201
Jan Peter Ozga
Director of Health Care
Human Recources & Employee Benefits Sec.
Chamber of Commerce of the U.S.
1615 H Street, NW
Washington, DC 20036
1420 16th Street, NW
Washington, DC 20036
202/328-4155
President's Luncheon
Page 2
Burt Pines
Vice President of Research
Heritage Foundation
513 C Street, NE
Washington, DC 20002
David Sundwall, M.D.
Physician Advisor
Senate Labor & Human Resources Committee
Dirksen Senate Office Building
Room 4232
Washington, DC 20510
William Tobin
Vice President
National Tax Limitation Committee
1523 L Street, NW
Washington, DC 20036
Ralph de Toledano
Syndicated Columnist
Copley News Service
Room 398
National Press Building
Washington, DC 20045
ASHA NEWS
BIOGRAPHY OF LEROY A. PESCH, M.D.
LeRoy A. Pesch, M.D., is one of America's leading experts in health care.
With experience as physician, hospital director, university professor, and
private medical consultant, Dr. Pesch has a singularly informed perspective
on all phases of health care in America. After 25 years of thoroughly
researching all aspects of medicine, Dr. Pesch in 1981 founded the American
Self-Health Association, of which he is President.
Dr. Pesch has taught at such distinguished universities as Yale, Stanford,
the University of Chicago, and the University of Illinois. He has authored
more than 45 scientific papers, with particular emphasis on nutrition, and
has been a keynote speaker at some 20 seminars and symposia on health care
problems and organizations. His medical degree was awarded cum laude from
Washington University, and he was elected to the national physicians' honor
society, Alpha Omega Alpha.
His professional appointments match his outstanding academic appointments:
After completing post-graduate training at the National Institutes of Health
in Washington, DC, he began his career at the Yale-affiliated Grace-New
Haven Hospital. He was Physician-in-Chief for the Rutgers Medical Service
within two years, then Dean and Director of University Hospitals and
Professor of Medicine at SUNY-Buffalo.
From Buffalo, Dr. Pesch moved to California, where he was Associate
Physician for the Stanford University Medical Center and Attending Physician
at the U.S. Veterans' Administration Hospital in Palo Alto.
For four years, Dr. Pesch served as President, Chief Executive Officer, and
member of the Board of Trustees of the prestigious Michael Reese Hospital
and Medical Center in Chicago. At the same time, Dr. Pesch established one
of the first Health Maintenance Organizations (HMOs) in Chicago, KMB Health
Systems of Illinois.
In 1976, Dr. Pesch founded L. A. Pesch Associates, Inc., a medical con-
sulting firm which provides planning, organizational, financial, and manage-
ment consulting services to organizations, government agencies, and human
service institutions.
As consultant to the Office of the Executive Vice President of the Univer-
sity of California at Irvine, Dr. Pesch implemented a multi-phase process to
integrate the functions of the UCI Medical Center with the main university
campus. Dr. Pesch has also served as a Special Consultant for Manpower to
the Secretary of Health, Education and Welfare in Washington, DC.
American Self-Health Association
1420 16th Street, NW
Washington, DC 20036
(202) 328-4155
Biography of LeRoy A. Pesch, M.D.
Page 2
A member of such respected professional societies and organizations as the
American Association for the Advancement of Science, the American Federation
for Clinical Research, and Sigma Xi, the national science honor society,
Dr. Pesch stresses that reform, not revolution, is what our nation's health
care system needs.
Dr. Pesch feels that all Americans can and must draw upon the fundamental
strengths of our society and its professions --both in the private and
public sectors -- to build a better health care system. The key to good
health, he declares, is not preventing illness but maintaining wellness.
The American Self-Health Association is the consummation of Dr. Pesch's 25
years of distinguished scholarship and practical experience in health care.
ASHA encourages the basic concept of wellness through self-health in all its
members and cooperating health care professionals and organizations.
ASHA NEWS
BIOGRAPHY OF CAROL B. BENJAMIN
MANAGING DIRECTOR
AMERICAN SELF-HEALTH ASSOCIATION, INC.
Carol B. Benjamin, Managing Director of the American Self-Health
Association, brings to the position almost a decade's experience working in
Washington-area associations. A native of Williamsburg, Virginia, Ms.
Benjamin is the first Managing Director of ASHA, having come from a variety of
positions which span the health care field and the administration of mem-
bership associations.
As Director of Membership and Computer Services of the American Society
of Association Executives for four years, Ms. Benjamin began and administered
the Society's first separate membership department, implementing programs to
increase new membership and retain more of the existing members. She deliv-
ered over 80 presentations on association management subjects, planned and
taught membership education courses, and developed a home study course for
association membership staffs.
Before joining ASAE, Ms. Benjamin served as Associate Director and
Education Director of the American Society of Consultant Pharmacists, in which
capacity she planned and directed education, meetings, publication, committee
and chapter liaison, and public relations. As the number two executive in the
association, Ms. Benjamin managed the Society's annual meetings, planned the
yearly program of activities, and developed the first state chapter manual for
the Society.
While at the American Society of Consultant Pharmacists, Ms. Benjamin
published "The Consultant Pharmacist: An Untapped Resource" in The Journal
of Long-Term Care Administration.
As Professional Liaison Specialist and Researcher for the American Health
Care Association, Ms. Benjamin conducted research and prepared background
papers on subjects pertaining to long-term health care. Responsible for main-
taining liaison with allied health, professional, and consumer organizations,
Ms. Benjamin is thoroughly knowledgeable in the practical applications as
well as the theoretical foundation of the American health care system.
A member of the Greater Washington Society of Association Executives, the
National Council of Career Women, the American Management Associations, and
the American Society of Association Executives, Ms. Benjamin was graduated
from Radford College, Radford, VA, in 1973 with a Bachelor's degree in
sociology. She is currently engaged in graduate studies.
American Self-Health Association
1420 16th Street, NW
Washington, DC 20036
(202) 328-4155
American Self-Health Association
WORKING THINGS OUT:
BRIDGING THE GAP BETWEEN HEALTH CARE
CONSUMERS AND PROVIDERS
Dr. LeRoy A. Pesch, President ASHA
Welcome to the American Self-
As consumers of health care,
Health Association. We are a unique
you want to have an active decision-
association of consumers of health
making role in not only the cost
care. We want to participate and
but the quality of health care. It
have a say in the process of total
is our task, through articles in the
wellness. We believe in the trad-
newsletter, to lend self-confidence
itional administration of medicine.
and persuasive commentary to you
We're not replacing the medical
when taking a position on health
logue to active, not passive, par-
care profession, but showing you a
issues. For the issues that directly
ticipation in choosing your best
better way of using the system in
affect you - health care finances,
wellness lifestyle.
relationship to your well-being.
allocation of health resources,
Each article in Self-Health will
We want you and your physician
health insurance and benefits cover-
explore areas of interest to you in
to have a new way of working
age - are issues from which con-
your changing, wellness focus. For
things out. There is a better way
sumers have been excluded in the
many of us, controlling modern day
to do it, and we're here to show
past.
stress, featured in this first issue,
you how to achieve it.
It is our task to open the dia-
Continued on page 3
WHAT'S so GREAT ABOUT BEING HEALTHY?
INSIDE S-H
How are you today? Feeling
could feel great, energetic, better
Jacques d'Amboise
.p.2
good? Or just O.K.? Well, you
than you've ever felt before - with
Stress: Don't be taken
.p. 2
a little work, that is.
Wellness Movement
.p. 3
It all depends on just how good
Spring Sniffles
.p. 3
you want to feel. And, how much
Values, rhetoric
.p. 3
effort you put into feeling better.
The YMCA revisited
.p. 4
It's no secret that healthy people
ASHA Notes
.p. 4
are more fun to be around. They
What's coming up
.p. 4
seem to have boundless energy and
enthusiasm for their jobs, their
all, a result of illness.
families, their friends. They seem to
To top it all off, healthy people
have time to pursue everything -
live longer.
sports, entertainment, cultural in-
And, in a country where more
terests, and a variety of other
than $200 billion was spent on
activities.
health care in 1979, less than one
Healthy people have lower health
percent of that amount was spent
care costs. They lead active lives,
to prevent illness.
and they don't get sick very often;
Even people who are feeling
and most health care costs are, after
Continued on page 3
SPOTLIGHT: JACQUES D'AMBOISE
Philosophers say that dance
The children he teaches are often
is a celebration of life. Jacques
from poor neighborhoods, like the
d'Amboise, as a dancer, choreo-
one he grew up in, and are of every
grapher, and now teachers, is a
race and ethnic background.
study in the expression - "joie de
His intense desire to teach
vivre."
children is motivated in large part
During his brilliant 20-year
by his close family life with his wife,
career with the New York City
Carolyn, and their four children.
Ballet, he danced leading roles in
works of George Balanchine, Jerome
We welcome Jacques d'Amboise
as a member of the National
Robbins and Martha Graham. He
also created several ballets, includ-
Advisory Board of the American
Self-Health Association.
ing The Chase and Quatuor, which
are also danced by the company.
After years of stardom with the
Each month we will spotlight
New York City Ballet, d'Amboise
children to dance. He teaches
one of the members of ASHA's
now concentrates on introducing
police officers, nuns, and children.
National Advisory Board.
DON'T LET STRESS TAKE YOU FOR A RIDE
For better or worse, stress of
wee PALS MORRIE TURNER
varying degree and duration is an
I'M GOING TO FIX
I'M GOING TOLET YOU
WHAT IS YOUR
JELLYBEANS!
DINNER NOW, MIKKI
PICK OUT THE
FAVORITE VEGETABLE ?
undeniable fact of life.
VEGETABLE!
Handled badly, we know stress
GREAT,
MOM!
can make us sick-very sick. Every-
thing from the common cold to
I
cancer may have its roots in stress
mismanagement.
4-19
Harold Rosenberg, M.D., co-
author of The Doctor's Book of
Wee Pals by Morrie Turner ©Field Enterprises Inc., 1982. Courtesy of Field News Syndicate.
Vitamin Therapy, is involved in
teaching business people how to
avoid "falling apart, getting tired
ness is first. "I tell patients to look
The real danger, of course, is
and uptight and underachieving in
for more natural substances, plenty
when you don't choose to be in the
a fast-paced world."
of vegetables, the right starches, and
thick of things and you're feeling
I help them get the most mile-
protein from fish and fowl-espec-
totally out of control.
age out of themselves." Food aware-
ially fish."
Then it's worth remembering the
He also suggests a program of
components of the "hardy" person-
supplements: "At least 500 milli-
ality. According to Suzanne C.
grams of vitamin C a day is essen-
Kobasa, Ph.D., a University of
ealth
tial." The B complex also disappears
Chicago psychologist who has ex-
under stress, and since many of its
amined the characteristics of stress-
members play a vital role in the
resistant people, those components
mobilization of proteins and the
are "control, commitment and
Publisher and Executive Editor: Carol B. Benjamin
smooth functioning of the nervous
openness to change."
Managing Editor: Eileen M. Hooker
system, supplementation here is
Put them together and you can
Circulation Manager: Nancy Granfors
particularly important.
be an expert in "transformational
Self-Health is published monthly by the
Exercise, as well, is valuable.
coping," the fine art of turning
American Self-Health Association, 1420 16th Street,
"Regular aerobic athletic endeavors
anxiety into opportunity.
NW, Washington, D.C. 20036,
(202) 328-4155
should be as much a part of life as
Special thanks to Yvonne Forsbergh, Mark
making a sale or putting a magazine
Excerpted by permission
Golberg, and Amy Schultz.
to bed," he says.
of Prevention Magazine
RAGWEED AND SNIFFLES -- POLLEN COUNTDOWN
"SELF-HEALTH QUOTE"
The scent of magnolia is in the
Try keeping your shoes Europ-
"The doctor of the future will
air. Bees buzz, birds chirp, and
ean style in the vestibule or some
often give no medicine but will in-
AAACHOO! You're sneezing and
other airy place in the house, ex-
terest his patients in the care of the
wheezing
again. It's that time of
cept for the bedroom.
human frame, in diet, and in the
year.
If you plan a vacation to get
cause and prevention of disease."
I recall, as a newlywed, picking
away from all that pollen a'poppin,
-Thomas A. Edison
flowers for my husband from out-
don't go North, Dr. Wolf advises.
side our first home. I proudly pre-
"The season at Cape Cod is about
BRIDGING THE GAP (from page 1)
sented him with, only to watch him
two weeks behind ours, and you
recoil from, a great big bouquet of
is a beginning step. Self-assessment
may just be adding two weeks to
ragweed
Yes, I've learned, and
of health records, the quality of
your misery."
according to Dr. Stanley Wolf who
insurance benefits coverage, and
runs The Allergy Center in Silver
Maybe there was something to
prevention programs will be ex-
Spring, Maryland, there are some
the saying, "Go West Young Man."
amined in depth in later news-
helpful tips out there to lessen the
letters. Interviews with leading
wellness and health luminaries
sniffles this season:
and the introduction of ASHA's
if you're a jogger or like a nice
Advisory Board will spotlight na-
stroll after dinner, it's a good idea
tional trends in our changing
to do either one at lunchtime or
health and wellness world.
before it gets cooler in the p.m.
Overall, our aim is to help ASHA
More pollen accumulates early in
members build a wellness-oriented
the morning or in the evening when
life and maximize the opportunities
the air gets nippier.
of the American health care system.
Try washing your hair (use your
We're in the business of wellness,
favorite herbal variety shampoo) at
not illness or the treatment of
night so the pollen doesn't get on
disease. The health care system re-
your pillow. Ask your partner to
sponds when you are ill; ASHA
do likewise.
offers to change your life. ASHA
will address positively, through
education and information, the
LET'S CELEBRATE WELLNESS
dimensions and structure of a well-
ness lifestyle.
Seems that wellness is contagious;
in southwest Virginia is expanding
Such a lifestyle, however, will
like spring, it's cropping up all over.
their department of nursing to a
demand that each of us assume
In San Francisco, wellness has re-
School of Nursing. They are tap-
personal responsibility to preserve
ceived the official blessing of
ping outstanding executives in the
and enhance our well-being. Be-
Governor Edmund G. Brown, Jr.
field of health care, and Ms. Benja-
coming a member of the American
Brown has set up a wellness com-
min is on the VIP list. We'll report
Self-Health Association is just such
mission with a $100,000 budget
the outcome of the Radford-Wash-
a commitment. With your parti-
and a staff of two. Their mission:
ington experience in the July issue.
cipation, a self-health environment
explore ways of promoting the
will emerge wherein knowledgable
"five components of wellness."
people concerned about their life
According to one commission staff
potential will responsibly use the
member, the five components are:
RHETORIC AND VALUES
American health care system to the
physical fitness, stress management,
fullest, at the lowest cost.
environmental sensitivity, nutri-
According to a recent survey
We're here. We can help you
tional awareness, and personal re-
conducted by the NRC, of what
create a new, self-health lifestyle.
sponsibility - all areas wellness
Americans value in life, there are
Use us!
buffs know inside and out
10 things people really care about.
Wellness has entered the poster
First on the list is health, followed
WHAT'S so GREAT (from page 1)
business. In fact, see our insert in
by financial security and then a
reasonably well often take their
this issue.
closer relationship to God.
health for granted, not really doing
And to top it all off, our Manag-
Pretty interesting, yes? If you
anything to improve and protect
ing Director, Carol B. Benjamin's
want more information, contact
it. Don't take your life for granted.
fame has blossomed outside of
Self-Health Central for a detailed
It only takes a little effort on your
Washington, D.C. Radford College
report on this survey.
part to do a lot for yourself.
ASHA
A NEW LOOK AT
HOME HEALTH DATA BASE
AN OLD FRIEND:
HEALTH-TEX™
THE YMCA
This July, the American Self-
Teri Domanski, head of the
Health Association will offer Health-
YMCA's Corporate Fitness Program
TexT.M; an in-home health computer
in Washington, D.C., met with
data base through the CompuServe
ASHA staff recently to speak about
Information Service.
the Y's full fitness center and well-
43
Health TexT.M. lets you maintain
ness programs developed to pro-
your own medical record and
vide "Employee Health and Fit-
family history as well as the latest
ness."
health news, and an extensive drug
"You know," Teri explained,
index. In addition, there will be
"the YMCA was the first specialist
health games: "healthy habits"
on the block for physical fitness. In
games for the children and cumu-
fact, in the old days, our members
lative health hazard appraisal tests
met to play basketball at the corner
for everyone.
playground. They used a peach
To enjoy Health-TexT.M., all you
fruit basket to play ball with; it
need is access to the simplest home
was only when a newcomer had the
computer and a "modem" tele-
bright idea to take the bottom out
phone hookup for your terminal.
of the fruit basket that they were
able to play basketball without
having to retrieve the ball every
time they scored a point."
greater energy to enjoy leisure time;
The bottom line, according to
decreased risk of heart attack; loss
the YMCA, is the health needs of
of weight; drop in blood pressure;
each organization. The successful
look and feel better; be more re-
organization not only meets the
laxed less tense; handle stress
needs of its employees by providing
better; increased efficiency; in-
medical insurance to cover illness,
creased productivity; increased em-
but offers health assurance through
ployee morale; decreased employee
employee fitness and health. The
absenteeism; decreased employee
Y's emphasis on wellness through
turnover; increased enjoyment of
physical fitness programs leads to
life.
If you have neither, both can be
healthier employees. Some of the
To learn more about the YMCA's
had for less than $400 from RCA,
ways employees and employers
health and fitness programs, get in
Tandy, or Commodore computer
benefit from these programs are:
touch with us and we'll pass the
manufacturers. CompuServe mem-
improved cardiovascular function;
word along to Ms. Domanski.
bers who are also ASHA members
will be permitted free access to
Health-TexT.M. For more details on
COMING ATTRACTIONS
subscriptions to CompuServe and
Health-TexT.M., please call Compu-
JULY 1982 ISSUE
Serve at 1-800-848-9990 or the
ASHA Self-Health Central at 1-800-
****
424-2462.
Sun-rays and Sun-bathers
...
tips for the beach
SALE
ASHA
****
The NEW STAY-WELL CENTERS
SEE OUR INSERT for the new-
****
est offering - 4 colorful health
posters designed for office or
© 1982
and much more!!!
home.
American Self-Health Association
All rights reserved
ASHA
POSTERS
COLORFUL, INFORMATIVE POSTERS will brighten up your kitchen, office,
or classroom. These handy guides to nutrition and exercise go anywhere, so
you can always have self-health at hand.
NEW AMERICAN
NEW GUIDE EATING
NUTRITION
EATING GUIDE
SCOREBOARD
Is that lunchmeat full of
Perfect for the refrigerator,
balogna? This eye-catching
the "Nutrition Scoreboard"
poster gives the bottom line
ranks the relative nutritional
on dozens of common foods,
values of over 200 foods.
slating them for "Anytime."
Foods get points for their
"In Moderation," or "Now
nutrient content and lose
and Then" eating. Especially
points for added sugar or
designed for people who are
sodium.
likely to be consuming too
much fat, sugar, and salt.
CHEMICAL
EXER-GUIDE
CUISINE
EXER-GUIDE
Dozens of activities, from
Dozens of colorings, perserv-
CHEMICAL CUISINE
watching television to playing
atives, emulsifiers, and other
ice hockey or reading are
additives are described on this
categorized by per-hour
poster. Safe additives are
calorie expenditure. Illustrations
printed in green, those to
are by famed New Yorker
avoid in blue, and "caution"
cartoonist Ed Koren.
additives in yellow. "Chemical
Cuisine" identifies the
function of each additive,
which processed food contains
it, and why it is dangerous
or safe.
Check appropriate boxes: Number ordered
New American Eating Guide
Name:
Chemical Cuisine
Address:
Nutrition Scoreboard
City/State:
Zip:
Exer-Guide
Return this order blank with payment to: American Self-Health Assn., 1420 16th Street, N.W., Washington, D.C. 20036
Enclose $3.50 for each poster ordered.
American Self-Health Association
ealth
JULY, 1982
VOLUME ONE, ISSUE TWO
The Link Between
Health Care Costs - What Will Re-Slice the Pie?
Cancer and Nutrition
There is strong and loud argu-
What are the characteristics that
by Yvonne Forsbergh
ment for looking once again at tra-
favor traditional regulation? These
Despite sometimes confusing ad-
ditional methods of government
are: market failures or imperfec-
vice from the medical field, diet
regulation when applied to medical
tions such as anticompetitive behav-
doctors, and health food propo-
care. Considerable agreement exists
ior; a belief that there is a crisis
nents - we have generally gotten
that the present approach to reg-
in the industry; inadequate infor-
the same message: consume less
ulating health care providers devel-
mation; and a concern for equal
fat, salt, and alcohol and more
oped without a clear understanding
distribution of goods and services.
fruits, vegetables, and whole-grain
of the problems inherent in the
These characteristics have tradi-
cereals. According to the National
health care industry. However,
tionally prompted government
Research Council committee of the
there was a clear sense that "some-
interference into private economic
National Academy of Sciences,
thing" had to be done to contain
transactions.
medical costs.
(Continued on Page 5)
that's more than just sound nutri-
tion. There is increasing evidence
CHART 1
"The present approach to
suggesting a direct link between
Breakdown of National Health
cancer and diet.
health care providers devel-
Expenditures as percentages of the total
After a two-year study compiling
oped without a clear under-
$274.8 billion spent in fiscal year 1981.
the research of scientists across the
standing of the problems
country, the committee has an-
inherent in the health care
PERSONAL
EXPENDITURES.
nounced these "interim" guidelines
to reduce the risks of cancer:
industry."
Limit foods high in saturated
Growth in expenditures, prices,
seojurs %61
and unsaturated fats.
and federal budget commitments to
Eat daily: fruits, vegetables,
health care raised political anxiety
Drugs
7.6%
whole grains, those which contain
and led to legislation for traditional
Hospital Care
high amounts of vitamin C, and
40.8%
forms of regulation in health
Nursing 8.4% Home Care
Card
carotene which converts to vita-
service delivery. Programs were
min A.
introduced such as: PSRO's (case-
2.17%
(Continued on Page 3)
by-case medical record review by a
PURO
INSIDE S-H
committee deciding on "appropriate
practices"); CON's (certificate of
Carol B. Benjamin
p.2
needs); committees of local federal-
Sunbums
p.2
ly funded health planning agencies;
ASHA Hosts Luncheon
p.3
and second-opinion programs. All
Source:
National Health Statistics
New Stay Well Centers
p.3
of the programs tended to have
Health and Human Services,
What's Coming Up
p.5
little impact on streamlining the
Washington, D.C.
Did You Know?
continuing rise in health care costs,
p.6
Reference: Health Care Finance and
according to numerous sources.
Trends, March, 1982.
Page 2
SPOTLIGHT:
plished public speaker, she has de-
livered over 80 presentations on
Carol B. Benjamin
association management subjects,
When you meet her, you're im-
planned and taught membership
education courses, and designed a
mediately struck by her vibrancy.
correspondence course for other
When you find out she heads one
association membership depart-
of the hottest new associations
ments.
in Washington, D.C., you're not
Prior to her move to ASAE, Ms.
surprised.
Benjamin served as Associate Dir-
foundations of the American health
Meet Carol B. Benjamin - Man-
ector for the American Society of
care system.
aging Director of the American Self-
Consultant Pharmacists. In this
A dedicated professional, Ms.
Health Association. Ms. Benjamin
capacity, she planned and directed
Benjamin is committed to promot-
brings to the position almost a
a variety of meetings, publications,
ing upward mobility of women in
decade's experience working for
committee and chapter liaisons,
the work place. A member of the
professional, Washington-based as-
public relations, and pharmacist
Greater Washington Society of
sociations spanning the health care
education. She is author of "The
Association Executives, American
field and the administration of
Consultant Pharmacist: An Un-
Society of Association Executives,
membership associations.
tapped Resource," which appeared
and the National Council of Career
As Director of Membership and
in The Journal of Long-Term Care
Women, she is often called upon to
Computer Services for the Ameri-
Administration.
chair business and civic events.
can Society of Association Execu-
While at the American Health
A lover of schnauzer dogs and
tives, she administered the Society's
Care Association as Professional
sailing, her open briefcase reveals
first separate membership depart-
Liaison Specialist and Researcher,
three books: Current Approaches
ment, and brought in innovative
Ms. Benjamin conducted research
to the Economics of Health Care;
programs which increased new
on subjects pertaining to long-term
Intermediate Sailing; and Good
membership and retained more of
health care. She is thoroughly
Dog - Bad Dog. That selection_
the existing members. An accom-
knowledgeable in the practical ap-
says a great deal about Carol B.
SUNBUMS
plications as well as the theoretical
Benjamin.
by Amy Schultz
On June 21st, summer began
most skin problems: dry skin, oily
way. The key to summertime
officially. As is typical of this
skin, sensitive skin.
safety is moderation and protec-
sunny season, people are stalking
Whatever the fashion industry
tion.
the perfect tan. Bronzed bodies are
dictates, tanned skin is not as
If you're going to be exposed to
the feature of advertisements for
healthy as protected skin. Also,
those golden rays, even for a few
everything from diet drinks to new
since the effects of sun exposure
minutes, apply a sunscreen --- the
cars.
are cumulative, you can suffer
higher the SPF (Sun Protection
But don't be fooled. A tanned
permanent damage after just a few
Factor) number, the better your
body is not necessarily a healthy
years of sun abuse.
protection.
body; tanning is the result of injury
The damage may be as mild as
People with fair skin who burn
to the skin.
dry skin, wrinkles, or age spots, or
easily and don't tan should use
Some facts: All tanning speeds
as severe as cancer. Melanoma, a.
products with SPF 15. If you tan
the effects of aging on your skin.
easily, you can get away with less
Exposure to the sun will aggravate
protection, an SPF between 6-8.
"SELF-HEALTH QUOTE"
The more sensitive your skin,
Look to your health - and if
the less time you should spend in
you have it, value it next to a good
the sun at one sitting. It's helpful
conscience; for health is the second
to apply moisturizers to your
blessing that we mortals are capable
skin as well, especially after you've
of; a blessing that money cannot
been outside - sun is a major cause
buy.
of dry skin, and those beach-side
Izaak Walton
breezes, and salt or chlorinated
The Compleat Angler (1653)
water, exacerbate the problem.
Sunscreens won't keep you from
tanning, though they do slow down
form of skin cancer, is life-threat-
the process. If used carefully, they'll
ening. Other skin cancers are more
keep you from burning and sharply
superficial and usually curable.
reduce the sun's damage to your
It isn't as grim as it seems. A
birthday suit. And after all, it's the
little common sense goes a long
only one you'll ever have.
Page 3
ASHA Introduction
The audience responded with en-
The New Stay Well
thusiasm to Dr. Pesch's remarks,
Luncheon
.the time has come for the
Centers
June 9, 1982, the American Self-
American consumer to recognize
his role in bringing down the cost
Imagine, once sedentary Ameri-
Health Association held its first in
a series of luncheons designed to
of health care and determining his
cans up and running, swimming,
introduce the association and the
own self-health."
and engaging in other aerobic exer-
cises - during lunch-hours, after
president, Dr. LeRoy Pesch, to
work, and all in the name of the
members of the Washington busi-
company they work for.
ness, civic, government, and as-
Businesses, in growing numbers,
sociation community. The Presi-
are more than ever aware of the
dent's Luncheon drew such dis-
link between exercise and pro-
tinguished leaders as White House
ductivity. Thus, many companies
luminaries and members of the
have begun wellness centers in
Washington Press Corps. Dr.
their organizations.
Pesch spoke at length after a
Over 500 businesses already have
"metametrix" maintenance lunch-
physical fitness programs, including
eon, a nutritionally controlled pro-
such well known names as: Bonne
gram developed by Dr. Pesch. He
Bell, Chase Manhattan Bank, Exxon,
then spoke of the commitment
Firestone, General Foods, IBM, and
ASHA has for the reform of the
Xerox.
health care system, and explained
Of those companies with fitness
ASHA's mission.
A syndicated columnist in attend-
first ideas, wellness is manifested
ance has written an article on the
with coffee carts heavy with fruit,
private sector's response to the es-
vending machines that dispense
calation of prices in the health care
yogurt as well as cola, cafeteria
industry, and drew heavily on
menus that show the number of
ASHA's contributions thus far.
calories in each item, and scales in
Dorothy Maney Tella, economist
some rest rooms.
and consultant, questioning Dr.
To encourage desk-bound work-
Pesch after his presentation, went
ers to attend its wellness center,
on to say that "ASHA is the most
one company in Nashville, Tennessee,
exciting and innovative plan for the
pays each employee six cents for
health care system to emerge in
each mile they bike, twenty-four
years."
cents for each mile they walk or
run, and ninety-six cents for each
mile they swim.
CANCER AND NUTRITION (Cont. Page 1)
Who says keeping fit doesn't pay
Eat "very little" salt-cured, salt-
cers. Compounds such as nitrites
off?
pickled, or smoked foods.
and certain hydrocarbons found in
these foods cause cancer in labora-
Drink alcohol in moderation.
tory animals and are suspected of
Laboratory scientists and epi-
causing cancer in humans. The foods
demiologists concur that there is a
in this category include ham, bacon,
relationship between eating more
sausages, and smoked fish, although
fats and cancers of the breast,
there is inconclusive data that char-
large bowel, and prostate. There
coaled foods contribute to the OC-
seems to be no difference in the
currence of cancer.
risks posed by saturated fats and
Moderate alcohol consumption
unsaturated fats, unlike cardiovas-
is stressed, "especially in combina-
cular disease; there also is no evi-
tion with cigarette smoking." The
dence to connect cholesterol and
likelihood of cancers of the mouth,
cancer. The committee suggests
larynx, esophagus, and colon seem
that both saturated and unsaturated
to be compounded. Alcohol "in
fats, whole milk dairy products,
moderation" is not explained in
and fatty meats should be restricted.
this report, but is usually considered
© 1982
Salt cured, salt - pickled, and
to be not more than two drinks per
American Self-Health Association
smoked foods have been associated
day.
All rights reserved
with esophageal and stomach can-
(Continued on Page 5)
AMERICAN SELF
HEALTH ASSOCIATION
MEMBERS CANNOW
TAKE OFF,TOO.
You can take dollars off daily Rates* every time you
help our customers stay fit while they're on the road
rent a car for business of pleasure, because Hertz now
with us. We've arranged with selected private sports
offers a discount to members of your association.
clubs to provide free admission to Hertz renters. You
We've given your association the ID number printed
can bring a guest or arrange for a playing partner. To
below to be used with your membership card or Hertz
take advantage of this offer simply present your Hertz
discount card next time you rent a car. Just show your
rental agreement at the participating club. Ask for
card, and mention the ID number, at any participating
information at the Hertz counter when you pick up
Hertz location and your discount will be subtracted
your car.
from your rental charges.
For further information, contact your association
Also, we at Hertz believe that business people stay
headquarters. For reservations, see your travel
ahead by keeping fit. So, we designed a program to
consultant or call Hertz at 1-800-654-3131.
HERE ARE YOUR DISCOUNTS:
#1 For Everyone.™
AMERICAN SELF HEALTH ASSOCIATION
Hertz rents Fords and other
fine cars.
CDP I.D. #94075
UNITED STATES
5% discount on published daily, weekly and monthly
"Standard Unlimited Mileage" ("SUM") Rates or, in
Hertz
the event "SUM" Rates are not available, a 35%
discount on Basic Rates may apply.
®
INTERNATIONAL
20% discount in Japan.
15% discount on published "Basic" Rates in Canada, except
that Class A cars are non-discountable.
10% discount in Western Europe, Israel, Africa, the Middle
East, Asia, the Pacific, Latin America and the Caribbean.
5% discount in Eastern Europe and Iceland.
*Discounts do not apply to "Touring Rates," including "Economy Fares." and certain other
non discountable rates as described in the Hertz Worldwide Directory from time to time. All
rates exclude gas and tax and are subject to change.
Page 5
HEALTH CARE COSTS (Cont. Page 1)
Medical care is comprised of a
(This is the first in a series of four articles
These economic conditions are
complex array of goods and
that will explore some of the main prob-
not seen in the health care industry,
services that are difficult to
lems and solutions facing the health care
and would therefore suggest that a
standardize.
industry today. We'd like to express our
"mismatch" has been made between
thanks to the American Enterprise Insti-
the medical care system and direct
tute, which held a conference on health
government intervention via reg-
care late last year and has since published
ulation.
excerpts from those distinguished econo-
The conditions conducive to
mists, academicians, and government of-
regulation are: natural monopoly;
ficals in attendance. The book A New
the industry produces one or a few
Approach to the Economics of Health
Care is edited by Mancur Olson. In this
homogenous products; where in-
first series we will excerpt from Richard
centives, rewards or penalties have
Zeckhauser's and Christopher Zook's,
little effect on behavior; where the
Failure to Control Health Costs: Depar-
problem centers around a few poor
tures from First Principles.)
performances; and where there is a
single, measurable objective. In
sum, none of the above criteria are
"If I'd known / was going to live this long
elements of the health care sector
I'd have taken better care of myself."
as a few of the following examples
show:
Where will this take us? With reg-
With 7,000 hospitals and
ulations impinging on the health
380,000 physicians, the indus-
care industry and the components
Publisher and Executive Editor: Carol B. Benjamin
try is far from being a natural
so mismatched, what solutions are
Managing Editor: Eileen M. Hooker
monopoly.
possible to influence the industry
Circulation Manager: Nancy Granfors
The problem is pervasive, not
and promote competition? The
confined to a few extremely
next issue will discuss the historical
Self-Health is published monthly by the
American Self-Health Association, 1420 16th Street,
poor performers.
and actual cost of health care.
NW, Washington, D.C. 20036,
(202) 328-4155
COMING ATTRACTIONS
AUGUST 1982 ISSUE
CANCER AND NUTRITION (Cont. Page 3)
The foods that seem to have
not fully understood, it is recom-
preventive qualities are those con-
mended that fruits such as citrus,
taining large amounts of vitamin C,
dark-green leafy vegetables, carrots,
What Price Health Care?
vitamin A in the form of carotene,
winter squash, tomatoes, and vege-
and some other "non-nutritive
tables in the cabbage family, includ-
(Second in a
compounds." In laboratory tests
ing broccoli, brussels sprouts, and
these have actually inhibited tumor
cauliflower, be eaten instead of
Continuing Series)
growth and formation. Since the
taking high dose vitamin supple-
mechanism and relationship of these
ments.
naturally-occurring compounds are
The overall view of the commit-
tee is that most cancers are prevent-
able. Diet and habit influence the
probability of cancer more than
any other factors. There is still
WELLONT
much to be learned about the re-
Before You Salt
lationship between certain foods
and cancer. Even then, the com-
that Corn on the Cob
SEE OUR INSERT for the newest
mittee stresses, following such a
offering handsome savings on
diet will not ensure a person that
he or she will lead a cancer-free life.
Some Salty Facts !!!
Hertz Rent a Cars in the United
States, worldwide, and health fit-
But it is about the simplest advice
ness Centers.
on cancer prevention we've heard
so far.
Page 6
Did You Know?
That intuition plays a major
have to train their personnel to
It's that time of year again when
part in corporate executives' de-
send heart attack patients to the
certain plants, flowers, spices, and
cisions? That when asked how cost
hospitals where cardiologists are on-
vegetables, when ingested, are harm-
analysis, market surveys, and finan-
call to administer this important
ful or fatal; and that goes for pets
cial statements measure against
new treatment.
too. Here are a few samples of
intuition, executives will still decide
what to avoid consuming or even
to go by "a feeling in my bones."
During the height of infestation,
nibbling - daffodils, lily of the val-
An intuitive conclusion seems to be
gypsy moths are everywhere -
ley, azalea, wild mushrooms, fools
what psychologists term selective
houses, cars, lawn furniture, trees
parsley (poison hemlock), the pits
perception. It is not a hunch or an
and shrubs. But don't brush those
or seeds of plums, peaches, apples,
impulsive act, says one CEO, but
fuzzy caterpillars off with your
apricots, pears, and raw tapioca,
rather a feeling that persists "and
hand - you could be sorry.
"greened" potatoes (and sprouted
gnaws and gnaws and gnaws at
Devouring your trees and shrubs
eyes) and raw green tomatoes, to
you," or as Albert Einstein once
isn't the only adversity attributed
name only a few. Over 700 species
said, "that flash of insight we know
to gypsy moths. Some people ex-
of plants grow in the United States
as intuition."
perience allergic reactions to the cat-
that have been identified as danger-
erpillar hairs ranging from a local-
ous ifconsumed. Plants that blossom
A new treatment called strep-
ized skin rash, caused by direct
indoors, (such as the evergreen yet)
tokinase, administered best 0 6
contact, to welts and swollen eyelids.
are sometimes poisonous. If you
hours after the onset of a heart
The best protection is to keep
know or suspect someone has eaten
attack, appears capable of stopping
the skin covered in moth-infested
a poisonous plant, call the nearest
heart attacks while they are under-
areas. If you do develop a rash, Cala-
poison control center and your
way.
mine lotion and over-the-counter
physician.
The National Institutes of Health
hydrocortisone ointments often
recently awarded a $3.1 million
give temporary relief. A dermatol-
grant to specific hospitals who will
ogist can prescribe a more effective
test the theory that it makes an
preparation to clear up a severe re-
important difference if a clotted
action.
coronary artery is opened quickly
Be cautious! This summer as
in patients with heart attacks, as
you protect your trees and shrubs,
opposed to the usual treatment for
protect your skin too.
heart attack victims.
If the findings from the NIH
group substantiate that strepto-
kinase is life saving, the implica-
tions are profound: it will become
imperative that the nation is better
educated to the signs of a heart
attack; and ambulance units will
It's easy to become a member of the AMERICAN SELF-HEALTH ASSOCIATION. Simply enclose a check or credit card number for
$35.00 for a one-year ASHA membership, effective immediately. I understand that I will receive my ASHA membership card, pin,
handbook, newsletter and decal by return mail.
Charge to my credit card:
Master Card
VISA
Credit Card #
Expiration Date:
Signature:
Name:
Zip Code:
Address:
City/State:
Telephone:
Office:
Profession:
Please enroll my spouse for a one-year ASHA membership, at the low price of $15.00, effective immediately. I under-
stand that s/he will receive the same benefits as I do. Spouse's Name:
Please enroll my children (under 18 years of age) for one-year ASHA membership, effective immediately, for $5.00 per child. I under-
stand that each child will receive an ASHA membership card and decal.
Children under 18:
©1982 by American Self-Health Association, Inc. All rights reserved.
ASHA NEWS
HEALTH-TEX: ELECTRONIC HOME HEALTH
With the invention of the microcircuit and silicon chip in the late 1950's,
the second industrial revolution began. It's been going strong ever since then.
Increasingly, microcomputers are becoming a regular part of office equipment and
home appliances. To keep pace with the information processing explosion, Health
Resources Corporation of America, in cooperation with CompuServe, Inc. of
Columbus, Ohio, is offering Health-TexM, a computerized health information data-
base.
Health-Tex offers the user a menu of choices -- emergency information,
general information and games, ans information about the American Self-Health
Association, plus a catalog of ASHA products and services, all accessible by
home computer.
Subscribers to CompuServe, a home computer version of cable television, can
tap into Health-Tex+ files. Under emergency information, they receive step-by-
step instructions on how to handle common household emergencies from poisoning
to heart attack or stroke to insect bites or sun burns. The emergency menu
includes CPR and the Heimlich maneuver, carefully outlined in an easy-to-follow
format.
General information and games lists several choices, including a personal
health quiz game, an annotated bibliography of health books, self-health
manuals, and popular magazines, and a monthly feature. The interactive service
also offers users the chance to "correspond" by electronic mail with HRCA.
Consumers can ask questions or suggest products and services they'd like to see.
ASHA is taking advantage of the interactive capabilities of the service by pro-
viding an ongoing survey of the interests and opinions of Health-Tex users.
General information also includes detailed information on prescription and
over-the-counter drugs you may have in your home. Drugs are listed by generic
and brand names, with data provided on their effects and side effects, and war-
nings of who should and should not use a particular substance.
For ASHA members, Health-Texᵀ provides special information, including the
electronic edition of Self-Health, the monthly newsletter, educational and
health products, and a home medical records file in which users can enter and
update their personal medical file. The files can be accessed by any doctor who
is a subscriber to CompuServe; electronic transfer of the files from one city to
another, if necessary, is automatic.
The Health-TexM database is compiled from extensive public and private
sources, and is continually revised and updated as new information becomes
available.
American Self-Health Association
1420 16th Street, NW
Washington, DC 20036
(202) 328-4155
July 28, 1982
American Self-Health Association
METAMETRIX
One of the important benefits available to American
Self-Health Association members is a Metametrix program.
Metametrix offers a formula for life. All too often, people
repeatedly try the latest "fad diet." They lose weight
only to watch the weight come right back once they begin
eating normal foods again.
The philosophy behind Metametrix is not simply weight loss.
Rather, it is a nutrition-controlled program based on sound,
portioned nutrients and a look at the ways and means of indi-
vidual eating patterns. On a given day, you might want to
find out how you eat. Conciously write down the times you
eat, what food and the amount you consume, and your thoughts
at the time. In this way, you can begin to see a connection
between certain foods, times, and events.
Metametrix is a comprehensive program that helps you maintain
your weight, shows you the importance of good nutrition, and
resolves to help you work on your new self-image for life.
According to Janet T. Robbins, Vice President of Metametrix,
feelings of self-esteem are very important to those who take
off excess weight. Counseling on a one-to-one basis is
arranged, as well as business seminars on nutrition and pro-
ductivity.
With 7 out of 10 Americans overweight and looking for direc-
tion, Metametrix's sound principles based on nutrition will
enhance your total wellness lifestyle. Do it for yourself.
Get healthy!
SELF-HEALTH FACTS
As a nation, we have come to expect the latest and most
advanced medical equipment and technology available. As one
executive of an insurance company stated, "One reason medical
costs are so high in this country is that a lot of people
don't know how high the bill is.
Americans devote one month of their work each year to pay
the nation's health care bill through hidden taxes and
insurance premiums. 2
As Stanford University economist Alain C. Enthoven sees it,
"The health care industry is a classic example of market
failure. We have allowed it to evolve in a direction in
which waste, overuse, and an upward spiral of fees are
encouraged; while efficiency and economy are discouraged. "3
An ounce of prevention is worth a pound of cure.
4
Most people view health as a state you are in when you are
not sick, without disease, free of pain. In other words,
health is associated with the absence of something -
illness. When you believe this, the best you can hope for is
not to be sick. The alternative, which wellness invites, is
to describe health as having a positive dimension. The idea
of wellness is to help you recognize, pursue, and achieve a
state of health beyond "not sick". 5
Wellness is a positive approach to living where the payoffs
are pleasurable. The wellness lifestyle is unique to each
person. Wellness has 5 dimensions to its' make-up: self-
responsibility, nutritional awareness, physical fitness, 6
stress management, and environmental sensitivity.
Often, normative shaping influences in our society get in
the way of a robust wellness lifestyle. For example, there
is a widespread belief that health education and prevention
programs do not work - the negative message often only points
out causes but not solutions. 7
The medical system neglects the whole person, for it is a
system targeted exclusively on the treatment of disease and
disability, while neglecting prevention and health promotion.
8
Often, the physician is expected to be a godlike healer and
fixer. Consumers often feel intimidated, passive 9 and do not
take their becoming well as their responsibility.
The American Self-Health Association embraces the prin-
ciples of self-health, and has tools consumers and health
care professionals need to make reasoned and articulate
choices about their health care needs. ASHA believes that
now is the time to take charge of our lives through the
simple prescription that living well is living at its best. 10
References Cited
1. Quinn, J.B.,: Medical Insurance Firms Study Cost-Cutting
Plans, Washington Post, January 16, 1978.
2. Business Week, February 8, 1982, "The Spiraling Costs of
Health Care."
3. Ibid.
4. Quoted from text of Poor Richard's Almanac, Benjamin Franklin.
5. Dr. Donald Ardell, 14 Days to a Wellness Lifestyle,
Whatever Publishing, Inc., Mill Valley, California, 1982.
6. Ibid.
7. Ibid.
8. Ibid.
9. Ibid.
10. White Paper, The American Self-Health Association on the
Economic Impact and the Nation's Response to Health Care
Costs, 1982.
agarmaccon service
Products
10day magazine
July 1aug. 1982
HEALTH-TEX
antidotes, CPR and mouth-to-
you need.
mouth resuscitation, Heimlich
MEDICAL
In the listing of ASHA, services,
maneuver and first aid. You have
you will find MetaMetrix, a per-
INFORMATION
to pick the one you need. You'll
sonalized nutrition program. You
then find step-by-step instruc-
can use it to develop α personal
tions, good for beginners and the
diet, geared to your lifestyle. In
In a health emergency, would you
more experienced alike when
concert with new member bene-
be able to remember the steps to
handling a real emergency.
fits, ASHA offers a comprehensive
take for CPR? How would you ad-
If you are not facing an emer-
personal health profile. The pro-
minister the Heimlich maneuver?
gency, you'll push N for no and
file, developed by General Health
What antidote should you admin-
select from a menu that offers gen-
Inc. in Washington D.C., charts
ister for α child who has eaten α
eral information, as well as a host
each person's current and past
bottle of aspirin?
of American Self-Health products
behavior and lifestyle and gives
Now you can have emergency
and services. Under general in-
specific suggestions for your fu-
health information as well as a
formation alone you'll find, for ex-
ture health. Although the per-
virtual library of preventative
ample, information on prescription
sonal health profile is not a
medicine in a new videotex offer-
drugs you may be taking. Drug
diagnosis, it provides you with in-
ing called Health-Tex on
information is revised and up-
formation about yourself and your
CompuServe. Developed by
dated as soon as any new infor-
health SO that rather than simply
Health Resources Corporation of
mation about a prescription drug
preventing illness, you can main-
America, Health-Tex offers in-
becomes available. The guide lets
tain wellness.
formative and factual data to keep
you know the pluses and minuses
Although the primary goal of
you and your family in tip-top
behind medicines you may have
Health-Tex is to develop self-health
shape. For those who want more
than just the basics, there's a
membership option. You can join
the American Self-Health Associ-
ation, a part of the Health Re-
sources Corporation of America
- at a special membership rate
- through the CompuServe In-
formtion Service. With member-
ship, you'll have access to even
more health related information as
well as opportunities to purchase
health items at a discount.
Health-Tex offers 11 standard
menu items and an additional 25
in your home. A guide to over-the-
for individuals, other benefits are
for members. Topics range from a
counter drugs completes the pic-
planned as well. One is to develop
guide to prescription drugs to pos-
ture and even includes home rem-
a referral system of doctors and
itive mental attitude courses.
edies.
nurses who are sensitive to pa-
A capsulized version of Health-
But perhaps you want to read d
tient's needs. Another is to help
Tex shows what you might find on
list of information on beta block-
users establish their own personal
your own video screen. Whenever
ers, the new drugs used to prevent
medical records which can be kept
you tune to Health-Tex, you will
heart attacks. General reference
and transferred as necessary.
first be asked, "Is this an emer-
and popular magazines are two
Electronic mail between members
gency?" For any answer but no,
Health-Tex choices that put today's
can offer a yet-to-be-tapped infor-
the system immediately goes to the
latest medical information at your
mation base for all users who want
emergency mode to allow for the
fingertips. Since Health-Tex scans
to devote at least a portion of their
real panic that may take place in
print media daily for news that
time to maintaining good health.
an actual emergency situation. The
affects your health and well being,
emergency menu offers poison
you can be sure to find all the news
by Kathy Bissell
1982
9630
Federal Register / Vol. 48, No. 45 / Monday, March 7, 1983 / Rules and Regulations
DEPARTMENT OF HEALTH AND
Comments should be submitted by
necessary to apprise appropriate
HUMAN SERVICES
May 6, 1983.
persons of the protections afforded
ADDRESSES: Comments should be
under Section 504. The interim final rule
Office of the Secretary
submitted in writing to the Director,
specifies the type of information and
Office for Civil Rights. Department of
manner of posting that is necessary to
45 CFR Part 84
Health and Human Services, 330
bring the protections of Section 504 for
Independence Avenue, S.W., Room 5400,
handicapped infants to the attention of
Nondiscrimination on the Basis of
Washington, D.C. 20201, or delivered to
those persons within the recipient
Handicap
the above address between 9:00 a.m.
program or activity who are most likely
AGENCY: Office of the Secretary, HHS.
and 5:30 p.m. on regular business days.
to have knowledge of possible violations
ACTION: Interim final rule.
Comments received may be inspected
as they occur.
during these same hours by making
2. 45 CFR 80.8, as referenced by 45
SUMMARY: The interim final rule
arrangements with the contact person
CFR 84.61, which sets forth procedures
modifies existing regulations to meet the
shown below.
for the Secretary to effect compliance
exigent needs that can arise when a
FOR FURTHER INFORMATION CONTACT:
with Section 504, including referrals to
handicapped infant is discriminatorily
Susan Shalhoub at (202) 245-6585, Office
the Department of Justice for the
denied food or other medical care. Three
for Civil Rights, Department of Health
initiation of appropriate legal
current regulatory provisions are
and Human Services, 330 Independence
proceedings. The existing regulations
modified to allow timely reporting of
Avenue, S.W., Room 5514, Washington,
require a 10-day waiting period from the
violations, expeditious investigation,
D.C. 20201.
time the Secretary notifies a recipient of
and immediate enforcement action
SUPPLEMENTARY INFORMATION: The
its failure to comply to the time the
when necessary to protect a
President's directive of April 30, 1982,
Secretary makes a referral to the
handicapped infant whose life is
and the HHS Office for Civil Rights
Department of Justice or takes other
endangered by discrimination in a
"Notice to Health Care Providers" of
legal actions to effect compliance. When
program or activity receiving federal
May 18, 1982, reminded recipients of
a handicapped infant is being denied
financial assistance.
federal financial assistance of the
food or other necessary medical care,
Recipients that provide health care to
applicability of Section 504 of the
however, more expeditious action may
infants will be required to post a
Rehabilitation Act of 1973. Section 504
be required. New § 84.61(c) creates a
conspicuous notice in locations- that
provides: "No otherwise qualified
narrow exception to the 10-day waiting
provide such care. The notice will
handicapped individual
shall, solely
period when, in the judgment of the
describe the protections under federal
by reason of his handicap, be excluded
responsible Department official,
law against discrimination toward the
from participation in, be denied the
immediate remedial action is necessary
handicapped, and will provide a contact
benfits of, or be subjected to
to protect the life or health of a
point in the Department of HHS for
discrimination under any program or
handicapped individual.
reporting violations immediately by
activity receiving federal financial
telephone.
3. 45 CFR 80.6(c), as referenced by 45
assistance."
Notice and complaint procedures have
CFR 84.61, which requires each recipient
The Notice to Health Care Providers
been effective instruments for
to permit access by Department officials
explained what is already clear from the
deterrence and enforcement in a variety
to facilities and information pertinent to
language of Section 504 and the
of civil rights contexts. The Secretary
ascertaining compliance with Section
implementing regulations (45 CFR Part
believes that the interim final rule
504, during normal business hours.
84): The discriminatory failure of a
provides the best means to ensure that
Allegations of denial of food or other
federally assisted health care provider
violations can be reported in time to
necessary medical care to handicapped
to feed a handicapped infant, or to
save the lives of handicapped children
infants may require an immediate effort
provide medical treatment essential to
who are denied food or are otherwise
to ascertain compliance. The interim
correct a life-threatening condition, can
imperiled by discrimination in the
constitute a violation of Section 504.
final rule provides that access to records
provision of health care by federally
This interim final rule does not in any
and facilities of recipients shall not be
assisted programs or activities.
limited to normal business hours when,
way change the substantive obligations
The procedures to be followed for
of health care providers previously set
in the judgment of the responsible
investigation of complaints are outlined
forth in the statutory language of Section
Department official, immediate access is
in the supplementary information below.
504, in the implementing regulations,
necessary to protect the life or health of
The Secretary intends to rely heavily on
and in the Notice to Health Care
a handicapped individual.
the voluntary cooperation of State and
Providers. The interim final rule sets
The purpose of the interim final rule is
local agencies, which are closest to the
forth procedural specifications designed:
to acquire timely information concerning
scene of violations, and which have
(1) To specify a notice and complaint
violations of Section 504 that are
traditionally played the key role in the
procedure, within the context of the
directed against handicapped infants,
investigation of complaints of child
existing regulations, and (2) to modify
and to save the life of the infant. The
abuse and neglect. This will not exclude,
existing regulations to recognize the
Secretary believes that those having
of course, a vigorous federal role in
exigent circumstances that may exist
knowledge of violations of Section 504
enforcing the federal civil rights that are
when a handicapped infant is denied
against handicapped infants do not now
at issue.
food or other necessary medical care.
have adequate opportunity to give
The Secretary invites comments on all
The interim final rule affects the
immediate notice to federal authorities.
aspects of the interim final rule. Aspects
following portions of existing
A telephone complaint procedure can
on which comment is particularly
regulations:
provide information to federal
invited are set forth in the
1. 45 CFR 80.6(d), as referenced by 45
authorities in time to save the life of a
supplementary information.
CFR 84.61, which requires recipients to
handicapped infant who is being
DATES: The interim final rule becomes
make available such information, in
discriminatorily denied nutrition in a
effective March 22, 1983.
such a manner, as the Department finds
federally assisted program or activity.
Federal Register / Vol. 48, No. 45 / Monday, March 7, 1983 / Rules and Regulations
9631
Events of the past several years
Section 504. 45 CFR 80.7(e), as
emergency situations. All modifications
suggest that handicapped infants have
referenced by 45 CFR 84.61, prohibites
made by the interim final rule are
died from denial of food in federally
intimidatory or retaliatory acts by
necessary to protect life from imminent
assisted programs. The full extent of
recipients against individuals who make
harm. Any delay would leave lives at
discriminatory and life-threatening
complaints or assist in investigations
risk. Immediate publication and
practices toward handicapped infants is
concerning possible violations of
implementation of this rule will not
not yet known, but the Secretary
Section 504. This provision fully protects
cause undue burden to any party. The
believes that for even a single infant to
individuals who make complaints or
Secretary therefore finds it necessary to
die due to lack of an adequate notice
assist in investigations concerning
publish this rule as an interim final rule
and complaint procedure is
possible withholding of food or other
taking effect less than 30 days following
unacceptable.
necessary medical care from
publication. The Secretary deems 15
For quick and effective response to
handicapped infants.
days to be the minimum in which the
complaints, the Secretary counts not
Comments solicited. The Secretary
necessary apparatus can be in place to
only the enforcement resources of the
seeks public comment on all aspects of
receive and respond to telephone
federal government, but also on the
the interim final rule. Comments will be
complaints. The interim final rule is
assistance of state child protective
considered and modifications made to
therefore made effective March 22, 1983.
agencies, which can respond quickly
the rule, as appropriate, following the
and effectively to referrals from the
comment period.
List of Subjects in 45 CFR Part 84
Federal government, and which are
The Secretary also solicits comments
Civil rights, Education of
often closest to the scene for speedy
on the advisability of requiring (1) that
handicapped, Handicapped.
investigation of life-threatening child
recipients providing health care services
to infants perform a self-evaluation,
Approved: March 2, 1983.
abuse and neglect. The Secretary
intends to contact state child protective
pursuant to 45 CFR 84.6(c)(1), with
Thomas R. Donnelly, Jr.,
agencies whenever a complaint is
respect to their policies and practices
Acting Secretary.
received that falls within the definition
concerning services to handicapped
infants; and (2) that such recipients
PART 84-[AMENDED]
of child abuse or neglect, in order to give
States an opportunity to make their own
identify for parents of handicapped
Interim Final Rule
investigation and to take appropriate
children those public and private
action.
agencies in the geographical vicinity
45 CFR 84.61 is amended by
The Secretary expects that States will
that provide services to handicapped
designating the existing provision as
follow their customary procedures for
infants.
paragraph (a) and by adding paragraphs
investigating allegations of child abuse
Regulatory impact analysis. This rule
(b), (c), and (d) to read as follows:
and neglect that involve an imminent
has been reviewed under Executive
84.61 [Amended]
danger to life. State agencies that
Order 12291. It is not a major rule and
receive federal financial assistance are
thus does not require a regulatory
under the same obligation as other
impact analysis.
(b) Pursuant to 45 CFR 80.6(d), each
recipients not to provide a qualified
Regulatory flexibility analysis. The
recipient that provides covered health
handicapped person with benefits or
Regulatory Flexibility Act (Pub. L 96-
care services to infants shall post and
services that are less effective than
354) requires the federal government to
keep posted in a conspicuous place in
those provided to others.
anticipate and reduce the impact of
each delivery ward, each maternity
For those complaints that are
rules and paperwork requirements on
ward, each pediatric ward, and each
expeditiously and effectively
small businesses and other small
nursery, including each intensive care
investigated and pursued by State
entities. This rule has no significant
nursery, the following notice:
agencies, the Secretary anticipates that
effect on small entities. Therefore, a
DISCRIMINATORY FAILURE TO FEED
additional federal efforts will often be
regulatory flexibility analysis is not
AND CARE FOR HANDICAPPED
unnecessary. The Secretary will closely
required.
INFANTS IN THIS FACILITY IS
PROHIBITED BY FEDERAL LAW
monitor all investigation and
Paperwork Reduction Act. This rule
enforcement activity taken pursuant to
contains no information collection
Section 504 of the Rehabilitation Act of
complaints. The Secretary will make
requirements subject to the Paperwork
1973 states that no otherwise qualified
available to State agencies any
Reduction Act of 1980 (Pub. L. 96-511).
handicapped individual shall, solely by
information and assistance that is
Public participation in rulemaking.
reason of handicap, be excluded from
participation in, be denied the benefits of,
helpful and appropriate. For those cases
With reference to the Secretary's
or be subjected to discrimination under any
where direct federal action appears
Statement of Policy, dated January 28,
program or activity receiving federal
helpful, the Secretary will have at his
1971, concerning public participation in
financial assistance.
disposal the usual means of federal civil
rulemaking (printed at 36 FR 2532; Feb.
Any person having knowledge that a
rights enforcement. The interim final
5, 1971), the Secretary finds that this
handicapped infant is being
rule makes it possible for the Secretary
interim final rule is exempt from the
discriminatorily denied food or customary
to conduct immediate investigations and
requirements of 5 U.S.C. 553. Under 45
medical care should immediately contact:
to make immediate referrals to the
CFR 80.6(d) and 84.61, the Secretary is
Handicapped Infant Hotline
Department of Justice for such legal
already authorized to specify the
U.S. Department of Health and Human
Services
action as may be necessary to save the
manner in which recipients make
available information concerning federal
Washington, D.C. 20201
life of a handicapped child who is
Phone 800-
(Available 24
subjected to discrimination by a
legal protections against discrimination
hours a day)
recipient.
toward the handicapped. The exception
or
Federal enforcement action can also
to the 10-day waiting period of 45 CFR
Your State Child Protective Agency
be taken against any recipient that
80.8(d)(3) and the exception to 45 CFR
Federal law prohibits retaliation or
intimidates or retaliates against any
80.6(c) to allow access outside normal
intimidation against any person who
person who provides information
business hours are minor technical
provides information about possible
concerning possible violations of
changes and are necessary to meet
violations of the Rehabilitation Act of 1973.
9632
Federal Register / Vol. 48, No. 45 / Monday, March 7, 1983 / Rules and Regulations
Identity of callers will be held
(2) Copies of such notice may be
official, immediate remedial action is
confidential.
obtained on request from the
necessary to protect the life or health of
Failure to feed and care for infants may
Department of Health and Human
a handicapped individual.
also violate the criminal and civil laws of
Services.
(d) Notwithstanding the provisions of
your State.
(3) The required notice shall be posted
paragraph (a), access to pertinent
(1) Recipients may add to the notice,
within five days after the recipient is
records and facilities of a recipient
in type face or handwriting. under the
informed by the Department of the
pursuant to 45 CFR 80.6(c) shall not be
words "Your State Child Protective
applicable toll-free national telephone
limited to normal business hours when,
number.
in the judgment of the responsible
Agency," the identification of an
Department official, immediate access is
appropriate State agency, with address
(c) Notwithstanding the provisions of
necessary to protect the life or health of
and telephone number. No other
paragraph (a), the requirement of 45 CFR
a handicapped individual.
alterations shall be made to such notice.
80.8(d)(3) shall not apply when, in the
[FR Doc. 83-5781 Filed 3-3-83; 9:42 am]
judgment of the responsible Department
BILLING CODE 4150-04-M
Hospital says dad tried to bar care for deformed child
LANSING - (AP) - A deformed baby born to a surrogate
mother was treated for an infection over the objections of the
father, who had told the hospital not to care for the child, a.
lawsuit says.
Kids of surrogate moms: Who are legal fathers?
Ingham County Circuit Judge Michael Harrison, acting on the
suit by Lansing General Hospital, issued a temporary order
By JOYCE WALKER-TYSON
the paternity act," Judge Walter Cynar wrote in the majority
allowing the hospital to conduct tests and treat the baby.
Free Press Staff Writer
opinion. "Studied legislation is needed before surrogate ar-
The suit filed in Ingham County Circuit Court says the father,
The state Court of Appeals ruled Thursday that a man who
rangements are recognized."
Alexander Malahoff of Middle Village, N.Y., had told the hospital
paid a married woman to bear his child cannot be named the le-
"That's what we've been saying all along," said Noel Keane,
and doctors to "take no steps or measures to treat the strep
gal father of the child.
the Syrkowskis' attorney and a leading figure in arranging
infection or to otherwise care for" the baby.
In a 2-1 decision, a three-judge panel agreed with the state
surrogate mother contracts. "We need legislation in that area.
Malahoff gave the order because of a "contract granting him
Attorney General's Office that the husband of the surrogate
The court's decision is just plain unrealistic. The case will be
rights to custody" of the baby, the suit says.
mother who bore the child is the child's father despite
appealed immediately."
ACCORDING TO the suit, Judy Stiver of Lansing acted as a
arrangements between the surrogate mother and the biological
Syrkowski had been denied legal paternity in Wayne County
surrogate mother for Malahoff and his wife and delivered a
father. But the court did not rule such arrangements illegal and
Circuit Court because Appleyard is married and her husband is
microcephalic baby boy who also suffered from a strep infection.
suggested legislation was needed to cope with such situations.
considered the father of the child.
Microcephalism, which means the child's head is smaller than
The ruling was handed down in a case involving Sheila and
"If we'd used (an unmarried) surrogate, we wouldn't be.
normal, frequently indicates retardation.
George Syrkowski, who paid Corinne Appleyard $10,000 to
confronted with this problem," Keane said. "Any man can just,
Pediatricians believed the child's life was endangered by the
bear Syrkowski's child after artificial insemination.
infection and wanted to administer intravenous antibiotics. They
"The courts should not be called upon to enlarge the scope of
See SURROGATE, Page 11A
had the consent of the mother and her husband, Ray Stiver.
Malahoff, however, objected.
spokeswoman would not disclose his condition.
A contract usually says that the father will take custody of the
The baby was a day old Jan. 11 when Judge Harrison granted
Under surrogate agreements, a woman conceives through
child and that the natural mother is paid for her medical expenses.-
the hospital the temporary order allowing treatment and tests.
artificial insemination for a male sperm donor who war's to
Often the natural mother gets add cional payment of $10,000 or
The baby remains in Lansing General Hospital. A hospital
father a child, then surrenders the baby when it is born.
more.
WITHDRAWAL SHEET
Ronald Reagan Library
Collection Name
Withdrawer
BLACKWELL, MORTON: FILES
RB 3/21/2011
W
File Folder
FOIA
DEPARTMENT OF HEALTH AND HUMAN SERVICES (2 OF 6)
F06-0055/07
POTTER, CLAIRE
Box Number
6
10
DOC Document Type
No of Doc Date Restric-
NO Document Description
pages
tions
Note
1
LETTER
1
ND
B6
DUKE TO MORTON BLACKWELL RE. DEPT. OF
HEALTH AND HUMAN SERVICES
Freedom of Information Act [5 U.S.C. 552(b)]
B-1 National security classified information [(b)(1) of the 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 FOIA]
B-4 Release would disclose trade secrets or confidential or financial information [(b)(4) of the FOIA]
B-6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA]
B-7 Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA]
B-8 Release would disclose information concerning the regulation of financial institutions [(b)(8) of the FOIA]
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.
FYI
WEEKLY REPORT
I.
ISSUE:
Mr. Martin A. Janis retired from his service as the Director of
the Ohio Commission on Aging and a member of Governor James
Rhodes' Cabinet on January 10, 1983.
II.
BACKGROUND:
Martin A. Jamis has served in the Cabinet of Governor Rhodes for
15 years. His first eight years were spent as director of the
Department of Mental Hygiene and Correction; the last eight
years were spent as the director of the Ohio Commission on
Aging. His appointment has ended with the expiration of
Governor James Rhodes' term of office.
III.
DISCUSSION:
The newly inaugurated Governor, Richard F. Celeste, has not yet
announced an appointment to the directorship of the Ohio
Commission on Aging. Mr. Kenneth M. Mahan, Assistant Director
of the State Agency will serve as the acting director until that
announcement is made.
IV.
OF IMPORTANCE TO:
The Commissioner and the Assistant Secretary.
CONTACT PERSON
OFFICE PHONE
AOA REGION
Eli Lipschultz
8-353-3141
V
Fact Sheet on HPS Family Planning Regulation
Background
HHS proposes to amend Federal family planning program regulations which
presently pendt minors to receive birth control prescription drugs and devices
without the knowledge of their parents. Following discussion at the January 21
meeting of the Human Resources Cabinet Council, HRS has made several amendments
to the original draft to provide for the maximum parental involvement that can
be legally defended under the existing statute.
Major Provisions of Proposed Regulation
- Requires that in providing prescription drugs and devices to a child 17
or under, the family planning center would, within 10 days, provide
notification to the child's parents, unless the director of the family
planning center determines that the notification would result in sub-
stantial physical harm to the minor by the parents or guardian.
-- Requires family planning centers to obey State laws that provide for
parental consent for family planning services to minors (Utah has such a
State law).
Revisions to Prior Draft
- The exception clause in the prior draft ("notification would have adverse
physical health consequences for the minor") has been tightened to read
"notification will result in physical harm to the minor by the parents or
guardian." This exception is necessary to satisfy the legislative
requirement that family involvement may not be mandated; we can only
"encourga" family participation "to the extent practical." The new
language, however, makes clear that the exception is very narrow -it
applies only when there would be physical harm to theminor by the parents
or guardian.
- The notification requirement has been strengthened to require that the
center verify that the parents received the notification. If the center
is unable to verify that the notification was received, additional
prescription drugs or devices may not be provided.
- To monitor compliance, the recordkeeping requirements have been
strengthened to require that family planning centers keep records, not
only on exceptions, but also on notifications and certifications that the
notices were received. HHS must be given access to these records upon
request.
Support for Regulation
The proposed regulation has the strong support of Senator Hatch (whose State has
passed a parental consent law that cannot be enforced against federally funded
centers without this regulation) and several pro-life and pro-family organiza-
tions.
10
1. The last sentence of the definition of "low income family" in 42 CFR 59.2
is revoked.
2. 42 CFR 59.5 (a) is amended by adding thereto the following paragraph (12),
to read as follows:
{ 59.5 What requirements must be met by a family planni 1 project?
(a)
(12) Encourage, to the extent practical, family participation in the
provision of the project's serivces to unemancipated minors. A
project shall -
(i) (A) When prescription drugs or prescription devices are
initially provided by the project to an unemancipated
minor, notify the minor's parents or guardian that
they were provided within 10 working days following
their provision. The project must tell the Minor
prior to the provision of services about this noti-
fication requirement. The project shall verify that
the notification was received Where the project: is
unable to verify that the notification was received,
the project shall not provide additional prescription
drugs or prescription devices to he minor.
(B)
A project is not required to comply with the first sentence
of subparagraph (A) of this paragraph where the project
director determines that such notification will result in
physical harm to the minor by the parents or guardian.
(C) For the purpose of this paragraph (i), an "unemanci-
pated minor" is an individual who is age 17 or under
and is not, with respect to factors other than age,
emancipated under State law.
(D)
The project must keep records on notifications pro-
vided pursuant to the first sentence of subparagraph
(A), and on verifications that those notifications
were received. The project must also keep records of
the number of determinations made under subparagraph
(B) and the factual basis for such determinations.
The project must make the records required by this
subparagraph available to the Secretary on request.
(E)
This paragraph (i) does not apply where prescription
drugs are provided for the treatment of venereal dis-
ease.
(ii)
Notwithstanding any other requirement of this subpart,
where State law requires the notification or consent
of a parent or guardian to the provision of family
planning services to an individual who is unemanci-
pated minor under State law, provide such services
only in compliance with such law.
AUTHORITY: Sec. 6(c), Pub. L. 91-572, 84 Stat. 1507, 42 U.S.C. 300a-4(a).
TELEGRAM
To: The President
The White House
Washington, D. C.
Honorable Richard Schwieker, Chairman
Cabinet Council on Human Resources
DHHS RM 615F
200 Independence Ave., S. W.
Washington, D. C. 20201
Honorable Edwin Meese, III
Counselor to the President
The White House
Washington, D. C.
Honorable James A. Baker, III
Chief of Staff
The White House
Washington, D. C.
The Cabinet Council on Human Resources has under consideration
changes in Department of Health and Human Services regulations
concerning family planning services, particularly with respect
to services to minor children (unemancipated teenagers).
As reported in the press notification of parents after a
prescription has been given to a minor child is useless. It does
not allow parents to excercise their parental rights and
responsibilities.
1. It is much more important that the regulations address
the question of using federal funds to counsel (in
favor of) or refer minors for abortions. The new
regulations should restrict taxpayer funds only to those
organizations which refuse to provide counseling or
"education" and referral of minors for abortion
without prior written parental consent.
2. The new regulations should prohibit prescriptions for
or distribution of free samples of birth control
materials to minors without prior written consent of
the parents.
3. The new regulations should require written consent of
the parents before sex education is given to any minor
child.
Judie Brown
-
American Life Lobby
Paul Brown
-
Life Amendment PAC
Rev. Don Wildmon
-
National Federation for Decency
Howard Phillips
-
The Conservative Caucus
John Becket
-
Intercessor for America
Father Charles Fiore, O.P. -
National Pro-Life PAC
Gordon Jones
-
United Families of
Family Policy Insights
Free Congress Foundation 721 Second Street. N.E., Washington, D.C. 20002 (202) 546-3004
Vol. I: Number 4
December 18, 1981
FREE CONGRESS FOUNDATION SURVEY
I. INTRODUCTION
In December, 1981, Decision Making Information of Santa Ana, California, issued
the results of a survey commissioned by the Free Congress Foundation. The survey
covered six major areas: education, economy, family and social issues, government,
courts, and national defense. Results indicated strong conservative leanings on
several issues of importance to the pro-family movement. Sixty-eight percent of those
questioned said that the family is weaker now than several years ago. A large number
attributed the degeneration to a decline in moral standards and increasing permissive-
ness 01 parents toward children. Seventy five percent oppose sllowing a eenager to
have an abortion without informing her parents Fifty-five percent favor removing
issues such as busing and school prayer from federal court jurisdiction. Forty-nine
percent believe the federal government to have too great an influence on public edu-
cation, and 57% favor a system of tuition tax credits for parents of children in private
and parochial schools.
The survey was taken by telephone from a random sample of 1,000 voters across the
United States.
II. EDUCATION
Education was the first issue discussed in the survey. Voters were asked to name
the major problems facing public education. Most frequently mentioned were problems
related to quality of education and lack of discipline. Forty-six percent criticized
the quality of education received in public schools, with one-third of these pointing
specifically to a lack of emphasis on the basics. Forty-one percent expressed concern
over a lack of discipline. The third and fourth most frequent answers concerned in-
adequate funding and poor teaching methods. Twenty-nine percent spoke of low funds,
large classes and low teacher salaries while 26% blamed teachers themselves, referring
to teachers as unqualified and lacking concern for students.
The second question dealt with the federal government's influence on education
policy. Voters were asked whether the federal government has too much, too little, or
about the right amount of influence. Nearly half (49%) said that the federal government
exercises too much influence, 18% thought the federal government does not do enough, and
Note: Nothing written here is to be construed as necessarily reflecting the views of the Free
Congress Foundation or as an attempt to aid or hinder the passage of any bill before Congress.
- 2 -
26% said that the right amount of influence is exercised. Suprisingly, those voters
who categorized themselves as liberals tended more toward the opinion that federal
government is too influential in education.
Overall, state governments fared better on this same question. The largest
percentage of respondents (38%) said that state governments exert the right amount of
influence on education policy, 27% said that state governments have too much influence,
and 28% believe them to have too little influence. Blue collar workers and Blacks
showed the greatest desire to increase state government influence on education.
When asked to rate the response of public schools to concerns expressed by parents
about course offerings, textbook selection and facility maintenance, 48% rated their
schools as excellent or good, 32% said "only fair," and 13% rated them as poor.
Over two-thirds (68%) agreed that taxpayers should have a chance to review textbooks
before they are used in public school classrooms. Thirty-one percent disagreed.
An overwhelming number (93%) agreed that students should receive a high school
diploma only if they are able to pass a test requiring a certain level of skill in read-
ing, writing and mathematics. Seven percent were in disagreement with such a policy.
When asked whether they would favor or oppose a bill to permit parents to subtract
up to $250 from annual taxes for each child enrolled in private or parochial elementary
or secondary school, 57% favored the bill while 39% opposed it. Those voters who consider
themselves "very liberal" joined younger voters and Catholics in showing particular
support for the proposal.
III. FAMILY AND SOCIAL ISSUES
Over two-thirds (68%) of the voters questioned believe that American families are
weaker now than they were several years ago. Thirty-one percent believe that they are
not weaker. When asked, "What do you think has caused families to become weaker?" the
largest response (mentioned by 45%) blames a lowering of standards and an increase in
permissiveness. Two answers typical of the attitude expressed are:
"Parents have let down their standards and children need good standards
tc follow."
" an attitude of permissiveness, the Doctor Spock syndrome, indulging
of children and letting them do their own thing."
Specific causes mentioned in this category also include the influence of television,
materialism, selfishness and a decline in religious activity. Thirty-one percent pointed
to an increase in the number of families in which both parents are working, while 16%
blamed economic conditions. However, of those who mentioned economic conditions, almost
one-half said that a poor economy forces mothers to work and thereby weakens the family.
In 35% of the cases in which the woman of the house worked full-time outside the home
the respondent named working mothers as a strain on family unity.
Exactly fourths of those interviewed oppose the performance of an abortion on
a teenager without informing her parents.
AL
AMERICAN LIFE LOBBY INC.
NATIONAL HEADQUARTERS MAILING ADDRESS P.O. BOX 490. STAFFORD. VA 22554
OFFICES: ROUTE "6. BOX 162.F. STAFFORD, VA 22554
(703) 659-4171
METRO DC 690-2049
GOVERNMENT LIAISON OFFICE: 6B LIBRARY COURT SE (CAPITOL HILL) WASHINGTON, DC 20003 (202) 546-5551
January 21, 1982
MEMORANDUM
To: Cabinet Council on Human Resources
From: Judie Brown, President, American Life Lobby (202) 546-5550
Subject: Meeting on DHHS Regulations on Federal Family Planning
Programs
Attached are two letters and an information package concerning
waste and abuse in a federal family planning program with
recommended budget cuts and recommended changes in restrictions
on federal family planning programs.
We also call your attention to the following letter President
Reagan sent to Senator Hatch:
"I regret we do not have the votes to defeat the family
planning program and assuming this is the best we can do under
the circumstances, I reluctantly conclude that the best course
is to enter into the proposed conference agreement. Perhaps we
can remedy some of the problems in the family planning program
administratively during the three years that it will remain as
a categorical grant. "
(Signed) Ronald Reagan
The pending DHHS regulations in our judgement do not solve the
major problems in the federal family planning programs, let
alone "defeat the family planning program."
With God for life,
(Mrs.) Judie Brown
President, American Life Lobby, Inc.
A.L.L.
for God, for Life, for the Family, for the Nation"
AME
OBB
NC.
December E, 1981
Mr. David Stockman
Director
Office of Management and Budget
Old Executive Office Bldg.
Washington, D.C. 20503
Dear Mr. Stockman:
This will follow up my letter of October 13, 1981 concerning the
Г.Ү. 1983 budget for the Title X Public Health Service Act Program. I write
to propose restrictive appropriation language that will atone for and at the
same time solve some very disturbing public policy questions and provide
additional savings over and above those that have been calculated based on
the June 1981 GAO study.
In addition to limiting the budget of the Title X program to $98
million, there are major public policy questions surrounding this program
that the Authorizing and Appropriations Committee have not addressed, that
can be solved through restrictive language. Among these are:
1. Should Federal funds be used by grantees to counsel minor
child patients (in favor) or refer them for abortions
without parental consent? Note: PPFA argues that existing
DHHS Regulations and Guidelines require them to do SO.
2. Should sex education courses including materials and lists
of abortion clinics be given to minor children without
parental consent?
3. There has been testimony before both House and Senate
Authorizing Committees that Title X grantees are engaging
in lobbying and political organizing even to the extent of
loaning clinic patient names and addresses to certain
political candidates. Is this a proper function of a
recipient of Federal funds?
4. PPFA and its affiliates have engaged in a major advocacy
campaign for abortion on demand as an acceptable form of
birth control. PPFA has testified before Congress that
HHS policy does not prohibit "promotion and encouragement
of abortion" (p. 77 Oversite of Family Planning Programs,
Labor and Human Resources Committee U.S. Senate). Is this
advocacy a proper use of Federal funds? Is this advocacy
within the spirit of Section 1008 of the Public Health
Service Act?
-2-
In order to address these serious policy questions in an effort
to limit Title X programs, to its original and only legitimate function of
providing Family Planning Services, I strongly urge that the following
bill language be included in the Administration's F.Y. 1983 budget request
for Title X of the Public Health Service is 1:
"To carry out the non-research programs of Title X of the
Public Health Service Nit $85,000,000:
Provided that no part of the appropriation contained
in this paragraph may be used to pay for the performance
of an abortion, or the referral of the patient for the
performance of an abortion except to save the life of
the mother, or for the provision of Family Planning
Services, materials, counseling or education without
written Parental Consent, or to make any grant or
contract without a provision requiring that all persons
receiving compensation under such grant or contract shall
be subject to chapter 29 and section 1913 of Title 18 of
the United States Code, or to support or defeat any
candidate for public office or any measure pending in
congress, or for the advocacy by any means of abortion
as an acceptable method of Family Planning."
This language restricts use of Title X funds in five ways:
1. It restates and clarifies the prohibition on abortion contained
in section 1008 of the Authorizing Act. It makes clear the now
ambiguous regulations concerning referrals of patients for
abortions by restricting abortion referrals only to save the
life of the mother.
2. Sets a clear and uniform standard for provision of Title X
programs to minor children by requiring written Parental Consent.
3. Because of testimony before the Authorizing Committee concerning
the involvement of the Title X funded clinics in Political and
Lobbying campaigns. No grants or contracts may be made unless
there is a requirement that all persons receiving Title X funds
as compensation will be subject to the Hatch Act and Anti-
Lobbying laws now applicable to Federal Employees.
4. Because questions were raised in testimony before the Authorizing
Committee that Title X funded clinics patients mailing lists and
telephone numbers may have been used for Political campaign or
Lobbying purposes. It makes clear, NO funds can be used to
support or oppose any candidate for public office or any measure
pending in Congress. This anti-lobbying provision is a restate-
ment and clarification of the Moorhead Amendment which has been
part of the Treasury Post Office Appropriation Bill for several
years.
-3-
5. Because many Title X grantees and their employees are out-
spoken advocates for abortion as a proper and acceptable
method of Family Planning or Birth Control, a very HIGHLY
controversial position which is opposed by a huge number
of Americans, it makes clear that Federal funds shall not
be used for advocacy of this view. The opponents of such
views do not have Federal funds with which to advocate
their opposition. This makes sure that Title X funds are
neutral in the debate on this issue. Individual Title X
employees can continue to advocate a pro-abortion view but
not with taxpayers dollars or on the taxpayers time.
This Bill language will, if adopted, result in further savings
by eliminating ancillary functions now carried on by most of the 5100 Title
X funded clinics. Even if this language resulted in a savings of over
$2000 per clinic per year, that is an additional $10 million per year savings.
I again strongly urge that you submit this language with your F.Y.
1983 Title X budget request. Our office is available to you for research
assistance, if needed.
With God for Life,
(Mrs.) Judie Brown,
JB:mb
President
CC: Mr. Donald W. Moran, Assoc. Director
Mr. David K. Kleinberg, Dep. Assoc. Dir.
Mr. Lee Mosedale, Budget Examiner
Mr. Michael J. Horowitz, Special Counsel
Mr. J. L. Cullen, Asst. Pirector
AL
AMERICAN LIFE LOBBY INC.
EXECUTIVE OFFICES 68 LIBRARY COURT SE CAMEL Hull 9 WASHINGTON DC 20003 202-54@-5550
EDUCATION OFFICE PO BOX 490 STAFFORD VIRGINIA 22344 703 659-4193 OR METRO DC *590-2049
September 14, 1981
Donald W. Moran
Associate Director of O.M.B.
262 Old EOB
Washington, D.C. 20503
Dear Donald:
President Reagan has asked all agencies of the Federal Government to find
further budget cuts. We believe that based on the GAO Report HRD S1-63, the
Title X (of the Public Health Service Act) Family Planning Program can be cut
to $85 million for FY 1982.
This is a $77 million savings from the ГУ-1982 appropriation, and a $36.5
million reduction from the FY-1982 budget request if you allow for the 25%
General reduction as envisaged by President Reagan in hi- block grant budget
proposal of March 10, 1981.
The $36.5 million savings result from a very conservative estimate of
excessive costs that GAO has identified in GAO Report HRD 81-68. A reduc-
tion of $36.5 million would not reduce services, it would only eliminate
excessive patient visits, excessive testing, excessive education, increased
recovery of fees and elimination of duplication with Title V Maternal and
Child Health Program. Enclosed is an explaination of our computation of
these cost savings with excerpts from the relevant pages of GAO Report HRD
81-68.
We strongley urge that DHHS and the Administration make a formal request
to the Appropriation Committees of Congress that Title X receive no more than
$85 million for FY 1982.
Please feel free to call us for any further information.
With God for Life,
(Mrs.) Judie Judie Brown
May Gry Cumon
President
A.L.L. for God, for Life, for the Family, for the Nation"
Title X Cost Savings
SOURCE: GAO Report HRD 81-68, June 19, 1981 state that Title X Family Planning
Funds serve 3.8 million people in 5,125 clinics. (P-1) The Following
is a very conservative estimate of Cost Savings that are indicated by
this GAO Report.
Source
Annual Savings
A. GAO estimate of savings due to reduction of
patient visits to American College of GYN
and Obstetrics standards. (P-10 & 13).
$ 13,000,000
B. Wrong type and too much education. GAO report
indicates that education time can be reduced
by half. (P-16) A very conservative estimate
is this change could save $1,000 per clinic X
5,100 clinics.
$ 5,100,000
C. Routine Anemia screening not needed (HCFA
Reimbursements range from $1-$4) Us $2.00
average cost per test X 3.8 million X & =
2 million. (P-17)
$ 3,800,000
D. 2 Routine V.D. tests not cost effective by
HHS own standards. $1.00 per test X 1/2 client
population. (P-20)
$ 3,800,000
E. Institution of Sliding Scale reimbursement
for all grantees. (GA 6 month fee collec-
tion $150,000 X 2 X 50 states). (P-35)
$ 15,000,000
F. Duplication of Maternal and Child Health Program.
New Title V Authorization requires emphasis on
Family Planning. (House Report 97-208, Page 786)
$ 8,000,000
Total Savings
$ 48,700,000
FY 1982 Budget Request for Title X
$121,500,000
Minus Savings
$ 48,700,000
Balance
$ 72,800,000
Title X FY 1982 Appropriation. Should Not Exceed.
$ 85,000,000
TO THE UNITED STATES SENATE AND HOUSE OF REPRESENTATIVES
September 28, 1981
RE: HR 4560, FY 1982 Labor/HHS
Appropriation Bill
GAO Report HRD 81-68, June 19, 1981, entitled "Family Planning Clinics Can
Provide Services at less cost but clearer Federal Policies are needed"
identifies many areas of cost savings.
This report states that the clinics funded through Title X (of the Public
Health Services Act) program have engaged in excessive patient visits,
excessive education programs, excessive medical testing and insufficient fee
collection. In addition, Title X program duplicates part of the Maternal
and Child Health program.
A conservative estimate (copy attached) of the excessive costs associated
with this program indicates that $48.7 million could be cut from the FY 1982
appropriation request.
Based on this estimate, we strongly urge you to vote to reduce the Title X
funding in the FY 1982 Labor/HHS Appropriation Bill to $85 million.
This is a vital issue and we will be communicating with our members on how
their elected officials represented them on this matter.
Sincerely,
American Life Lobby
Coalitions for America
Conservative Caucus
Concerned Women of America
Moral Majority
National Christian Action Coalition
National Pro-Family Coalition
United Families of America
REPORT BY THE
Comptroller General
OF THE UNITED STATES
Family Planning Clinics Can Provide
Services At Less Cost But Clearer
Federal Policies Are Needed
In fiscal year 1980, the Department of Health
and Human Services spent about $375 million
for family planning services through several
programs. The Department could reduce the
costs of such programs and make services less
costly and more attractive to clients without
compromising quality care by eliminating un-
necessary medical procedures or tests. The
cost of the title X program could be further
reduced by more vigorously enforcing fee col-
lections to ensure that only needy persons re-
ceive free or subsidized services. Also, the
Department needs to resolve conflicts in fee
policies between the title X program, which
requires fee collections from persons with
ability to pay, and the title XX program, which
permits free service regardless of client income.
UNITED STATES
GENERAL
OFFICE
HRD-81-68
ACCOUNTING
JUNE 19, 1981
CHAPTER 1
INTRODUCTION
In fiscal year 1980, the Department of Health and Human Serv-
ices (HHS) spent about $375 million for family planning services
and contraceptive supplies through several different programs.
The program authorized under title X of the Public Health Service
Act (42 U.S.C. 300) is the largest HHS family planning program.
Since its enactment in 1970, HHS has provided over $1 billion for
project grants for family planning services under title X. In
fiscal year 1980, these funds went to about 5,125 clinics serving
about 3.8 million people.
How well these clinics are managed can have a significant
effect on the efficiency, effectiveness, and costs of federally
funded family planning programs. This report focuses on management
improvements needed or in process in several areas to reduce costs,
improve efficiency, and possibly enhance effectiveness of HHS-
funded organized family planning clinics. The issues discussed
are of particular interest to representatives of the congressional
committees having jurisdiction over the title X program--the Sub-
committee on Health and the Environment, House Committee on Energy
and Commerce, and the Subcommittee on Aging, Family and Human
Services, Senate Committee and Labor and Human Resources. (See
pp. 5 and 6.)
EVOLUTION OF FEDERAL ROLE
IN FAMILY PLANNING
Before the 1960s, family planning services were generally
available only to those who could afford them through private
physicians and clinics. Federal policy concerning family planning
services emerged gradually during the 1960s, as recognition of the
health benefits associated with such services increased and the
desire to provide access to those lacking services gained wide
acceptance. Federal funds for family planning services for low-
income women were provided under the broad authority of title V
of the Social Security Act, the Maternal and Child Health program.
These services were made available through maternal and child
health formula grants and maternal and infant care project grants.
The Economic Opportunity Amendments of 1967 (Public Law 90-222)
established family planning services for low-income persons as a
special emphasis of the Office of Economic Opportunity. Family
planning services funded by this office were later transferred to
HHS.
1
be making at least one unnecessary visit to a title X clinic each
year at an annual cost of over $6 million. (See p. 12.)
HHS guidelines recommend
too many routine visits
HHS' family planning program guidelines recommend that oral
contraceptive clinic clients make two more clinic visits during
the first year and another visit during subsequent years than re-
quired by ACOG's standards. Also, officials at nearly half of
the clinics we visited believed that HHS' guidelines called for
too many revisits.
Both HHS' guidelines and ACOG' standards require initial and
annual visits, during which physical examinations, laboratory
tests, and other services are performed and oral contraceptives are
provided or prescribed. However, HHS' guidelines recommend two
additional visit during the first year and one during subsequent
years as shown below.
Comparison of Recommended
Revisit Policies and Standards
Months
elapsed from
HHS guidelines
initial visit
ACOG standards
1st year:
Initial examination
-
Initial examination
Limited examination
3
None
Limited examination
9
None
2nd year:
Annual reexamination
12
Annual reexamination
Limited examination
18
None
3rd year:
Annual reexamination
24
Annual reexamination
On routine revisits (limited examinations), HHS' guidelines
require an update of the client's medical history, an examination
of the client's weight and blood pressure, and an interview with
the client to discuss possible problems and changes in contracep-
tive methods. Clients also receive a resupply of oral contracep-
tives at these visits.
10
Data indicate that in 1979, title X clinics served 3.6 mil-
lion persons nationally, of which about 2.3 million were
taking oral contraceptives and could potentially make at
least one unnecessary revisit, either as a first-year or
continuing patient.
-Because we were unaware of any information nationally on
the number of new or continuing oral contraceptive patients
-
who remain in the program (do not drop out), we assumed
that 50 percent of the new and continuing patients stayed
in the program long enough in 1979 to have made one un-
necessary revisit. 1/ Thus, 1.15 million (one-half of
2.3 million) women made one revisit that may not have been
necessary if clinics had used ACOG's recommendations.
--To estimate the costs of unnecessary revisits, we used the
fees that several of the clinics we visited would charge
full-paying clients for routine supply visits. The fees
ranged from $6 to $12. Therefore, the annual cost of the
1.15 million additional revisits could range from $6.9 mil-
lion 13.8 million.
Our estimate of the costs associated with unhecessary revisits
could be overstated or understated depending on the variability
nationally of such factors as the number and timing of client drop-
out, the types of revisits, and the actual costs of revisits. We
discussed our assumptions and methodology for estimating the number
and cost of unnecessary visits with Office for Family Planning
officials. They believed the estimates and underlying assumptions
are reasonable in view of the lack of national data needed to com-
pute the actual costs.
In addition to direct costs of clinic operations, unnecessary
visits to clinics increase the inconvenience and costs to the
clients. Some clients must take time from work or other activi-
ties to travel to and from the clinic and to be served. As another
consequence, limited clinic resources are not put to their best
use. The clinics could serve others in need of services if efforts
were not devoted to scheduling, serving, and keeping records on
clients coming for unnecessary visits.
1/The 50-percent estimate is derived from data we obtained on the
actual number of routine revisits made in excess of ACOG's rec-
ommendations at six of the seven clinics where we made statis-
tical samples of new 1978 clients.
13
proceeding with the regular visit. Generally, clinics using group
sessions had interpreted recommendations in HHS' guidelines as a
requirement for all new clients, and they felt compelled to cover
all topics regardless of the client's background or circumstances.
Some clinics using individual sessions relied on handout material
to cover part of the recommended topics and focused counseling on
the needs of the individual.
We could not determine with certainty whether group sessions
enabled clinics to provide services at a lower cost. In some
instances, however, the use of group sessions for new clients
(1) created bottlenecks in clinic operations because clients had
to wait until the session began and could not receive other serv-
ices until the session was completed and (2) usually increased the
time clients had to spend at the clinic for education and for the
entire initial visit, as shown below.
Average time
Average time
for education
for initial visits
Clinics with group
education (16 clinics)
53 minutes
2 hours 52 minutes
Clinics with individual
education (10 clinics)
24 minutes
1 hour 57 minutes
According to an earlier evaluation (see p. 25) of teenager
services made for HHS, group education sessions were often manda-
tory for all new patients, conducted as lectures, and entailed
little, if any, group discussion. The report concluded:
"While information about birth control methods
presented by most clinics was very detailed, with a
heavy emphasis on oral contraceptives, it was not
organized in such a way as to help the teenagers make
a decision, or even to communicate to the teenager
that such a decision was her responsibility to make.
Most presentations were didactic descriptions of what
each method is, and how it works. Information on ad-
vantages and disadvantages of each method as they
relate to one's particular situation * * * was rarely
included. As a result, teenagers tended to be bored
and impatient."
We discussed clinics' interpretations of HHS' guidelines on
education with Office for Family Planning officials. They said
that the discussion of client education in the current guidelines
was not intended to result in clinics providing education to
clients regardless of need. Consequently, they clarified their
draft revised guidelines to provide more flexibility to clinics
in tailoring education to suit specific needs.
16
ROUTINE ANEMIA SCREENING QUESTIONABLE
HHS could reduce costs by relaxing or eliminating its re-
quirement and recommendation for routine anemia screening. HHS'
guidelines require clinics to do anemia tests on all clients
during initial and annual visits. Although the clinics visited
were generally performing anemia tests on their clients, as re-
quired in HHS' guidelines, several clinic officials believe that
the requirement should be eliminated or relaxed.
Anemia screening entails taking a blood sample and testing it
for iron deficiency. The tests are commonly called hematocrits or
hemoglobins. ACOG's standards for basic gynecologic care call for
routine anemia testing. However, the standard is prefaced by the
statement that the obstetrician or gynecologist is often the sole
physician relied on by women. The portion of ACOGL standards
speci fically discussing family planning services state that anemia
tests should be done on when appropriate. ACOG's director of
practice activities told us that he does not believe anemia tests
need to be performed routinely on all family planning clients.
The results of our survey of Cincinnati gynecologists support this
view. Only 8 of 45 respondents said they routinely performed anemia
tests on oral contraceptive clients during initial visits and only
one said he routinely did such tests during annual visits.
This view was also supported by officials of several title X
grantees we visited. For example, the directors of New York State's
Bureau of Family Planning and the Cincinnati Health Department's
Maternal and Infant Care Program believe that HHS should eliminate
the requirement for routine anemia tests and allow them to be done
as needed. Officials at Grady Memorial Hospital believe the test
should be done every other year. Fayette County, Ohio, Health
Department officials suggested that it be done only at the initial
visit.
Only 4 of the 26 clinics visited had summary data on the re-
sults of anemia testing for recent periods. At three of the
clinics, less than 1.5 percent of the clients had test results the
clinics considered to be indicative of anemia. At the fourth
clinic, which served teenagers, about 12.5 percent of the clients
had such test results. However, the clinics did not always use
the same standards for defining anemia. For example, the latter
clinic considered hematocrit levels below 35 to be indicative of
anemia, while another one used a hematocrit level of 33 or below.
The full charges for these tests at the clinics we visited
in Ohio, for example, ranged from $1 to $5. Title XX reimburse
ment for these tests at several of the clinics ranged from $1 to
$4 HHS data indicate that family planning clinics did about
3 million anemia tests in 1978.
17
Gonorrhea Detection Results
Gonorrhea
positive test
Number of
results rates
clinics
(percent)
0 to 0.9
2
1.0 to 1.9
5
2.0 to 2.9
8
3.0 to 3.9
1
4.0 to 4.9
1
Total
17
At 10 of the 24 clinics making routine gonorrhea tests, offi-
cials said they did them because they thought HHS' guidelines re-
quired them. Since 1976 HHS guidelines have not recommended
routine venereal disease tests, except when circumstances indicate
the need The other 14 clinics made routine tests because of local
or State requirements.
Cost of routine screening
appears substantial
Although the clinic effort required to test any one client
is not substantial, the total costs of routine venereal disease
screening in cases where it is not justified may be substantial.
The syphilis test involves drawing blood from clients and sending
it to a laboratory for analysis, as well as completing and filing
related paperwork. The gonorrhea test is done by taking a specimen
culture during the pelvic examination, and it involves the same
type of related efforts as the syphilis test.
Data are not available to estimate the number and cost of
questionable routine venereal disease tests done by family plan-
ning clinics nationally. According to the Centers costs of
laboratory tests (exclusive of costs for collecting and transport-
ing the samples or specimens for syphilis range from $0.95 to
$1.90 and range from $1 to $1.50 for gonorrhea. Clinics we
visited charged clients up to $6 for each syphilis test and maxi-
mum charges for the gonorrhea test ranged from $3 to $12.
expects the maximum charge to represent the reasonable cost of the
service.) At one Ohio clinic, Medicaid paid $1.50 for collecting
the gonorrhea culture, and at an Indiana clinic, the Social Serv-
ices program paid $3 for a gonorrhea or syphilis test.
20
client fee system in September, but expected it to resume by the
end of 1980. Clinic officials said the ensuing client confusion
would probably make fee collection more difficult. Inequities
resulted because some clients were not charged while collections
were suspended, and others did not have visits during the free
service period. Also, clients with greater ability to pay could
receive free service while others with lower incomes would have
to pay.
Clients often think
services are free
Some clinics have been deterred from charging and collecting
client fees because clients believe they offer free service. This
is especially true of health departments which offer other serv-
ices besides family planning. Some staff members at health depart-
ments believed fees would deter some clients from seeking service.
Officials at 14 clinics told us most clients expect family
planning services to be offered free of charge. Eleven of these
were health department clinics which are traditionally viewed
as providing an array of free services to needy persons. For ex-
ample, at the Whittier clinic of the Los Angeles County Health
Department, officials said they had no fee scale because the de-
partment's policy is to provide free services. Clinic directors
in Detroit told us they collect only modest amounts from clients
because the city advertises its health department services as
free. At a Cincinnati Health Department clinic, staff members
said they have not charged for services because many of their
family planning clients are "graduates" from the title V prenatal
program, which does not require fee payment.
SOME CLINICS HAVE USED FEE
SCALES SUCCESSFULLY
Some clinics have implemented workable fee policies and de-
monstrated their potential to generate additional income. Some
of these clinics use techniques which could be applied elsewhere
to increase the fee income of title X clinics.
Georgia and South Carolina clinics, which are primarily
health departments, began charging fees recently when HHS' Region
IV officials insisted that they do SO. Georgia implemented a fee
system in September 1979. In the first 6 months of 1980, Georgia
clinics collected $183,105 compared with $38,793 collected in
been accomplished without charging clients who
met the State eligibility test for title XX which is about 150
percent of poverty. South Carolina began collecting fees in Jan-
wary 1980, and it had collected $176,040 by the end of June.
Charleston County Health Department officials told us that they
were surprised at the rate of collections. Charleston collected
as much from July through September as in the first 6 months of
35
H REPT97-208
786
do so, however, only after adequate notice and an opportunity for a
hearing cond cted within the State and after the Secretary has
conducted an investigation.
AGE DISCRIMINATION AMENDMENT
Conference Agreement
Conferees agreed to H.R. 3831 with Senate amendments. The
present law restricts any individual over the age of 64 from being
appointed Surgeon General of the United States Public Health
Service Corps. This bill removes this arbitrary age restriction and
specifies that the nominee have significant experience and special
ized training in public health programs.
The post of Surgeon General is filled by presidential appoint-
ment subject to confirmation by the United States Senate. It is not
the intention of this amendment to limit the responsibility of the
Senate to determine the qualifications of the nominee.
BLACK LUNG CLINICS
Senate Bill
The Senate bill proposed to repeal the authority for the black
lung clinics contained in Section 427(n) of the Federal Mine Safety
and Health Act of 1977 and to include this program in its health
services block grant.
House Bill
No comparable provision.
Conference Agreement
The conference agreement does not repeal the black lung clinic
authority and does not include it in a block grant.
MATERNAL AND CHILD HEALTH BLOCK GRANT
1. Authorization of Appropriations
(a) House bill.-The House bill provides for the consolidation of
the following programs into a block grant to the States under Title
V of the Social Secu. ty Act: Maternal and Child Health (MCH)
and Crippled Children's (CC) Services: Supplemental Security
Income for Disabled Children; Lend-based Paint Poisoning Preven-
tion; Sudden Infant Death Syndrome; Hemoph!lia Treatment Cen-
ters; and Adolescent Pregnancy.
Senate amendment-Similar provision, except does include Goi
netic Diseases programs in the MCH block grant but does not in-
clude Adolescent Pregnancy under the MCH block grant.
included
Nae
nrovisios differention
(b) House bill.-The House bill authorizes an appropriation of
$394,000,000 in fiscal year 1982 for the MCH block grant.
Republican
Study
Committee
RSC
Chairman
Executive Director
REP. RICHARD T. SCHULZE
RICHARD B. DINGMAN
TITLE X (FAMILY PLANNING) BUDGET CUTS WILL REDUCE WASTE AND DUPLICATION
SCOPE: This Fact Sheet will identify areas in which the
Title X family planning program can be reduced, based on
(a) GAO's findings of waste and mismanagement, and (b)
Title X's duplication of family planning services provided
elsewhere.
Current Status
Title X will be funded in the FY '82 Labor/HHS/Education appropriations bill.
Neither the House's nor the Senate's full Appropriations Committee has yet marked
up this bill.
Background
The Administration proposed the consolidation of Title X into a preventive
health services block grant at 75% of FY '81 appropriations, or $121.5 million.
Instead, Congress authorized Title X as a categorical program, with a FY '82
funding level of $130 million.
Because of the unusually high level of waste and mismanagement in Title X, and
because of its duplication of family planning services that are provided else-
where, the Title X program can be drastically cut without adversely affecting
services, and thereby contribute to a large reduction in the federal deficit.
The GAO Study of Federal Family Planning
On June 19, 1981, the GAO released a report entitled, "Family Planning Clinics
Can Provide Services At Less Cost But Clearer Federal Policies Are Needed."
According to the GAO, DHHS "could reduce the costs of such programs and make
services less costly and more attractive to clients without compromising
quality care."
This material was prepared at the request of a member of the Republican Study Committee. I he views contained in 11 should not be construed as
being the views " the Republican Study Committee. its officers or its members.
ROOM 413, CANNON PUDIN S. HOUSE OF EPRESENTATIVES, WASHINGTON, DC 20515 (202 225-0587)
In FY '80, Title X served 3.8 million people in 5,125 clinics. It is the largest
federal family planning program, and the only federal program devoted entirely to
family planning issues. Some of the services provided by Title X clinics are re-
imbursed by other federal programs, such as Medicaid and social services (Titles
XIX and XX). For the sake of budgetary convenience, this Fact Sheet will group
together GAO-recommended savings in all the Title X-related federal family
planning programs.
Just by reducing waste and mismanagement in areas identified by GAO, it is esti-
mated that the federal goverment can save up to $39.3 million in Title X's
clinics. Additional savings are possible in areas where Title X duplicates
other federal family planning programs.
A. GAO-Identified Areas for Savings in Family Planning Programs
1. Unnecessary revisits to family planning clinics (1.15 million
unnecessary revisits in 1979). GAO estimate of cost for
unnecessary visits
$6.9 - 13.8 million
2. Unnecessary education provided to clients. GAO does not give
a specific estimate. However, if each of the 5,125 Title X
clinics wasted only $1,000, the total would be
$5.1 million
3. Unnecessary routine anemia screening. Reimbursement in
sample clinics ranged from $1-4 per patient. If only half
the 3.8 million clients received unnecessary screenings,
at an average cost of $2.50, the waste would be $4.75 million
. .
$4.8 million
4. Unnecessary routine VD tests. Of 26 clinics visited by GAO,
24 routinely tested all clients for gonorrhea, and 14 for
syphillis. This frequency is far in excess of normal medi-
cal standards and DHHS guidelines. Extra costs for VD tests
include lab fees, transportation of samples, pelvic exams
and paperwork. If half the 3.8 million clients received
unnecessary VD routine tests at a cost of $4 each (conser-
vative estimate), unnecessary costs would be
$7.6 million
5. Failure to implement sliding scale fee schedules. GAO
does not estimate the loss nationally. But two states
cited Georgia and South Carolina increased their
clinic fees by $144,000 and $176,000 respectively in the
first six months they began charging fees. This is an
annual average of $320,000 for each of those states.
If only half the states could make similar reforms in
charging fees, the savings would be
$8.0 million
Total Savings in Areas Identified by GAO
$32.4 - 39.3 million
B. Title X Appropriations Can Be Further Reduced To Avoid Duplication of Other
Family Planning Programs
1. The new Maternal and Child Health block grant includes
$8 million for Adolescent Pregnancy. A large proportion
of Adolescent Pregnancy money is used for family planning.
Since the states are most likely to spend their MCH
adolescent pregnancy family planning money in existing
Title X clinics, a sum equal to the money so spent can
be removed from Title X with no overall loss of service
up to $8 million
2. Up to $20 million can be transferred to the new
Adolescent Family Life Program. AFL incorporates
an innovative approach that is more likely than
Title X to succeed in reducing unwanted pregnancy
and abortions. By contrast, massive Title X
funding has failed to achieve these objectives.
According to Planned Parenthood statistics,
adolescent pregnancy rates nearly doubled between
1971 and 1979, and the abortion rate nearly
doubled between 1973 and 1979.
Transferring funds from the ineffective Title X
to the innovative AFL program will avoid unnec-
essary duplication of services that will be provided
more effectively by the new AFL program
up to $20 million
Possible Additional Savings
up to $28 million
TOTAL POSSIBLE SAVINGS
up to $67.3 million
*
Jack Klenk
September 18, 1981