Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, January 27, 1993 TAG: 9301270312
SECTION: EDITORIAL PAGE: A11 EDITION: METRO
SOURCE: CABELL BRAND
DATELINE: LENGTH: Long
VIRGINIA IS FAILING ITS HEALTH-CARE DUTY
PRESIDENT Clinton has said the biggest issue he faces in the country is health care - controlling costs and expanding coverage. This debate, while critical and ongoing, obscures local and state health issues.The federal government has a huge responsibility by funding Medicare, 50 percent of Medicaid, setting rules and regulations, etc. However, basic health care is delivered locally by our area doctors, hospitals and medical facilities.
Thirty years ago, there was no Medicare or Medicaid. The first health insurance was established 60 years ago. But public-health responsibilities go back more than 100 years.
Budget problems in Virginia have been dominated by increases in mandated Medicaid, under which the state pays 50 percent of the cost for about 300,000 poor people. This overlooks the 1 million Virginians who are uninsured, and perhaps 1 million more who do not participate in the health-care network with primary-care access.
The Virginia Department of Health has the responsibility of protecting the health of all Virginians. Specifically, it protects the health of children with immunizations; Women, Infants and Children (WIC); Children's Specialty Services; Well Child Clinics, newborn screening, etc. It helps protect the health of expectant mothers with prenatal services. It helps with family planning to reduce teen-age pregnancies and unwanted pregnancies.
The department protects the public water supply, and regulates sewage-treatment plants and wells. It protects the food supply and certifies all food establishments. It maintains vital records, investigates unexplained causes of death, assures competent local emergency medical services.
The department is responsible for the prevention of communicable diseases via immunizations and epidemiology investigations into tuberculosis, HIV and AIDS. The department regulates hospitals, nursing homes, home health-services, and medical laboratories, and issues certificates of need for new or expanded medical facilities.
The department does all of this with 2 percent of the total state budget, but with only 1.52 percent of Virginia's general funds. More money is passed from the federal government through the state to deal with the above services than Virginia contributes.
It is tragic that the percentage of state general-fund dollars to the Health Department has declined from 1.68 percent to 1.52 percent in the past eight years. This is in spite of the drastic rise in health-care costs and risks.
Recognizing the responsibility of the Department of Health - with local health directors, local offices and clinics in every city and county in Virginia - we have developed a six-year plan to identify unmet health-care needs that can be provided locally. We have prioritized them. We have estimated the costs.
The Department of Health needs an additional $134 million a year to fulfill its responsibility, with a concentration on prevention, primary care, early intervention and children. There is an absolutely critical need for $29 million now, to help locally with the health-care needs of pregnant women and children, public-health nursing, immunizations and rural health initiatives, and to provide public support for the extraordinarily successful Child Comprehensive Health Investment Program (CHIP), started in Roanoke and still funded by the Kellogg Foundation for one more year.
Other unmet needs include environmental-health activities, work-site health-promotion programs, home-health indigent care, infant-tracking programs, increased Medicaid services, expanded child-development clinics, and early intervention.
The governor and most of the Virginia legislators have overlooked these responsibilities, and have made no effort to find the needed resources.
The tragedy is that these resources would exist from increased tobacco and alcohol tax revenues. Virginia has the lowest tobacco tax in the nation - 2.5 cents! The average in other states is more than 25 cents, with 47 cents in Hawaii. New York has 39 cents, with a new proposal to add 21 cents and make it 60 cents a pack.
Our proposal is quite simple. Get the same revenues other states get. Since Virginia is required to pay 50 percent of Medicaid costs, and the federal government will get this year 24 cents per pack from Virginians, we should tax Virginians at the federal level of 24 cents.
By indexing this to the federal level, we will tap a source of revenue for us to pay our share of these and other health-care costs. Bring the alcohol tax rate up to the federal level as well. Then allocate these additional funds to health care in Virginia, leveraging the dollars as best we can with more federal dollars.
If all this were done, Virginia could raise more than $250 million a year. Many states raise much more. We could then meet all the additional local and state health-care needs identified above, plus start a trust fund for the uninsured.
This program is logical. At least 25 percent of the total medical costs in Virginia are directly related to smoking. About 40 percent of the total medical costs are related to tobacco and alcohol. This tax, therefore, is a user fee, further warranted by the new data on the health effects of secondary smoke and the problems on our highways with drunken drivers.
This proposal would be supported by more than 70 percent of the people. What is needed is a people's lobby to overcome the powerful tobacco lobby and the irrational "no new tax" philosophy that have tied the hands of many legislators.
Nobody wants taxes increased. We don't want to have a negative impact on the earnings of tobacco farmers, tobacco companies, or alcohol-producing and -distributing companies. Increased costs will cut demand. But the suggested increases would have minimum economic effect on Virginia businesses, while the benefits would be enormous.
One simple concluding statistic: The Carnegie Foundation has shown through an extensive study that nearly 30 percent of the children in America are not ready for public kindergarten, with poor health being a major contributing factor. If the Department of Health had the resources explained above, we could ensure that all children in Virginia would be in the health-care network when they enter the public-school system. This would create healthier, more productive citizens, which would pay enormous dividends over their life and to society.
Sooner or later, these taxes will be imposed and these programs will be implemented. The longer we wait, the less healthy our children and our society will be.