Interview in "The Nation's Health"

Q. If the nation's private health insurance industry has been unwilling to adopt effective cost containment mechanisms, unsuccessful in assuring significant consumer policy input, and slow to incorporate coverage for innovative elements of comprehensive care, what role, if any, would you encourage the industry to perform in any governmental national health insurance scheme?

Governor Carter. I support the enactment of a phased-in, comprehensive national health insurance program. I think the public wants such a program and I intend to work vigorously to get it.

I have also repeatedly said that financing reform alone is not enough. We must bring about basic changes in the way health care is provided to our people. We must emphasize the value of personal preventive care. We must work to make our environment more health-promoting, and less healthdamaging.

While I have proposed reforms in several areas of our health care system, I have also repeatedly pointed out that there is much that is very good and of which we can be proud about that system. We must preserve that part and build for the future.

As we set out to improve the system, I urgently want the cooperation of health professionals and health workers. Similarly, I want the cooperation and assistance of the private health insurance industry. I have not finished my analysis of the precise role the industry should play. I think we must establish a framework for their participation in a reasonable manner.

What our goal must be is what is best for the people of this country. Our people have a right to expect high quality medical care that is readily available and affordable. If the private insurance companies can help achieve that goal, then I want their help.

Q. Both the geographic maldistribution of health personnel and varying stale licensure practice contribute to serious inequities within the nation's health care system. To what extent would you encourage national certification or institutional licensure as alternatives to the traditional model of state licensure in health occupations?

Governor Carter. The problems of health personnel maldistribution are very serious, and I am not prepared to decide on a single approach to this problem. I am studying the problems and various proposed solutions, and with the advice and assistance of the health community and others I am attempting to find a sound approach that is related to our needs for health care financing reform and delivery system reform.

I believe we can develop incentives, rather than coercive measures, to attract manpower to underserved areas and to make reform possible in related areas.

Q. How would you modify the Food Stamp Program to assure its manageability and cost effectiveness?

Governor Carter. Like other categorical programs for the poor, the Food Stamp Program has become a morass of waste, fraud, and mismanagement GAO reports have found that college students with average incomes as high as $500 per month have been receiving stamps, and that waste and fraud may be costing the government $23 million per month or more. A study in California found that as much as half or more of food stamp expenditures go for administrative overhead.

Obviously, we need to reform and tighten the system to insure that food stamps are only available to those who truly need them. This reform, however, should not consist of broad, blind cutbacks eliminating many of the elderly and poor from the rolls. More importantly, we need to consider food stamps as part of our overall program for welfare reform. A single national program providing a basic level of benefits will be far more efficient and manageable than the current multiplicity of programs, each with separate standards, administrative machinery, and clientele.

Q. Increasingly, U.S. policies concerning international health have been linked to political goals. Are there political considerations which would lead you to advocate withholding available food, medical assistance, or disaster relief from the needy of certain countries?

Governor Carter. What is important is to redirect international aid to meet the human needs of the greatest number of people. This means an emphasis on food, jobs, education, and public health—including access to family planning.

We must insure that our aid gets to where it does the most good.

For years our policies have either ignored the developing countries or treated them as pawns in the big power chess game.

The emphasis in aid should be on those countries with a proven ability to help themselves, instead of those that continue to allow enormous discrepancies in living standards among their people.

Q. Should manufacturers be required to prove the nontoxicity of substances before releasing them into the environment and marketing them for public use?

Governor Carter. I have long supported, and if elected would vigorously enforce, legislation requiring that new chemicals be screened prior to their introduction on the market. Chemical manufacturers should be responsible for testing their products to ensure that they do not pose unreasonable risks to human health or to the environment We have too long permitted our workers and our environment to be used as the testing ground for potentially toxic chemicals, and the Toxic Substances Control Act approved by Congress on September 28 deserves the full support and commitment of the President.

By waiting until after release to determine toxicity, we increase the difficulty and the costs of correcting the problem—costs which are ultimately borne by both the industry and consumers.