&dquo;In the United States we&squo;re very good at inpatient care, in other words when you go have surgery,&dquo; says Shuler. &dquo;But what about the follow-up? What about your diet going forward? What about your exercise going forward?

&dquo;We all ultimately have to be accountable for our health, but one of the big keys is we have to have more people participating in (disease management) programs because when people are being more accountable their health becomes better.&dquo;

Shuler has spent a lot of time recently working on health care issues as Congress continues to debate potential reforms. Earlier this month he held the first of two Tele Town-Hall meetings on health care to hear from constituents. He plans to hold the second Tele Town-Hall meeting next Tuesday. To participate, area residents can call Shuler&squo;s office at 202-225-6401 for a tollfree number to access the conference.

Shuler, now in his second term, is a member of the Blue Dogs, a fiscally conservative wing of the Democratic Party that objects to&bsp; costs associated with the current House proposal, HR 3200. Reform should be &dquo;deficit neutral,&dquo; he says, adding that it can&squo;t be funded by printing money.

&dquo;I don&squo;t ever see HR 3200 making it out of the House,&dquo; he says. &dquo;There are so many changes that need to be made to it. At least there was not the support in the House when we left Washington, and not just from the Republicans and the Blue Dogs, but from the Dems.

&dquo;The problem with HR 3200 is the waste, fraud and abuse that&squo;s in the system, and without correcting some of those problems, just adding people to the system is not going to fix it. It&squo;s only going to compound the problem over a longer period of time.&dquo;

The House is expected to resume work on health care reform proposals following the Labor Day holiday. While Congress is out of session, Shuler has been travelling across N.C.&squo;s 11th Congressional District, which includes Polk County, and discussing health care. On Tuesday he met with the Western Highlands network, which covers Polk County, to discuss issues relating to mental health care. On Wednesday, he met with Polk County government officials and also discussed his views on health care with the Bulletin.

The Asheville Project

Shuler explained that he hasn&squo;t had to go far to find a successful working model for health care reform. His district is home to The Asheville Project, often cited as a leading example of changes that reduce health care costs, while improving participants&squo; health.

The project, started by the City of Asheville, a self-insured employer, created disease management programs for employees. The program targeted employees with health problems such as diabetes who had the highest annual costs in their group. Those employees were provided insurance to cover all of their medical costs, including medication, test strips and copayments. It also required them to meet with their pharmacist to learn proper blood testing and medication use, to meet with a dietician to develop a suitable diet and to meet with a physical therapist to establish an exercise routine.

After 10 years, the program has expanded from 50 to more than 1,500 people and spread to other cities. In additional to diabetes patients, it also helps those with hypertension, asthma or mental stress. As a result of the program&bsp; Asheville has seen a 50 percent reduction in absenteeism, while medical costs are down more than $2,000 per person per year, according to Shuler.

&dquo;They found that the people participating in the program, the people who had a disease, had (medical costs) equal to or lower than those for people who were not in the program,&dquo; says Shuler.

He adds that the program has a 95 percent satisfaction rate among participants, who are now &dquo;engaged in a better quality of health.&dquo;&bsp; As their health improves, their life satisfaction and their productivity at work also improves, but their health costs go down.

Shuler is so impressed by the success of The Asheville Project that he&squo;s presented the program, including a host of facts and figures showing its positive outcomes, to Congress. The project and others like it can be the model for a national health care system, says Shuler.&bsp; He says he believes Congress will work on such ideas when it goes back into session in September.

Cooperatives

While he&squo;s raised concerns about the proposals that include a public option for health care insurance, Shuler says he sees &dquo;some great ideas from the cooperatives standpoint. He stresses the need, though, to build large co-ops so costs can be spread over a large pool of people.

Shuler says any reform, whether incorporating cooperatives or not, must focus on improving access to health care, making health care more affordable and improving the quality of health care.&bsp; He emphasizes that the emergency room can not serve as primary care for citizens. They need&bsp; more access, he says, to primary care physicians for &dquo;routine check-ups, physicals and prevention so we can head off a lot of these problems before they become major issues.&dquo;

Shuler says even parts of the Farm Bill he helped pass in the House this year were aimed at preventing health care problems.

He notes that North Carolina ranks 5th in the country for obesity among children. To combat that problem, the farm bill promotes locally grown fruits and vegetables for the WIC program and programs in schools. Such programs can help students develop better dietary habits while supporting local farms, he says.

Medical records

Shuler also is an advocate for expanding electronic medical record systems.

&dquo;I was in the electronic medical records field and smart card technology before coming to Congress and what you find is you can do the interface between two different (records) systems so you don&squo;t have to duplicate records,&dquo; he says. &dquo;With the datalink system we have in our local hospitals they send data electronically so when a patient is transported from one of our outlying hospitals to Mission the information is actually sent before the patient arrives.&dquo;

That way the doctor at Mission can see what tests have been run, review the patient&squo;s healthcare chart and avoid duplicating tests. Shuler says the same technology should be used when someone is transferred from a primary care physician to a specialist or from one specialist to another.

&dquo;Far too often they will schedule them to have another MRI or CAT scan or to have X-rays so we can cut some of the costs down by having electronic medical records,&dquo; he says.

If the reforms he is promoting are adopted, Shuler says residents would see a decrease in their health insurance permiums, and an increase in the quality of their care. He also says patients would not be dropped from insurance for pre-existing conditions as they often are now.

Reform &squo;a necessity&squo;

Despite the problems reaching a consensus on even a direction for health care reform, Shuler says reform is &dquo;truly a necessity&dquo; and Congress must continue working toward a solution.

The current system&squo;s long-term costs, which are even more pronounced during slow economic times such as now, are not sustainable for many individuals and small businesses, he says.

&dquo;I hope people realize that this is about the health and livelihood of the people of this country, and that they need to have access to&bsp; affordable quality healthcare,&dquo; says Shuler. &dquo;We can do that if more and more people join the Blue Dog caucus and decide to drop the political barriers and get reform that is right for the people of this country.&dquo;