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Carolina Journal Radio No. 725: Direct primary care could help fight chronic diseases, disabilities

Carolina Journal Radio / Donna Martinez and Mitch Kokai
The Truth Network Radio
April 10, 2017 12:00 am

Carolina Journal Radio No. 725: Direct primary care could help fight chronic diseases, disabilities

Carolina Journal Radio / Donna Martinez and Mitch Kokai

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April 10, 2017 12:00 am

An increased focus on direct primary care could lead to major benefits in the fight against chronic diseases that lead to disabilities. That’s the conclusion of the latest report from Katherine Restrepo, the John Locke Foundation’s director of health care policy. Restrepo explains why DPC holds so much promise for addressing one of the most vexing problems in American health care. As policymakers in Washington consider potential repeal and replacement of the Affordable Care Act, one observer who’s watching their actions closely is Tevi Troy, chief executive officer of the American Health Policy Institute. Troy is also former deputy secretary in the U.S. Department of Health and Human Services and a White House official under former President George W. Bush. Troy discusses the reforms he would like to see as efforts continue to repeal, replace, or reform Obamacare. Some state lawmakers are focusing increased attention on fighting opioid abuse. Republican legislators and Democratic N.C. Attorney General Josh Stein recently stood together to promote the potential benefits of the STOP Act. You’ll hear highlights from their presentation. Competition has helped make the Triangle one of the best places in the nation for college basketball. That same type of competition could help improve public education in the Triangle and across the state. That’s the assessment from Richard Vinroot, the former Charlotte mayor and N.C. charter school pioneer who also had firsthand experience with Triangle basketball competition as a member of the UNC Tar Heels playing for Coach Dean Smith. Vinroot explains why he believes competition plays such a key role in education reform initiatives. Payments tied to North Carolina’s eugenics compensation program have been delayed because of ongoing court cases. Jon Guze, the John Locke Foundation’s director of legal studies, explains the significance of the legal dispute and its impact on eugenics survivors.

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From Cherokee to current attack and the largest city to the smallest and from the statehouse into the schoolhouse Carolina Journal radio your weekly news magazine discussing North Carolina's most of public policy events and issues welcome to Carolina Journal Radio One Coke during the next hour, Donna Martinez and I will explore some major issues affecting our state as policymakers in Washington continue to haggle over the future of healthcare. The head of the American health policy Institute offers ideas about the best way to approach reform a bipartisan group in Raleigh is backing the stop act. It's a measure that steps up the fight against opioid abuse. You learn details of former UNC Tar Heels says the competition that is made college basketball so great in North Carolina have positive impacts on public education to learn why. Plus, you learn why court cases are causing delays and payments tied to the states eugenics compensation program.

Those topics are just ahead. First, Donna Martinez joins us. She has the Carolina Journal headline. It's called direct primary care and innovative approach to delivering medical services and now a new report from the John lot foundation concludes that if we used direct primary care more we see better outcomes for patients with chronic diseases and further we can actually cut the incidence and severity of disabilities. Catherine Restrepo is the author of this new policy report she's the director of healthcare policy for the Locke foundation Catherine welcome back Pinky before we talk about the details. This is pretty exciting because you're talking about having a real impact on job on people's health explained to us what DPC as it's known really is, how does it work yet direct primary care DPC as you say it's it's like a healthcare gym membership to think of it that way.

So, in exchange for a monthly fee and average monthly fee is $75 for a patient in return for that fee. That patient has around-the-clock care to their primary care physician on and it also includes this define package of basic primary care services that can be EKG testing that can be skin biopsies on joint injections, comprehensive annual physicals and those can really go on and they are on these doctors also on offer generic medications they can prescribe them in North Carolina and in 44 other states that matter in Houston. They can also I negotiate discounts with with lab companies and wholesale cost to to do lab you can actually text your doctor or email your daughter and that quick response email your doctor and you now don't get me wrong, there's a lot of primary care practices where you had patient portals, and you can check in with your doctor through patient portal and look at your electronic medical record, but the key difference here is that these doctors there so price transparent and they're making healthcare much more affordable for low and middle income families were struggling to pay for their health insurance premiums and not simply because they do not accept insurance. There completely removing primary care from insurance and knothole concepts can make health insurance so much more affordable for more people you been digging into the data on this and it's a fascinating report.

It's available@johnlock.org you been looking at what would happen if we not only increase the use of direct primary care about what's been happening from the providers who are already using it and you say that if we used it more we can actually help folks who have these chronic diseases explained that yes and when you look at this model, people think of this model it's it's similar to concierge medicine. These doctors charge a premium. People have to have disposable income to have this around care access and be able to afford that, but were only healthy and these doctors are only cherry picking healthy patient that have the money to access them. But that's really quite the opposite. If you look at this model the patient's really that would benefit from Moses to a get the most out of their monthly healthcare gym membership.

If you and referred to it as that. Are people with multiple chronic conditions. I mean nationwide, more than one into people are diagnosed with just one chronic disease more have been so many people have multiple or known as comorbid patients and when you can spend more time, I mean time is the value here in the direct care model when you can spend more time with their physician that improves access to care and he can really reduce healthcare costs downstream the specialty care visits the hot unnecessary hospitalization visits are unnecessary referrals to specialists as well.

So let's just be clear to you when you're talking about people who have chronic issues and multiple issues as they maybe someone has high blood pressure right diabetes diabetes. Maybe they've got a problem with their thyroid so that these different conditions that are all affecting them in different ways and you're saying if they use direct primary care and have this very easy access to their doctor right. It really keeps it under control.

But yes, because there I mean 50% of people with high blood pressure in the report with the other statistics that there are a high percentage of people who have chronic conditions and can have a current chronic condition can be managed can be managed well meaning year you're in compliance with her medications are going to see her primary care physician you're engaged with your health, your managing your disease well but there are many people out there simply because of the access and time issues that many patients are facing the healthcare system when they have these chronic condition conditions under not being controlled or not controllable, and that again because of lack of time so more an investment of the primary care level more time with their physician can really rein in the spending on on patients with healthcare or with chronic conditions and improve the patient's overall health in the policy report you, lay out the data said that you just described, but you also then say that if we were able to do this and the fact that done this helps people and would help more people manage them chronic issues.

It's going to lead to a lesser number of people who have disabilities. How is that will because if you have chronic conditions and they go untreated or go and manage that can lead to disabilities.

For example, on kids with asthma. I mean, that can lead to limited mobility limited activity they can to ongoing people who are diabetic and their holistic care is not taken care of in a timely and appropriate matter that can lead to foot amputations or or other problems which leads to other disabilities. This sounds really exciting to me. Really, just because I happen to have a number of people in my family who are dealing with multiple issues and it's a problem they're constantly trying to see different doctors and the doctors are having to talk about how the medications interact and all that it may become well exactly and it mean to have such a greater impact for timing because the report also spells out and a lot of academic medical literature says that there is more of a stronger association with lower income people having been diagnosed with chronic illnesses and that again goes back to lack of access, adequate access to healthcare and if this were incorporated into Medicaid somehow where there's will know use Bill have preserved that relationship between the physician and the patient on this can really be an impact for taxpayers new letter funding, Medicaid, and more importantly for the Medicaid patients themselves there so many aspects to this whole thing and one of them that you write about Catherine is them the issue of government actually using this. I know that you have talked previously about when to be interesting of the state health plan, perhaps to the advantage of this, but we know that Union County the government employees in Union County have access to this as an option has a working yes they do. It's been working great on within one year. They've saved over $1 million in healthcare claims not just on 44 to 40% of Union County workers that have chosen a direct care physician as their primary care provider and again this these direct care physicians. They don't accept insurance.

But the great thing about Union County or from an employer's standpoint, is that when the offer direct care as a value-added benefit option is still works alongside their traditional health insurance plan so they can still have access to specialists in network that their health plan offers for specialty care hospital care to scan the best of both worlds. The true rat what people call a wraparound policy so everything wraps around the insurance plan itself that's designed by Union County because they are self-insured employer meeting there there at risk for all the claims they incur by their their workers on you.

They are able to restructure their healthcare benefits where it wraps around primary care benefits and adjust include specialty in and things are catastrophic. Her last nursing medically. Lastly, Catherine.

How prevalent is this in terms of the number of doctors who are going this route just say no to insurance on the deal with my gadget well you know it's growing for Cheramie and still very niche market and mean only about 30 doctors are practicing in the state of North Carolina may be between three and 5000 nationwide, depending on if it's considered pure direct care they don't accept insurance or affect the concierge doctor who does do insurance but charges that monthly retainer fee. It's all laid out in Catherine Restrepo's new policy report Catherine thank rein can say with as much more Carolina journal radio to come in just a moment government plays a key role in your life affecting your paycheck will you educate your kids the way you do business.

How can you tell if government is doing a good job making the right choices. Spending tax dollars wisely. Carolina journal.com tackles those questions every day.

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No one else is covering what else a rundown of the best new stories, editorials and opinion columns in North Carolina. John Hood's daily Journal new stories and important public events@carolinajournal.tv and the voices of the newsmakers themselves at Carolina journal radio imprint on the air and on the web. You can find the information you need@carolinajournal.com welcome back to Carolina journal radio I Michiko God. It's hard to read a newspaper watch a TV newscast or listen to talk radio without hearing something about the future of American healthcare as policymakers debate the merits of replacing the affordable care act or Obama care were joined by an analyst with expertise on that topic. Debbie Troy is CEO of the American health policy Institute is also a former deputy secretary in the US Department of Health and Human Services and an aid in George W. Bush's White House next door to us the Sharper Image so this obviously is one of the big news items that we been dealing with really ever since the election than we do.

The Donald Trump would be the new president is what's going to happen in the future of government involvement in American healthcare as you're watching this debate. What are you focusing focusing on making sure that we maintain the key building blocks of the American health policy system. So for example hundred 77 million people get their healthcare through their employers will make sure that the that continues a lot of people get healthcare through Medicare and Medicaid you want to make sure. To the extent that we are committing resources to meet our promises to the elderly and to impoverished that we have systems in place that are or maintaining the systems, but in a responsible way. Obviously, I think there's too much spending and too much fraud in some of those programs. I think they can be trained in, but they are looking for those together and those in the basic building blocks where the vast majority of Americans get their coverage and then you have to worry about where the people who been falling through the cracks and that was the whole reason for the ACA. The Obama care debate is that the too many people been falling through the cracks. People who aren't employed are people who don't have an employer that provides health insurance and then soak you have to think about those people and how to fit them in. That doesn't necessarily have to govern how old the entire rest of the system operates it.

I think it's shortsighted to say there's a group of people who fall through the cracks and were to remake the entire system for that group. We need to focus a program or series of programs or policy approaches that help those specific people without initially upending the entire lot of the debate these days has been about to repealing and/or placing the affordable care act or Obama care and some people of said one of just repeal the law that was passed in 2010 to go back to what we had before. 2010 is that even possible. It really isn't possible referral character has a lot of problems with the huge premium increases. Think a lot of incursions on liberty including the individual mandate, and the employer mandate limited choices in its network in terms of insurers falling out so there's a lot of probably ACA, but there a lot of problems with our system beforehand, including way too many people who were uninsured.

So I think there are ways to get to a more value driven system.

A system that uses our heavy spending on health. We spent about 18% of our GDP on healthcare, which is twice what are our European allies spend about so we can use those resources more effectively to get more could care more people so I don't want to go back to the old system. I want to use the ACA. I think we need 1/3 way going forward. That is the voice of Debbie Troy. He is CEO of the American health policy Institute, also a former deputy secretary in the US Department of Health and Human Services during the Bush administration as we've heard the various debates about how to move forward.

Are you are you mainly encouraged discourage mix about what people are talking about are they focusing on the right things most discouraged when things are too focused on the politics into this party winners a party when I think was unfortunate that the ACA went forward with only Democratic votes, and that meant that this Unipart is an approach to include Republicans and that's a problem because throughout our history we have had controversies over social welfare legislation, but all previous pieces of social welfare legislation have passed with bipartisan support, which meant that the American people swallowed it afterwards and moved on. It's okay this something that they agreed on Washington never going forward, given the Unipart is an approach of the ACA.

There's no sense of the Republicans are going to do it with no Democratic votes in large part to the Democrats and we also refused to cooperate over think that Pres. Trump you have someone who Democrats might look initially, this does not a traditional Republican. Perhaps we can make deals with them. But there's been no interest was far from the Democrats so I would like to see a sense of sensible but also bipartisan approach going forward that really love the American people say, okay. Both parties have had their say they work together on this and this is the way were going to use a work with her health system going forward.

I'm nothing. Evidence of that rhino, the things that has struck me in talking to people who are experts in your field. The field of healthcare is. Some people say the formal care act spent a lot of time a lot of political resources a lot of money and really dealt with health insurance but didn't necessarily address some of the key problems in healthcare itself. Are we missing the boat before focusing only on the insurance aspect and not on things like access to care, improving the care that we have the ACA said it was good to be about bending the cost curve. Nobody really was. It was really based on coverage and the ACA's proponents say correctly that more people are covered. As a result of the ACA.

But when you subsidize something and you make it illegal not to do that. Something, then you're going to have more of it and it was just a basic fact of life and so by doing this focus on coverage only.

I think the ACA do a disservice and didn't really look at ways to improve the system. When the publicans are looking for their own approach. They obviously have to deal with what they been handed to in the form of the ACA and that shapes their approach as well so I think the problem is the original sin if you will, of the ACA continues to cause problems for so as the legislation moves forward that would change repeal replace Obama care is that mean they're still going to need to be some work done outside of that whole context to deal with American healthcare and government's proper role or, absolutely, but I think that some of the key things that have to happen could be led by the private sector think we need to move to a more value-based healthcare system would let me means were people take cost and quality issues into account when they are making their own decisions right now with a heavily third-party payment system.

People don't think about where they're going to get there care where the doctors of the best places or the doctors provide the best value if you had a more value to base driven system. Then you would potentially be able to drive down costs and drive quality up.

We seen this and every other form of our economy and if you look at the iPhones or if you look at TV cameras or even radio equipment. All these things, the quality keeps going up and the cost keeps going down because the power of consumerism.

We've not unleashed the power of consumerism in our health care system, largely because of third-party payments and I understand that in the parts of healthcare that aren't affected by third-party. You actually do see things like the laser riser. Valerie my six great example here is something where the technology continues to improve. The price continues to go down because people pay out-of-pocket would let me means the price compare and they will drive from one end of the state to another and stick to my truck to another state.

Sometimes they may drive to another another country to get better services and because of this power concern consumerism that the providers have to improve their product and reduce their costs. If you have third-party payments, then you're going to have providers who know that they effectively have either a monopoly or a disengaged consumer base in the consumer base is just going to go wherever they go, because that's where their insurance company tells them close to their house synonymously can best care at the best price in the brief time that we have left. How confident are you that once this debate on Capitol Hill is concluded going to end up something better than what we have now under the form correct. Well once you have the political process at work.

I lose a lot of confidence in the ability to better things.

I think the affordable care act has been extremely problematic so I'm I'm somewhat optimistic they will have something better than it but I don't think were going to solve the problems American healthcare with government action. One of the people who's going to be watching that government action very closely is to be Troy CEO of the American health policy Institute. Also, former deputy secretary in the US Department of Health and Human Services left on Carolina Journal radio just about are you looking to make North Carolina more free the John Mott foundation is in here are three things you can do today to help us make it happen.

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Welcome back to Carolina radio why Michiko got North Carolina lawmakers want to take more steps to fight opioid abuse. One option a piece of legislation called the stop act State Sen. Jim Davis explains the problem every year.

This takes a painful pole on our families and are committed across North Carolina every day for North Carolinians God from a medication or drug overdose, 36 are hospitalized and 64 are taken to the emergency room. The number of statewide opioid overdose.

This has grown by nearly 400% seven drug overdoses. Now the number one cause of accidental surpassing vehicle crash another Republican legislator representative Greg Murphy is also a physician. Enough is enough and it is time that we turn the tables on the scourge that is paralyzed my wife's goal has been to serve others is a physician but I'm here today in a unique position as both a physician and a legislature to help provide leadership to our states healthcare providers as we once were actually prescribed legal take ownership and leadership on this issue.

It is the hope and the intention that by common sense, legislative restriction of some opioid prescribing habits that we will slow the flow of yours being misused Democratic Atty. Gen. Josh Stein supports the stop act. In addition to this incalculable human cost to society our societies including billions of economic costs and the problem is worsening by the you. This must stop in the stop act as an important first step in this regard. To successfully confront the opioid epidemic needed to implement a multifaceted approach that includes better prevention, treatment, and enforcement. That means smaller prescribing more funding and focus on treatment and recovery and smarter enforcement to aggressively go after the dealers and traffickers who are profiting on people's misery and death. Republican Sen. Tom McInnes adds a personal story epidemic that impacted my family. We lost a beautiful absolutely wonderful song to this started because of an automobile accident where he broke a couple of bone was given of all of these horrid drug and they started a downhill spiral with the loss of his life started because he was given about 30 of these bills and the reason you hate the first goal of all cardio that's Sen. Tom McInnes, one of the supporters of a bill called stop act aims to help fight opioid abuse in North Carolina will return with more Carolina Journal radio in a moment.

Are you tired of fake news. Well you won't find it here at Carolina Journal.

We don't make things up and we don't presume or assign motives. There's no simpler way to put it then that were proud to say that honest, factual, rigorous journalism is the Carolina Journal way I reporting team is focused on accountability in government and policymaking. No matter which political party is in power, and regardless of the person taken to task in the story at Carolina Journal were beholden to the truth and to transparency.

Unlike fake news lies, innuendo, questionable sourcing all meant to create controversy not inform the debate. So the next time you're confronted with fake news one onto Carolina Journal.com or pick up the latest print edition you'll find compelling news reporting from a team that knows what it means to be real journalists committed to truth Carolina Journal, you can count on us for the facts. Welcome back to Carolina Journal radio why Michiko got spent much time in North Carolina and you learn about the intense college basketball rivalry among UNC NC State and Duke. Our next guest has some experience with that rivalry and he says the competition that is made these basketball teams so good should be applied in other areas, especially education. Richard been route is a former mayor of Charlotte, former Republican candidate for governor in North Carolina and a pioneer in North Carolina's public charter school movement. Thanks for joining us with you. Thanks for inviting me before we talk about how education can help a Rachel competition can help in education, we should tell people that do you do have some first-hand experience with this rivalry at college basketball remind us of how have you applied for one of the rivals are played for current smooth North Carolina 60 so learn first. Much we wanted to be studied and vice versa are good that was for basketball in this area with about 26 miles.

There are three of the greatest programs and college basketball history with 12 national championships to show for the last half-century and it's all born out of competition between each of those schools wanting to be the other wanting to be better program.

I believe in competition.

I believe absolutely American way. Good for college basketball in the back road area 1+ principles in public education.

Why do you think competition would end up being such a helpful tool for improving education will close like anything in life you want the other guys you want to perform better.

You want to succeed.

I would love to be the only lawyer in my city, I would be lazy.I would not work. I would charge a lot for it to be stuck with me, but because there are 4000 other lawyers and muster the artwork. Darn hard to get my share of the work and perform it well enough to keep my clients and do things well enough to be alive and well know, you also have in addition to the experience in the college basketball rivalry. You also do have experience in this idea of adding some level of competition education because you helped up with the early days of of charter schools where there I did. I was running for governor: Bob Mauldin and Rocky Mountain resort charge nor the one charter school laws.

I came back to Charlotte after seeing what was going on there convened a group of friends of mine about 10 of us Democrats. Publicans block white men and women and decided we would give it a try, and we created in the inner city of Charlotte charter school now is about 1500 very poor African-American children. It is now 19, 20 years later, the best-performing school for those kids are part of North Carolina and one of the one or two or three best in the state of North Carolina. But it was not easy, and we learned the hard way how hard education is the hardest thing in the world is educated but in North Carolina and in America it's the most important thing to do it well or in our state will school succeed or we do it poorly and we will not succeed. Education is the great equalizer something that gives you an opportunity to compete and succeed. We are chatting with Richard been route, former mayor of Charlotte and as we mentioned, a pioneer in North Carolina's public charter school movement. Some people up here about school choice, public charter schools opportunity scholarship vouchers and things of that sort and say hey this is just robbing the public schools.

This is taking money away from the traditional public schools. Why is that not the way they should first of all the money don't belong to the system. It belongs to those kids when we, North Carolina's drug spent about $9000 per child.

So money belongs to the child. Why shouldn't he or she, or his or her parents be able to take that money and applied where that young person can get the best possible education wash be stuck with the system that in many cases is failing the child doesn't belong to the school system. It wasn't appropriate to a system for no reason.

It was appropriated for a child that was coming to that school system, school, so why not let that child take it somewhere else. And in this case we let him take it to charter schools at about 85% of the dollars go to the doctor about $0.42 on the dollar giving actually less money to the child who leaves to choose another system, charter school, Lori or private school with a voucher leaving a whole lot more money for the kids who chose not to leave the system so why are they complaining about losing a child and losing less money to go with the child since another argument you often hear about school choice options is that they skim the cream of the crop off of the class of students and the public schools are left with the hardest students to teach. Is there any merit to that book more poor kids are more minority children in charter schools than there are in the school system is not only true North Carolina only true in Charlotte is true in America across the country.

But somehow the people who were leaving are those who are simply going to go out to some other school because they want to leave because they just won't change scenery is below the kids that leaving the parents really were the most desperate of all, why wouldn't the poorest leave while working the ones who need the help, but mostly because there trying to get something for their child is not happening in the school system is just bogus. Another minute there been evaluations of the Stanford University University of Arkansas by your name across the country and every one of them is, the same conclusion more minority students and more poor kids in charge system so lonely all the thing that we've heard from advocates of school choice including charter schools opportunity scholarship is that no there is not an attempt to hurt the public schools. In fact, having all of this competition makes the public schools compete and will make them better that that is that's that's that's exactly what happened at NC State. Chapel Hill and when frightened wire came in here state got better perform and complete one before the Carolina got in the ark and won the first Garden State didn't come back and when one itself. Same thing for Duke when coach K got there they began to witness ships another. To my way of thinking. I really have no national championships at Duke and studied in all of them at Chapel Hill is Carolina grass.

I so I hired you as a Carolina job was unanimously survived is the competition factors school systems are going to stay in business to be prepared to compete with test scores now bear out the fact that gives in charter schools are outperforming those in the system in the state and across the country and in the state are doing it fairly dramatically with poor and more minority students bitterly can't stay in the business. Some things are happening they are there. There already doing more things to try to keep those kids there and not lose the dollars are good with children. That's exactly what I would do if our Lord were threatened with competition and could this be seen as one way for those who want to improve the public schools to do it but if your goal is to prove the public schools find a way to do it out, but more golf example Charlotte Sugarcreek charter schools, and others found it 1500 kids now with 400 on a waiting list up all the schools in our area is where the former superintendent sent every teacher and every principal from similar schools see what we were doing try to borrow from our success is what you want to do and I'll tell you when we find a school system.

School is doing something better than we are working to go there and look at them and watching them learn from them as well. That's out of work and it's too important to our country and to our success. To let a failing system be there by itself without somebody some somehow showing us the way to get better too important. That is the voice of Richard been route, former mayor of Charlotte pioneer in North Carolina's public jewel of public charter school movement. Once again, the idea being that competition is not just for basketball. Thanks so much for joining us. Thanks.

Risk level on Carolina journal radio just a moment if you love freedom we got great news to share with you now.

You can find the latest news, views, and research from conservative groups all across the state. All in one place North Carolina conservative.com one-stop shopping for North Carolina's freedom movement had North Carolina conservative.com. You'll find links to John Locke foundation blobs on the days news Carolina journal.com reporting and quick takes Carolina journal radio interviews TV interviews featuring CJ reporters and Locke foundation analyst plus opinion pieces and reports on higher education. All of that from the Pope Center for higher education policy commentary and polling data from the Cintas Institute and news and views from the North Carolina family policy Council. That's right, all of that, all in one place North Carolina conservative.com that's North Carolina spelled out conservative.com North Carolina conservative.com. Log on today. Welcome back to Carolina journal radio I'm Donna Martinez, a recent state Supreme Court ruling moves the ball forward in efforts to compensate victims of state mandated sterilization, but several court cases remain to be resolved. John my foundations John Coetzee who is the director of legal studies is here to bring us up-to-date on this incredibly ugly. Of North Carolina history. John welcome back to the program. Remind our listeners what the state eugenics board was and did well. This really is a shameful chapter of the. The state eugenics board was formed in 1933. But that was not you the beginning of eugenics, just in case any investors aren't aware of it. Eugenics means trying to engineer human biology so that specifically in this case by involuntarily sterilizing people who were thought unfit to reproduce.

This was something that was a major plank in the platform of the progressive movement not only wanted to reengineer society. They wanted to reengineer the people who were going to make up that society was widely accepted as a valid thing to do and it was done in many other states and was started North Carolina's early 1919. That's when the first eugenics law was passed the first sterilization started. I think 1929 but all the program really got underway in a major way with the passage of the law in 1933 that set up the state eugenics board eugenics board authorized all agencies of the local County and municipal level to sterilize people who work, who met certain criteria for being unfit. Those worth epileptics people were thought to be either feebleminded or somehow morally unfit to have children. John is your describing this time. If our listeners are like me. I mean it's just horrific to even hear you described that this was happening. This was sanctioned by the state of North Carolina other states did it as well. As you mentioned doing now about how many people in North Carolina were sterilize that they could not have children. We don't know exactly, but probably something on the order of about 8000 people. Almost all of them women are some that were sterilize, but for for whatever reason, the focus of the program was always on when the thing that makes this especially shocking is this you know for people in the 20s and 30s to think this was a good idea. It's hard to put ourselves in their mindset but it was commonly accepted all over the world.

Although it has to be said American progressives led the way the Nazis when they began their eugenics program actually looked to America as an example for this, but the thing that makes a case in North Carolina soon. Especially shocking is that unlike most states, even after the end of the Civil War when the horrors of Nazism had been revealed in most states decided they were going to go in for the study. More North actually accelerated the program. We did more sterilization between 1945 and when the program officially ended.

I think it was 1974 more sterilization vendor be done before thousands of people, mostly women were sterilize in the 50s, the 60s and even right into the 70s.

Let's fast-forward into just a few years ago, the state legislature. There was a lot of stories written about this of the state legislature really started to take notice and a movement took hold. To compensate the victims of this state sanction sterilization in the Gen. assembly approved a fund in order to do that tell us what has occurred. Have there been payouts to the victims of eugenics and and who is actually described as a victim.

Well, this is something that I think with the John Locke foundation could be especially proud of. Because we were one of the groups has been promoting this for a long time many years before finally passed in 2013 soon after the legislation passed some comp. Some victims were compensated.

Observation began but it was put on hold when these court cases rose and the reason was one of the unfortunate things about the way legislation was written, it set out total amount rather than amount per victim about about with $10 million. They can't really pay people until they know how many victims is going to be and they won't know how many victims there are. Until these court cases settle there's two issues that have arisen in two sets of cases that are holding things up in the one case, there are some people who were sterilize, but they weren't sterilized. The way the author of the notice to say there are sterilizations were illegal, even under the laws of the time. One of these women offer Mecklenburg County were sterilize in the 70s and it turns out Mecklenburg County acted without going through the state eugenics board so the way the law is written. She's not eligible under the letter of the law because the board the law says it has to be for people sterilized under the authorization of that particular act and she wasn't. She was illegally sterilize our father so she doesn't deserve compensation.

She probably has a civil case against Mecklenburg County but the courts have said she's not eligible under the act. She is appealed until the case gets resolved we won't know what step her status and the status of some others were in a similar position will be the other group errors of people who died before June 2013. The act says it's only going to pay compensation to victims who are alive on that date.

And that's because otherwise there would be a huge number of errors and they don't not go to deal with them but some of those errors. All three groups of them have sued say that this is arbitrary, violates the rights of due process and equal protection they want to get their part of the portion of the payout based on the fact that they are the heirs of somebody who was a victim who died before the cutoff date so those of the cases.

Let's make sure that we understand so a $10 million fund was set aside by the Gen. assembly to pay the victims but until these these two groups of cases are resolved. No payouts can take place there on hold unless they figure out a way around that they're going to stay on hold until they got a complete list of the John course you're an attorney, so based on what you know about them.

The facts of these two sets of cases do you think that to either one of these groups will prevail. I doubt it Although I'm very served with the people in the first group. They were clearly victims they ought to get compensated but unfortunately, the law was drafted in the way that took the possibility were sterilized at the county level but yes the state level, but they were sterilize illegally, even under the state eugenics board act so that means if we follow if we are if we are taxed to us. We follow love of the law as I think we should then something else needs to be done to help those people. As for the second group the people are simply errors of victims.

I don't really have a lot of moral sympathy for them because I think that if we have a limited amount of money to pay to compensate victims at all go to the living victims and not the people who didn't actually suck suffered injuries. I also think that the way the laws written don't have a very strong case, but the more important issue. It seems to me right now is that this is just holding things up. And the longer we wait the more victims die. It's terrible now a state Supreme Court ruling very recently has kind of jumpstarted this process again a little bit got a but it's still very frustrated because all that was involved in that particular ruling was a jurisdictional issue.

The question was where to those errors of victims go to make their constitutional claims and there were some dispute about that.

That's been resolved by the state Supreme Court. So now they can bring their claims but they're still going to have to be adjudication of the ruling and I really like it appealed so afraid we still years away from getting money into the hands of those poor victims who are so far have received nothing or very little. It just seems like it is so fundamentally wrong. To do this to a person to take away their right to reproduce. Well, it certainly seems that way to you and me, and in fact today. It seems that way even to most progressives, but we have to remember that I don't think we should let progressives ever forget that for decades and decades starting at the end of the 19th century and going right up until the 1970s in our state.

Progressives thought it was perfectly all right very much that's all the time we have for the program this week.

Appreciate you listening my cohost Mitch.

Okay Donna Martinez hope you'll join us again next week for another edition of Carolina Journal radio Carolina Journal radio is a program of the John one.

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