Governors on the front lines of health care reform
By Bill Settlemyer
President and CEO, Setcom Media Inc.
Earlier this month I had the chance to indulge my “inner policy wonk” by attending the National Governors Association meeting held at Charleston Place.
First off, I accepted an invitation to a dinner for the press corps held by Arkansas Gov. Mike Huckabee, the outgoing chairman of the association. The governor is an aspiring presidential candidate, as is Massachusetts Gov. Mitt Romney, who also attended the conference. Both men are Republicans and both have an admirable track record of working well with members of both parties on pressing issues facing their states.
At the dinner, Gov. Huckabee expressed the frustration he and other governors are feeling about the lack of cooperation from Washington, saying the states are often treated like “satellite offices” of the federal government.
Health care on their minds
That theme played out at the association’s sessions addressing health care. The governors, regardless of party, thought the states were going to have to take the lead in addressing health care reform.
South Carolina Gov. Mark Sanford is among a number of governors around the country who have been actively addressing the collision between rising Medicaid costs and limited state budgets. Last year, he introduced a plan to rein in costs while introducing several innovations in the delivery of health coverage designed to yield better outcomes at a cost that is realistic in relation to the state’s resources.
In his opening remarks at the first NGA session on health care, Gov. Huckabee said 75% of all health care costs are lifestyle related. He praised his fellow governors for coming together to focus on wellness and not just on the health care system itself.
The next speaker was Tommy Thompson, former U.S. Secretary of Health and Human Services and a former four-term Wisconsin governor. He now works with the Deloitte Center for Health Solutions, a unit of the Deloitte & Touche USA division of the well-known international consulting firm.
Thompson has developed a “Medicaid Makeover” plan that he is presenting at seminars and meetings around the country. He said “we have until 2013” to make changes to our country’s health care system, because that’s the year Medicare runs out of reserves and Congress will have to add funding each year thereafter to keep the system running. This is just one symptom of a trend that could double the percentage of the nation’s gross domestic product consumed by health care, an unsustainable level by any measure.
Thompson’s Medicaid reform plan addresses four key issues:
Medicaid does not adequately meet the health care needs of the diverse populations served by the program. He said the federal government should assume a larger role in meeting the needs of the elderly, especially long-term care needs, while allowing the states to take on greater responsibility for caring for those under age 65.
Medicaid should encourage individuals to play an active role in their health care. To help individuals take more control of their health, we have to promote and pay for programs that emphasize prevention and wellness.
Medicaid payment structures and technologies are outdated. Right now Medicaid pays for services rendered. Instead, we should be paying for quality care and better outcomes. The technology exists to use electronic databases to measure and improve care, and Medicaid should adopt those systems now.
Medicaid must do more to address the problem of the uninsured. A number of states are addressing the needs of the uninsured, but more can be done to support innovative options that are tailored to local needs.
A brief and very readable summary of Thompson’s proposals is available for download as a PDF file. Go to www.medicaidmakeover.org and you’ll find a link to the report. I highly recommend this thoughtful analysis of ways to reform Medicaid.
The second session on health care issues included a presentation by the current U.S. Secretary of Health and Human Services, Mike Leavitt. Like Thompson, he’s a former governor, having served three terms for the state of Utah.
No place on the leader board
Leavitt was even blunter than Thompson about the impact of runaway health care costs: “Health care is encroaching on every other aspect of our economy,” he said. “There’s no place on the economic leader board for a country that spends 25% of its GDP on health care.” Leavitt added that at the rate we’re going, we’ll reach the 25% level within a decade or two.
Secretary Leavitt also said it was unlikely that Congress would act soon on health care delivery issues, echoing the view of other governors that action at the state and local levels offers the best opportunity for progress in the near term. He identified three keys to tackling the cost of health care:
Electronic medical records. The health care industry needs “certified interoperable” systems that can share all kinds of information related to the delivery of health care. Such systems will help reduce medical errors, simplify billing for services, and provide the foundation for measuring quality of care and pushing the system toward consistent standards of care.
A new focus on quality of care. The current culture of health care makes it “impolite” for consumers to ask about the quality of care delivered by providers. That has to change so that care delivered by physicians, hospitals and other providers is measured against agreed-upon standards of care. Leavitt has found that physicians are receptive to the idea, but they are also skeptical due to fears that systems for measuring performance will be inaccurate or unreliable. In any event, he sees this as the only way to go.
Create incentives for action. Leavitt noted that the federal government currently provides health care coverage for 125 million Americans, if you count all the government programs like Medicare as well as insurance for federal government workers. Another 40 million are covered through programs run by the states. Taken together, that’s more than half the population of the country. Leavitt says federal and state governments should use that market power to generate the changes needed to improve the system.
Leavitt said he had visited 23 communities around the country where groups are organizing to work on quality standards and related issues. Here in our region, preliminary discussions have been held about forming the “Charleston Area Health Council” to bring providers, employers and the public and civic sectors together to tackle these challenges. As the summer hiatus draws to a close, it’s time to move beyond “preliminary discussions” and get the ball rolling.
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