Health Care Reform: A Work in Progress
Good Times Weekly, June 28 - July 4, 2007
By Alan McKay
On the presidential campaign trail and at the movie
theatre box office, the hot topic these days is our nation’s broken
health care system. Politicians are debating the merits of single payer
vs. employer-sponsored health care, and Michael Moore has put America’s
worst foot forward in Sicko.
In California, our Governor outlined his bold
plan for statewide health care reform on January 8, and then Democratic
legislators responded with their proposals. The fate of these plans swing
in the wind of California’s economic recovery, which is still fragile.
Remarkably, there is strong political will to tackle the health care challenge,
but the price tags are daunting, and there is the risk we will be “held
hostage to the perfect,” if we endlessly debate, but then default
to the status quo.
Part of the challenge of the reform debate is that health
care is such a unique and even strange industry. We typically take our
own health for granted until we become ill, and then it becomes our highest
priority. Then we consult health care providers (if we have access) for
a diagnosis and cure that we often don’t even understand. At the
end of this, we receive a bewildering bill and hope that our insurance
covers it. As one Sacramento lobbyist told me, “we all want health
care, and we all want somebody else to pay for it.”
Those of us that
have health insurance fret about our rising share of the costs. Those without
insurance worry about the risk of a serious illness or accident that could
lead to personal bankruptcy. Despite spending $2 trillion on health care
each year, we Americans haven’t purchased much peace of mind.
With
so many challenges at the national and state level, is it possible to “act
locally” in health care reform? The answer is yes. A countywide collaborative
of health, foundation, government and community leaders have formed the
non-profit Health Improvement Partnership (HIP), and is already making
headway.
Members of this organization have joined hands to bootstrap a
new insurance program for local children (Healthy Kids) and support outreach
to also enroll kids in the Medi-Cal and Healthy Families programs. Through
these efforts, more than 5,000 local children have secured timely and comprehensive
health care.
HIP’s other projects advance prevention and care of
chronic disease and expand use of electronic health records that provide
timely and secure information to physicians. This is one example of local
health care reform that works. Bigger picture solutions are still needed,
but it’s nice to light a candle or two here in Santa Cruz County
while we wait.
On a regional scale, Santa Cruz and Monterey counties have
lit another very big candle. In 1999, the counties partnered to create
the nonprofit health plan, Central Coast Alliance for Health, with a mission
to reform the over-promised and under-funded Medi-Cal program in our Monterey
Bay region.
With a 16-member local governing board, the Alliance’s
policies and services have attracted more physicians to provide the health
plan’s 87,000 members with timely and effective care. This “right
care at the right time” saves taxpayers over $40 million each year.
The Alliance’s success illustrates a point that is relevant to “big
picture” reform: all health care is local, and requires good relationships,
communication and trust to be effective.
With health care reform percolating
at the national, state, regional and local level, are there other frontiers?
Absolutely. Many years ago, on my first day of class at Cal Berkeley’s
School of Public Health, my professor said: “A few of you may die
in traffic accidents, or from violent crime. But most of you will die from
a thousand small decisions you make every day.” She proceeded to
explain the profound effect that our “small decisions” about
diet, exercise and smoking have on our health. These effects are every
bit as potent as the medical technology and treatments for which we seek
universal insurance coverage. Every day, even while we advocate for “big
picture” change, we can make small choices to reform health: our
own.
Alan McKay is the Chair of the Health Improvement Partnership, and
the Executive Director of Central Coast Alliance for Health.