By Adam Searing
Hidden away in the depths of the Legislative Office Building in Raleigh, a small part of the large-scale societal debate over health care transpired recently. It took place under harsh fluorescent lights in a cramped, windowless meeting room filled well past the fire code limits, almost entirely by professional lobbyists and legislators. At issue was whether to create a sliding-scale premium, affordable health plan for at least some of the 87,000 kids without health insurance in North Carolina. Such a move would not have been unique or unprecedented – at least 12 states have already moved towards covering all children with affordable health care — and in Washington, expanding children’s coverage is one of the only major health reforms given a good chance of passage.
Not today, however, and not in North Carolina. Despite support from Governor Easley and strong endorsement from the state House of Representatives, state senators vigorously raised objections to the plan. The refrain seemed to be that expanding kids’ health coverage was “too complicated†and “needed more study.†Depressing? Yes. Unusual? No. North Carolina has done very little to make health coverage more affordable to its citizens despite years of studies, reports and suggestions from some of the smartest people in our nationally ranked colleges and universities.
To see the outcome of these years of neglect, look no further than the recent report from the respected national foundation known as the Commonwealth Fund.
According to this report, North Carolina ranks 30th among states on measures of basic health care access, quality and prevention. Our state sits firmly in the bottom half of these rankings, along with states like South Carolina, Alabama and New Jersey. We do better than Mississippi, but then so does every other state except Oklahoma.
The Commonwealth report is more than a simple ranking, however. One of the most interesting conclusions is that higher quality health care is not necessarily associated with higher costs. A moment’s reflection shows why this is so. A major key to quality is keeping people out of the hospital – or from being readmitted to the hospital – by providing preventive care in the doctor’s office or at home. The most obvious example is making sure that someone with diabetes or asthma gets the drugs and help with lifestyle changes they need to keep them healthy and out of the hospital. Controlling chronic disease means not only far fewer expensive hospital admissions of very sick people, but better quality lives and better quality health care for people suffering with these conditions.
This is hugely significant for North Carolina and the other states in the bottom of the rankings. If we want to get serious about reining in health care costs, one thing we can do immediately is up preventive care. We could add the five vaccines we don’t cover to our universal vaccine program and start to match immunization rates in the top states that are near 95 percent. This costs about $37 million a year but won’t even be considered by our General Assembly. We could adopt the innovative medical home and care management strategies used by our state Medicaid program in the private sector and save millions from avoidable hospitalizations. These are not unachievable pipe dreams. Twenty-nine states – some of them even poorer than North Carolina – are doing much better than what we now define as our best.
Another major finding from the Commonwealth report is that the more people who have health insurance, the better the state does on measures of prevention and quality. It isn’t enough to trumpet the old cliché from the 1940s that, together, prevention and exercise are the key to reducing health costs. Of course they are – but no matter how much people change their lifestyles, if they don’t have health insurance they aren’t going to get the basic health care they need. Without a doctor they know and can go see, small, avoidable problems that are easily treated quickly become big, expensive ones.
North Carolina has the opportunity to expand access. State senators could stop their foot-dragging and instead join with their colleagues in the House and our governor — not just to cover some children without health insurance but to offer affordable coverage to all families in North Carolina. They could expand health coverage to adults by requiring businesses to either offer coverage or pay into a state-supported health insurance pool. Hawaii, with the best health status in the nation, has required businesses to do this for over 30 years.
Thus far, however, legislators in Raleigh are falling into the old trap of inaction and indecision. Now there is even less excuse for not confronting the inequities and despair caused by our failing health care system. The Commonwealth report shows that many, many other states have faced these problems and arrived at solutions that have improved the lives of millions, saved untold tax dollars and made their states places where problems with the health system are solved and not shelved.