Insight

One Year and Counting

--by Jeanne Ryer, Endowment for Health Program Director

This week will have plenty of prognostication about whether the health law will succeed or fail.  But I like to test my health policy assumptions against the real life experiences of people around me.

So far, it seems to be working out pretty well.  At least a couple of times each week I hear from people that have their young adult kids on the family health policy, providing peace of mind for the parents and some security for the “kids” in a pretty daunting economy. A bit less often, but more poignantly, are the families with children with serious illnesses who now can’t be denied health insurance.  Their relief is palpable, especially for those that were approaching the lifetime limits on care.

And there is NOBODY who regrets the end of what was called “rescission” where health insurance companies could deny your coverage, even after years of paying the premiums, because of some inconsequential error on your application. For our own family and others, preventive visits are now fully covered, and there is better protection from the dreaded Medicare donut hole.

So all in all, after a year, things are shaping up pretty well.  But we have a long way to go to get to the really essential changes that come in 2014.  I live in Carroll County, where the number of people who can’t afford or get health coverage is north of 17%, the highest in the state.  That makes us more like Missouri than the New Hampshire average and a lot closer to Texas than I am comfortable with. So I know, and know well, people who have never had any health insurance.  I know people who have died because they didn’t get the care they needed for lack of insurance. I know people right now trying to deal with serious illnesses and no health insurance.   These are hard-working people, proud, and contributors to their community.  It is a shame, really a shame, that those contributions will be diminished because they couldn’t’ get the health care they needed.

So while we have made a great start, it is just the beginning. And we must keep going.

 

Facts Are Stubborn Things

--by James W. Squires, M.D.

In 1770, John Adams observed: “Facts are stubborn things; and whatever may be our wishes, our inclination, or the dictates of our passion, they cannot alter the states of facts and evidence.”

One year after the enactment of health reform, public discussion of health reform is dominated by words and phrases that include “Government takeover of health care” and assertions that the law is unconstitutional. In my opinion these assertions do not rest on a body of facts. Rather, it reflects wishes, inclinations and political dictates.

Here, also in my view, are some facts:  (1) The rapid and sustained rise in the cost of health care in a significant contributor to the national debt. (2) Health care costs in New Hampshire are among the highest in the country. (3) The cost of health care plays a major role in business decisions in New Hampshire and the nation. (4) We spend far more on treating disease that preventing it. (5) Among the 1.3 million residents of New Hampshire, somewhere between 110,000 and 130,000 lack health insurance.

The Affordable Care Act attempts to address each of these five stubborn facts and much more.  Unfortunately, opinions are not facts.  Take, for example, the view that the law is unconstitutional.  No, the law is not unconstitutional and the matter will not be settled for years to come.  The facts are that a number of lower courts have expressed a variety of opinions on the subject.  Not until the Supreme Court makes a decision will the matter be settled.  Until then, the Affordable Care Act is the law of the land.

How the health reform debate plays out will be largely determined by whether or not our nation and our state can separate facts from wishes, inclinations, and political passions.  As for me, I fall in line with Mr. Adams and fervently hope we can stick to stubborn facts.

Significant Changes and a Big Leap

--by Scott Westover, Vice President for Strategic Management, Southern New Hampshire Health System

Several months ago I invited groups of patients to Southern New Hampshire Medical Center to have a conversation about health care.  I have long believed the best decisions in health care are made with the patient in the room, and this was a chance to listen to determine how our health system can best meet patient needs.  This particular evening opened my eyes to the responsibility each of us shares when it comes to keeping the conversation about health care reform productive and solution oriented.

Patients are nervous and uncertain about where to turn for answers where to find a fact-based discussion about the relationship between a patient and his or her physician.  While listening to patients share stories that evening, it occurred to me that that it is the polarizing national debate about the cost of health care and the shortcomings of the American health care system can also erode the confidence patients have in local health care providers. In some ways (I do not believe it was intentional) health policymakers have transferred the problems of the system from the industry to the patients.  We can do better.

Patients who receive insurance through an employer are experiencing dramatic, non-sustainable changes in benefits and personal “out-of-pocket” cost.  Patients who lack access to insurance are concerned about being treated as second-class citizens and some fear they may not have access to care if they become ill.  Patients enrolled in Medicaid and Medicare programs are suddenly aware the discounted payments doctors receive for services rendered to them are a major driver in the skyrocketing cost of health insurance. Everyone seems braced for new restrictions, decreased choice and more direct cost for the care they receive.

When we indulge in conversations that demonize either political party or trivialize the issues with clever sound bites, we are disrespecting our patients and undermining essential reforms. Sustainable solutions will require health care providers, politicians, insurance companies, patients and entire communities to work together.  Every conversation that discourages collaboration or gives an excuse for any party to stay away from the table is short sighted.  It may feel good to identify various boogiemen, but our patients expect more from the health care community.  They expect everyone to do the work that needs to get done in order to improve the overall value of American health care.