My Inconvenient Truth: Health Care Reform...what needs to be done.

Unless you have been under a rock and/or have no clue what is going on outside your own home, the hot button issue going on right now is the issue of health care reform. President Obama has it made it one of his cornerstones thus far in his adminstration and now Congress is the middle of the fray. They spent much of July debating and analyzing what can be done. They now have returned home to deal with their constituents and gather more information to bring back in September. I have listened to both sides of the argument. Have witnessed chaos at townhalls. However, wherever we are now; I realized that this debate would have to materialize sooner or later. I spent much of the first half of 2009 reading and researching this issue. My research was mostly pertaining to New Jersey, but a lot of what I found can be applied to the U.S. as a whole. I encourage those who don't know the facts or think they know the facts to take a look at what I have written. But more important than that, I encourage everyone to do the research themselves. Don't let others tell you what to think; whether its for or against reform.

Here it is:

Health care in the United States and in New Jersey needs to be reformed. The current state of health care is not the most ideal and unfortunately that puts many at a disadvantage. We pride ourselves as living in the land of opportunity and preach about equality. Granted there are other issues that those two statements can be linked to but health care and its reform is a major one. The current state of the economy has only made it tougher for those who are uninsured to get health care. At the same time, fewer businesses are offering certain benefits they used to provide in addition to the fact that there is a very high number of unemployed who add on to the group who was previously uninsured. All this begs me to ask, “Where do we go from here?” It is no doubt a daunting task. There has been initiatives discussed and some slowly put into place. To figure out an answer we must first see what the problems are, what some are saying, and what has been done and needs to be done. When we ascertain that, we can come up with the clearer picture of how to once and for all make it that all have the proper services they need and deserve. Whether it is health care insurance availability or health services availability; something needs to be there. Thus, it is my goal to display all the facts and information that leads me to believe me must institute a step-by-step solution to solve New Jersey’s and America’s health care problem.

To begin to access the issue, we must first attack what the problem is. First, health care costs are skyrocketing, hurting our families, as well as our economy. Over the past decade, health insurance premiums have doubled accompanied by increasing co-pays and deductibles that threaten access to care. That seems to be what is one of the most important things when accessing this issue. When people are not able to obtain or have access to care; there is a glaring problem. In addition, large medical bills have contributed to half of the bankruptcies and foreclosures. Rising health care costs place a burden on American businesses as they try to balance health benefit costs with job growth and competitiveness. To make matters worse, problems with health care quality and administrative “waste” contribute to medical errors that result in as many as 100,000 deaths per year in U.S. hospitals and on average, American adults received just 55% of recommended care for the leading causes of death and disability. So, what does all this mean? Well, the U.S. spent $412 per capita on health care administration and insurance in 2003, which is nearly six times as much as other developed countries. How is it that we have so much money to “spend” yet so many without care and insurance? It would seem that costs may be going up, but we need to use the money we have in New Jersey and the U.S. for health care wisely.

The second part of the problem with health care is over forty-five million Americans have no health insurance. With a number that big, I imagine a fair amount, at minimum, is affected in New Jersey. Nearly 160 million Americans have job-based insurance, but many are just a pink slip away from joining the ranks of the uninsured. To give that a little more depth and a sense of urgency; for every 1% point increase in unemployment rate; there are over one million people who become uninsured. So we know that there are over 45 million without health insurance and every day that number increases as part of the nearly 160 million with job based insurance are laid off. Moreover, being uninsured leads to delayed care such as late diagnoses for diseases as well as denied care. The simple formula becomes: no health insurance = less likely to receive care. Even people with coverage are increasingly finding that it is not enough or simply not there when they need it most. Nearly 1 out of every 5 Americans either delay care or have unmet needs despite having health insurance. These things should not be happening. We cannot let people let themselves die or suffer without the necessary treatment. It is a problem when there are so many uninsured as well as several that are not getting the proper care. It is a major negative check against the U.S. and as well as New Jersey by default.

The third and final part of the problem is our nation’s investment in prevention and public health is inadequate, which leads to a rapid spread of chronic diseases. Many of these diseases can be prevented or managed with the proper care. One in three Americans or 133 million have a chronic disease. There are five chronic diseases (heart disease, cancer, stroke, chronic obstructive pulmonary diseases, and diabetes), which cause over 2/3rds of all deaths. Additionally, one in three children born today will develop diabetes in their lifetime. It would seem that for a country that spends and spends, we do not put enough into what is most important: our lives and insuring that we are healthy. Only 4 cents out of every health care dollar is spent on prevention and public health. This number is way too low and that seems to compound an already bad situation.

Moving forward, to take these problems further we must determine what the current state of New Jersey’s health reform is. According to a report given by Heather Howard from Health and Senior Services, there are serious issues with New Jersey’s health care and progress. The state of New Jersey is facing fiscal problems and it is important then to determine the funding available for health care providers and for initiatives throughout the state. With that, there is a need to strengthen the health care delivery system. It would seem from the problems mentioned, that even having health care does not automatically guarantee service. A big initiative involves FamilyCare expansion. FamilyCare needs to be increased for parents who are between 133 and 200 percent of the federal poverty level. Additionally, New Jersey ranks last in terms of effective resource utilization. New Jersey is spending more on the last six months of life than any other state. New Jersey is spending more on care and not getting outcomes. And there have been crises in hospitals for many years in the making. Linked to this are: efficiency issues, the federal government not paying its fair share of Medicare, and too many hospitals in certain parts of the state. It would seem that there seems to be resources, but they mismanaged and that needs to change as more and more are left unintended and not given a fair share of the services. If we have the money and places, we need to redistribute them accordingly and hopefully we will see progress come.

Another individual who has voiced his opinion on the issue is State Senator Joseph Vitale. He had put out a report recently talking about the opportunity New Jersey has to lead the country in Health Care reform. The major payers of health care include Medicaid, Medicare, and the State Children’s Health Insurance Program (SCHIP). The last presidential administration either refused or had neglected to make health reform a priority and the result was millions of Americans have lost their health coverage and our economy has started to really suffer. One of the payers of health care, SCHIP, is especially crucial when talking about health care and those who probably need it most, children. SCHIP was implemented in 1998 and from that time to about 2004 the number of uninsured decreased due to the program’s success. The trend stopped in 2005 and by the end of 2006 there were 1 million more uninsured children in the U.S. then there had been in 2004. To make matters worse, over the past decade funding for SCHIP expansion has been eliminated, Medicaid policy is more limited, and enrollment activities for public programs have all but disappeared. This has then created further strain on the health care system by increasing cost-shifting to those with insurance and making it ever more difficult for employers to continue to offer health benefits to their employees. These are two major strains and affect so many people in terms of those without health care insurance. Even the former Chair of the Federal Reserve, Ben Bernanke, said that the lack of health coverage is the single largest drain on the nation’s economy. What the President must do with this information is recognize the impact that the uninsured have on the economy and demonstrate willingness to work hand-in-hand with Congress to make health reform a priority for the national agenda going into the rest of 2009.

Financing health care then becomes the aspect of this issue to target. Currently, the sources for funding the coverage will have to come from new revenue and slowing health care cost growth. A combination of both is what will be of most importance going forward. A federal partnership is also very critical. Federal matching funds have been critical to state health reforms. A big federal funding initiative is Medicaid, which was started half a century ago. Traditionally the federal government matches state Medicaid costs. Recent Medicaid regulations could result in New Jersey losing $347 million in federal funds over the next 5 years. Also, SCHIP should have been reauthorized last year but was vetoed. There was a directive that limited states’ ability to expand SCHIP eligibility for children past 250% of poverty. New Jersey is already at 350%. Federal SCHIP funds likely to be adequate to avoid shortfall this year. New Jersey should try to improve enrollment and retention and SCHIP for low-income. What do we know regarding all this? Census data indicates high non-insurance rates and low Medicaid/SCHIP participation among low-income people. What goes unmentioned in all this is the fact that helping parents with insurance helps children as well. Parents are likely to be uninsured. Expanding parent coverage improves take-up rate among eligible children and improves retention rates. Parental coverage increases children’s use of preventive health services. When there are policies that cut back parents’ coverage that also reduces children’s coverage. Additionally, the state has a serious deficit of late. There are structural problems that include health care costs plus there is a short-term economic slowdown. Even if there was a way to raise revenues this upcoming year, they would probably not go toward health insurance. They would probably go to ease the cuts or reduce the deficit. Looking at this issue beyond 2009, polls suggest some mixed support for higher taxes to pay for health reform as well as raising tobacco or alcohol taxes. The latter seems to be more popular, but unlikely to keep pace with health care costs. Health care provider taxes could keep pace with health care costs moving forward.

Keeping on track regarding health care, reform costs money as we stated. However, what else is there we can do to prevent cuts and prevent access in this tough economic environment. Reform will be costly no doubt. We must look, though, to focus on cost containment as well as cost shifting. Finding the necessary revenue source is a shared responsibility and we must be willing as a state to make that commitment to its citizens. There are ways to achieve success despite all that has been mentioned that makes it challenging to give coverage and have the money to make it more available then it already is. The ways in which to find revenue are: creative taxation with close loopholes, extraction from providers, insurers, and firms, mandating insurance market constraints, and cost-sharing by individuals and affordability. These are not necessarily easy tasks, but if taken into consideration worked into the current setup then results are very possible. These results would lead to better success for those who need the health care assistance most. There are still affordability concerns if these steps were to be put into motion. These concerns involve: having maximum thresholds for total health payments, limit premium costs for those with no subsidy, assure adequate and secure benefit packages, make system improvements and cost containment a priority, and commit to assurance of affordable quality health care. If this all works then there is the possibility to create a “culture of coverage” within New Jersey. That is what I see as the biggest objective that New Jersey should have not only for its citizens, but also for the country to hopefully follow.

Before concluding with that I feel as the moves we should make to change and fix the health care reform problems, I will highlight a health services issue through an example of a health center. Saint Michael’s Medical Center (SMMC) was a health center in Newark, a city that depends on things such as a charity care. As part of the growing problem affording health care and services in New Jersey in this economic climate, there are places that have been consolidating as well as closing. The Catholic Health East completed its asset purchase of Saint Michael’s Medical Center on August 1, 2008. The emergency department of Saint James Hospital continued uninterrupted when the hospital transitioned to a non-acute campus. Since the transition, emergency department visits have declined. The campuses host free public health events every month on topics like cancer and osteoporosis screening, HIV testing, diabetes education, and FamilyCare insurance enrollment. Saint Michael’s Medical Center has completed the sale of the Saint James and Columbus campus buildings and has signed a long term lease of space at the facilities. This is important since the buildings will continue to serve as medical destinations for the community. That is what needs to be analyzed as the key aspect: this will be a place for the community. However, by not having an extra place to go forces more people who need care to go to one place. These charity care places are crucial to underprivileged communities, yet not having enough is just as bad as not having any.

There was a Rutgers study that found residents were not content with health care in New Jersey, yet they did not seem to support reform. A poll showed that New Jersey residents were deeply concerned about their health care and wanted changes to be made. Large majorities said they wanted lawmakers to enact policies to address rising costs, cover the uninsured, and improve the quality of care that physicians and hospitals provide. More than half in poll participants said they were willing to accept higher taxes if everyone in New Jersey could have stable health insurance. One in three in this poll also agreed that health care in New Jersey has so much wrong with it that it needs to be completely rebuilt. Of that half say “fundamental changes” are needed even though they believe some aspects can be preserved. Additionally, two-thirds of those who took this poll expressed worry about being able to afford the health care they need and 82% are worried about rising costs. Lastly, nearly half are somewhat to very worried about losing their health insurance. What does the current state of New Jersey health reform/health insurance show? It seems from all this there is a large amount worried about not having insurance or joining the ranks of the insured. There then must truly be steps to alleviate this growing problem. The more who speak out and voice out, the more that hopefully will begin to occur. What we continue to see in New Jersey as a health care problem is the same problem just on different scales across the country. For this reason, President Obama has made one of his major objectives in his first year in office to bring change to the current health care system. President Obama believes that every American should have high quality and affordable health care. To reach this goal, he feels we must modernize our health care system in order to accomplish three main objectives. The three objectives are to improve health care quality and cut costs, expand coverage and access, and increase the emphasis on primary care and prevention. If we focus on these three objectives then in both New Jersey and the U.S., we will see something that resembles health care for everyone who needs and/or wants it.

To accomplish these three objectives, we must slowly begin to transition towards the necessary improvements. First, accessing how to improve health quality and cutting costs is tough in today’s current economic times. However, when there are problems; there are answers. Health quality is definitely not as good as it could be, no matter what the economic climate is like. The problem seems to be the lack of quality to those who have health insurance, not only the uninsured. We need to ensure and have enough hospitals, health centers, and similar facilities for people to go to when they are sick or injured. Reading reports of people dying or suffering from lack of care and quality to individuals is unacceptable. The second half of the first objective, cutting costs, is tricky to accomplish when trying to provide more quality. As I mentioned earlier, we seem to have $412 million to use, yet much of it does not go to where it needs to. If we were to better budget and manage the money given for health related services, then we can cut costs and still increase the quality through facilities and staff. One of the big things that I noticed was “wasted” administration as well. If we insure that we do not “waste” money on certain areas, then again cutting costs would not be out of the picture and we can still provide enough care to those who need it on a daily basis.

For the second objective, expanding coverage and access, this one is the one that may take the longest of the three of achieve, but still is possible. The amount of people who are covered and have access to insurance is too low for the size of this country. With the tough economic times, again it makes it difficult for certain things to automatically materialize, but we start to provide insurance that businesses know they can manage and give to their employees that is a start. Additionally, there needs to be the beginnings of a system that individuals who are currently uninsured can get into. The answer, as of now, is complex, but for those who need and want the insurance there should be that insurance for them. I think an easy way to provide that short-term would be through service initiatives. I really like the idea that President Obama came up to provide college opportunities who cannot afford it through community service. Why can’t we do the same for those can’t afford health care and insurance? Granted there are more people wanting health insurance then attending colleges and universities, but it would still alleviate the growing problem of more and more becoming uninsured. Not enough people are service-minded and can aids two groups: those needing care and those needing service assistance. Also, this is connected to the third objective, but we need more charity care. The access and coverage for health care is slowly increasing in the wrong direction, but if we had more locations, especially in cities with high poverty rates, then there would be another answer to the growing problem of assisting those who need care. The economy has hurt charity care in many of these cities and that increases the already large number of people without access to health care. When looking at the third objective of increasing primary care and prevention, there need to be more options for those who need instant care. Walgreens has begun to take steps to counteract all the charity care facility closings. Walgreens is a pharmacy-based store and being that; it can provide a certain level of care, especially to many of those cities with high poverty rates. However, there needs to be a better assessment when closing the primary care centers. Also, as we try to be fiscally sound, we need to stop building things strictly for profit reasons and consider filling open space with a health services facility and targeting it for charity care.

After laying out ways to improve the current health care situation and focusing on the three objectives, one can conclude that one overlaps the other two. When we find a way to increase quality and cut costs we can then provide better access and coverage through ensuring that we have enough primary or charity care facilities that would increase quality of health services. As I have stated, this is a not a simple goal, yet it is a possible goal. When we take steps in the right direction slowly we will eventually see the results we need. There is a health care problem, but if we take the three objectives seriously and look to implement some of what I said we will slowly solve this problem. With enough time and initiative, New Jersey can take steps to become the nation’s leader in health care. Health reform needs to be a top priority.