Health reform a necessity in N.H.

The financing and delivery of health care now bear an eerie resemblance to the credit and banking systems that financed and underwrote home mortgages in 2007. Fortunately, the dangers of an unsustainable health-care system are in clear view and the topic of public policy debates. So, with a front-row seat to the American political process in all of its glory, we are witnesses to a once-in-a-generation opportunity to address fundamental changes in our nation’s health-care system.

Unlike the mortgage crisis, we have the power to prevent this bubble from bursting. However, it is a mistake to try and reconfigure a broken, out-of-date and unstable system. It requires more fundamental reform.

Since the end of World War II, the United States relied on the business sector to provide two essential benefits: employer-paid health insurance and retirement vehicles such as the 401(k). This was possible up until the 1970s, when health care was relatively inexpensive, the United States dominated global markets, and Americans often spent entire careers with a single company. None of this holds true today. Does the relation of employment to the possession of health insurance still make sense? I think not.

Here in New Hampshire, employers and individuals are paying a larger share of the health insurance tab while in the last five years, income growth has been flat. Which reform approach will remedy this? It is difficult for even the savviest of health-care pundits to stay abreast of the health-reform details, including the discussions about individual mandates, employer requirements and expansion of public programs. There is no “perfect” solution.

Surely, however, we can find common ground with the president’s three bedrock requirements for real health-care reform: to reduce costs, ensure choice and guarantee quality of care for all.

In many respects, New Hampshire is ahead of the curve in understanding the impact of rising health-care costs and premiums and recommending actions to address them. Coalitions such as the New Hampshire Citizen’s Health Initiative and New Hampshire Voices for Health have been instrumental in moving the policy agenda ahead while positioning New Hampshire as leaders in health system innovation.

Additionally, the Endowment for Health, the state’s largest health foundation, continues to underwrite research about the availability, cost and quality of the state’s health care system.

New Hampshire has a relatively high percentage of healthy, insured people with access to quality care, but premiums for family health insurance coverage are still $3,000 higher than other top-performing states. According to the New Hampshire Center for Public Policy Studies, our total health-care expenditures as a percent of gross state product was 18.1 percent, as compared with 12.7 percent in the top five states.

Additionally, there is a well-documented shortage of primary care, oral health and mental health workforce in our state, which is especially acute in the North Country. Our system of care is often fragmented, with little coordination among providers and agencies. The state budget, like the budgets of so many other states, is severely constrained, even as we witness unprecedented throngs of people in need of assistance.

In short, we know there is an urgent need for reform, but we must also acknowledge that fear-mongering politics are not based in fact. Temper what you hear from these various factions and also recognize the well-meaning next-door neighbor who may not be basing health reform opinions on real information.

As the people of New Hampshire continue to watch health reform unfold, ask these questions of your policymakers and health-care providers about the goals of various legislative proposals:

• Will costs be stabilized while closing coverage gaps?

• Will an affordable option to uninsured or underinsured Americans be offered?

• Will the quality of care be improved?

• Will a payment system for primary care providers increase the availability of practitioners?

• Will an integrated approach to primary care, oral health, mental health and home-health services be encouraged and funded?

If we can answer “yes” to these questions, we can feel reasonably confident that the country’s reform efforts are on the right track and that the overall benefit to New Hampshire will be enormous. Then, perhaps, we can all understand and support efforts to reach a common goal.

James W. Squires, M.D., is president of the Concord-based Endowment for Health.

Categories: Opinion