Insurance reform won't heal what ails New England

[RandyW]

Sunday, June 25, 2006

Insurance reform won't heal what ails New England

By NEAL PEIRCE and CURTIS JOHNSON,

Copyright © 2006 Blethen Maine Newspapers Inc.

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ABOUT THE AUTHORS

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ABOUT THE AUTHORS

Neal Peirce and Curtis Johnson of the Citistates Group have delved into New England's challenges and hopes as part of the New England Futures Project, with findings at www.newenglandfutures.org.

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New England has basked in national attention this spring, ever since Massachusetts' big health care breakthrough - an agreement between Gov. Mitt Romney and the Legislature to require everyone to buy health insurance, provide new, state-subsidized private health care policies and dun nonparticipating employers.

Now many other states - Michigan, New York and Wisconsin among them - are considering parallel moves. Vermont legislators, in May, jumped on the bandwagon by offering coverage to virtually all low-income residents not already protected by Medicaid.

Health excellence in New England ought to be a given. With its world-renowned teaching hospitals, its supercluster of leading scientists and its national leadership in biosciences, the region has virtually unparalleled resources.

But ask yourself: Are New Englanders appreciably healthier than other Americans? Is the region exempt from the costs of health care gobbling up public budgets? Has it found a way to avoid the high levels of heart disease, stroke, diabetes and many cancers that can be held in check a lot better by diet and exercise than by after-the-fact operations and cures?

Sadly, the answers are no, no and no. Today, says Wendy Everett, chief executive officer of the New England Health Care Initiative, upward of 90 percent of all health care dollars go to expensive hospital diagnosis, treatment and surgeries - not prevention and public health. No one's paid to talk people out of smoking, but the system feeds big dollars to the physicians and laboratories called on to address the eventual lung cancer with chemotherapy and radiation.

Shortages of primary care physicians, the "family docs" who know a patient's full history and needs, are mounting - even as the big dollars flow to specialists. And to what end? Studies by Dartmouth Medical School professors Jack Wennberg and Elliott Fisher show that more expensive and extensive care often proves to be worse care.

There are some rays of light. First, pressure is mounting to reduce errors and costs by computerizing all individual medical records and, while keeping them private, making them portable (place to place and among doctors, clinics and hospitals). And second, to use information technology to track the tests and treatments that actually perform best - called "evidence-based medicine."

Rhode Island's Quality Institute is one leader on the measuring/improvement front. There's a Massachusetts eHealth Collaborative, funded with $50 million from Blue Cross/Blue Shield of Massachusetts, focused on creating a broad-based health electronics record system. NEHI, with Boston Foundation support, is creating an indicators-based "report card" to help identify new strategies to improve the region's health while strengthening its health care economy.

Even bolder strokes may be required. Arkansas Gov. Mike Huckabee found that out when he shed 110 pounds after being told he had Type 2 diabetes. He launched a campaign for a healthier state, including school tests so all parents know about their children's body mass, curbing sugar-laden drinks in schools and increasing the value of food stamps when they're used to buy fruits and vegetables.

Each of the New England states may have some elements of an Arkansas-like plan in place, but couldn't the six states together do it even better? Imagine a coalition of public health departments, hospitals, universities, businesses, sports leaders and the media - united in demanding more rigorous exercise and nutrition standards in schools, pushing for walkable environments, crusading against smoking and substance abuse, and helping low-income immigrant workers make a successful transition away from fast-food, high-temptation America.

There are islands of organized "healthy community" efforts across New England. Fall River, Mass., encourages local high schools to think beyond team sports to engaging all students' physical activity. Vermont's Champlain Initiative is pledged to "bend" back such unhealthy trends as obesity, poor nutrition and sedentary lifestyles. The Franklin Community Health Network, in one of Maine's most depressed rural counties, has focused hard on anti-smoking efforts and now can claim Maine's lowest smoking rate.

Connecticut has a "Healthy Valley" program coordinated by the Griffin Hospital to enhance health across the six-town Naugatuck Valley. New Hampshire's Foundation for Healthy Communities has initiated a "Walk NH" program to encourage children 6 to 12 to walk the equivalent of the state's length (190 miles) or width (70 miles) as a way to get in shape for life. And across the region, interest in farmers' markets and healthier, locally grown fresh foods is mounting.

It's time to connect those dots. And maybe it's time to resurrect the ethos of the sturdy New Englanders of past times, who weathered raging blizzards, storms at sea, thin soils and the challenge of farming on rocky hillsides. Captains of their own health. Why not again?