Health-care debate concerns far more than just insurance

Pizza is on Marcia Nielsen’s mind as she considers what frustrates her about the health reform debate in Kansas.
Imagine someone who’s just eaten a slice of thin-crust pie with sausage, pepperoni and extra cheese and isn’t happy with how it tastes. When he calls the parlor, should he focus his complaints on the delivery guy?
Kansans are doing something like that with health care when they focus the debate on making sure more people have health insurance, said Nielsen, the executive director of the Kansas Health Policy Authority.
Insurance issues are significant, but if policy makers in Kansas are going to lessen problems in the health care system, they must control costs and push Kansans toward healthier living. The authority plans to issue reform recommendations Thursday, and most of them won’t deal with insurance.
Offering a package focused only on insurance would be like getting a bad pizza and not thinking about how it was cooked or what ingredients went into it.
“The only thing we focus on from a policy perspective is the pizza delivery guy,” she said last week. “How big is his pizza delivery truck? How fast does he get here? Is he nice? Do we give him a big tip?”
Like their counterparts in most other states, Kansas legislators have struggled with health care issues for nearly two decades, alternating between waiting on Congress to approve national legislation and taking incremental steps themselves. Much of the discussion has focused on providing coverage to more people.
In January, Gov. Kathleen Sebelius called on legislators to enact a plan to eventually bring universal coverage to Kansas. Instead, they approved a bundle of less ambitious reforms and told the Health Policy Authority to study other changes.
The authority’s recommendations have emerged from meetings in September and October. They do include more aggressive attempts to see that children eligible for state medical coverage are enrolled and initiatives to help small businesses provide coverage for their employees.
The authority also has endorsed a statewide ban on smoking in public places and an increase in tobacco taxes to raise nearly $52 million a year.
But its recommendations will tackle a whole series of issues, including getting Kansans to eat better, making sure schoolchildren get more exercise, getting more information about health care to consumers, promoting a “whole person” approach to treating patients and encouraging providers to emphasize preventive care.
“Health insurance reform will be part of next year’s debate and should be, but we have to realize that the number of uninsured Kansans and Americans is a symptom of the high cost of health care,” said Sen. Jim Barnett, an Emporia Republican who’s a physician and chairman of his chamber’s Public Health and Welfare Committee.
Perhaps its easier to focus on insurance because it is a tangible thing, lived day-to-day by some 300,000 Kansans. It has easy-to-understand consequences: not being able to afford prescriptions or frantic trips to emergency rooms for problems that could have been treated early but for the cost of a doctor’s visit.
Some of the authority’s initiatives seem less concrete. For example, it wants to define “medical home” in state law.
It sounds like something to tack onto a bigger health reform package, a thick paragraph of dry language inspiring a big “Huh?” from most people who read it.
Describing it doesn’t make the idea sound dramatic, either. Kansans’ medical home would be a doctor or clinic that coordinates their care, linking them to specialists and emphasizing preventive care. If someone has diabetes, for example, every medical service he receives deals in some way with the condition.
The medical home would see that the patient doesn’t take the same tests two or three times, that records are shared and even that the patient has access to community support groups or information at the public library. A patient could consult with a doctor by e-mail to avoid an office visit.
The big change? Insurers and patients would pay doctors for e-mail consultations and coordinating care. Medical providers would be paid more if they created true medical homes.
The goal would be a health care system where services aren’t duplicated, preventive care is emphasized and information flows freely and quickly. Costs would be lessened.
If the state focuses only on making sure more people have insurance, Nielsen said, “We’re just adding more people to a broken system.”
“If we don’t do anything to fix the underlying system, you can just keep adding more people, but at some point the whole thing topples over based on its own weight,” she said. “And you know, we’re pretty close to being there.”
Finally, getting Kansans to do the things they should in their daily lives but don’t also promises to control costs. It’s so obvious people don’t consider it: Someone who’s healthy doesn’t need as much medical care.
“Because of all the advertising on television for pharmaceuticals and drugs, people believe there is a pill for everything,” Barnett said. “They undervalue the importance of exercise, weight control or smoking cessation.”
In short, Kansans need to take a broader view, because health insurance is like the pizza delivery guy, the means for delivering the pie.
“That’s the whole conversation,” Nielsen said, describing her frustration. “Except pizza and whether we like the pizza isn’t dependent on the pizza guy, unless he comes really late and the pizza’s cold.”