December 2009
From James R. Knickman’s December 14, 2009 Huffington Post column:
A Health Care Wishlist for 2010
With Congress moving toward a final resolution on health care reform and New York making positive strides on a number of systemic issues, 2010 holds great promise for improving our health care system. However, with mounting deficits at both the state and federal levels, nothing is guaranteed.
With that in mind, here's my wish list of reforms I hope we can accomplish in 2010.
The bill will need to be a compromise, as there are sharp divisions in how we think as a nation about health insurance coverage. However, we cannot let the opportunity for reform slip away, and most of us agree on the following core elements: expansion of Medicaid eligibility; subsidies for lower income families to purchase private coverage; a mandate requiring every person to have coverage; insurance reform that ensures every American is eligible for insurance; and a fair, affordable financing plan.
New York State's annual health care spending exceeds $126 billion and surpasses national spending on a per capita basis. These costs must be reined in to make health care affordable for New Yorkers. We have viable options to reduce costs without sacrificing quality: reduce unnecessary hospital readmissions; coordinate care for individuals with complicated and chronic health problems; pay for health care in a way that rewards efficiency rather than waste; and reform the medical malpractice system.
More than 1 million New Yorkers eligible for public insurance programs are not enrolled. In part, complicated paperwork requirements make it more difficult for those who are eligible to enroll and stay enrolled. Additionally, the federal government needs to rethink its many out-of-date rules that make it challenging for states to reach people who are eligible for public insurance programs.
The Nonprofit Finance Fund estimates that 100,000 community health providers nationwide could close in the next two years, seriously jeopardizing care for the most at-risk patients during a time when they need it most. Despite whether national health reform happens, community health providers are a critical asset to our health care system. One approach to making these community providers more viable is to facilitate mergers of small organizations to bolster their competitiveness in the current economic climate and allow them to maintain their critical services. The New York State Health Foundation piloted this method with 10 non-profit organizations in 2009 with $2 million in grant funding. The guidelines and best practices from that initiative should translate to a broader statewide effort.
Iraq and Afghanistan veterans and their families experience substantial strain from repeated and lengthy deployments, and often face challenges in accessing key health and social services at home. While most returning veterans are eligible for behavioral health services through the VA, real and perceived barriers prevent many of them from seeking care at VA facilities. And, families of veterans are not generally eligible for comprehensive counseling services through the VA--yet, counseling might be essential for a veteran's reintegration into life back at home. Finally, it is imperative that the approximately 900,000 outstanding claims and appeals for VA health care benefits are addressed quickly to ensure that veterans receive timely care.
Currently some 1.8 million New Yorkers have diabetes and another 3.7 million have prediabetes, putting them at serious risk of developing the disease. Together, these figures add up to a quarter of New York State's population. In spite of these jaw-dropping numbers, there is not nearly enough urgency throughout the State to address this potential health crisis. In 2010, we need to see more efforts to fight obesity (a key cause of diabetes) and to improve the medical management of this disease.
Perhaps the biggest wish for 2010 is continued, aggressive action--on the federal level to pass a comprehensive health reform bill, and on the state level to address the many smaller issues that plague our health care system.
James R. Knickman
