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And Finally...

Mending the System
How Utah can help find a solution to the nation’s health care conundrum.

By Robert Huefner

Robert Huefner
Robert Huefner

Today, the crisis in health care in the United States is broadly recognized. It isn’t new, however, but only continues to grow as we fail to confront it.

The current financial crisis in health care first became severe 35 years ago and keeps worsening, fueled by expansions in public and private insurance and advances in technology. Quality concerns prompted a revolution in medical education a century ago, and are resurfacing. And access to affordable health care has been a recurring priority in domestic politics throughout the 20th century and into the 21st.

As problems fester, reform may produce desperate conflicts between payers, providers, and patients, with one group suffering a major defeat because winning interests have used political power for a knockout blow to protect their own turf. As a result, patients could lose comprehensive benefits, insurers could become highly regulated—if they even survive—or providers could lose independence and significant income.

The problem is commonly framed as that of insuring the uninsured and of reshaping incentives directly affecting cost. This year, those issues are playing a major role nationally, in the upcoming presidential campaign, and locally, where the Utah Legislature has proposed an expansion of efforts encompassing collecting, analyzing, and distributing cost information and developing electronic exchanges of clinical records.

It is the fifth time in three decades that Utah has addressed the problem, and the State shouldn’t be blamed if an effort to assure insurance coverage fails again. Why? Because insuring the uninsured is a problem the federal government must resolve. States lack the fed’s potential bargaining powers and financial base.

However, Utah’s greatest opportunities lie outside the Legislature, though not independent of it-that is, to build upon Utah’s leadership in healthy lifestyles, health information technology, and the improvement in health care quality. Utah is in a position to significantly ease the access problem, improve people’s health, slow the growth of costs-and provide models for national reforms.

There are four types of improvements that build upon Utah’s strengths. Each presents difficult challenges.

Insurance: The State can make incremental improvements in the financing, eligibility, and structuring of insurance programs (Medicaid, SCHIP, etc.), as it did this year, extending coverage and proposing to shift from payment for procedures to payment for managing conditions. This requires federal flexibility, financial support, and responsibility for insuring the uninsured, made more promising by the attention given the proposed Healthy Americans Act, sponsored by senators Wyden (D-OR) and Bennett (R-UT).

Broader aspects of access: Insurance and access are incomplete if they don’t take into account differences in patients’ languages, cultures, economic circumstances, and values. Utah’s advantages include high levels of patient and provider education, and income disparities that are less than in most states. Still, we must be more proactive in sensitively serving Utah’s diverse population.

Costs: Utah is a leader in assessing and providing information regarding comparative costs and quality of health care, as well as informing business and public policy makers of health trends. The primary challenge to decision makers is to use the data effectively to inform the public, and employ the data within their organizations. Another challenge is to make data more useful for consumers, which requires a more complete measure of costs and quality, and to make them more widely accessible and understandable.

Quality: Quality improvement is key to cost control and to access. Utah ranks high for healthy lifestyle (with a population boasting higher rates of physical activity and lower rates of smoking), and it has an international reputation for improving surgical procedures. The key challenge is to establish a culture that energetically seeks improvement, and to escape the inertia of habit. This requires a commitment by health care professionals as well as the public, along with continuous attention to incen­tives and extensive educational efforts.

The solution to the health care crisis will not be found by promoting ideologies of either private or public solutions, or by announcing the superiority of either the federal or state government. The solution must entail collaboration by patients, practitioners, payers, and political parties to seek the most effective public and private, and state and federal reforms. Progress will be incremental and evolutionary-not accomplished in a year, not by one institution, not through one process, and not by one individual.

— Robert Huefner is professor emeritus of political science. He formerly held the Governor Scott M. Matheson Presidential Endowed Chair in Health Policy and Management.

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