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Connecticut Health Policy Project
  Improving Connecticut's Health Through Information

Tenth Anniversary

September 2009

In celebration of the CT Health Policy Project’s tenth anniversary, we asked wise and prominent stakeholders with very different perspectives in Connecticut’s health care system to reflect on the accomplishments and challenges of the last ten years and share their thoughts about our future.

Patricia Baker, President and CEO, CT Health Foundation

Question: What has been the most promising (or troubling) development in health care over the past decade? What is your biggest worry/best hope for the next 10 years?

Thank you for including the Connecticut Health Foundation in your reflections. In many ways I can’t help but see the world through this 10 year prism since the foundation is also in this reflective state.

When the Connecticut Health Foundation started its work, the public health issues facing the state looked very much like they did 10 years prior. Perennially some issues remain at the bottom of the list or deemed unachievable. The Connecticut Health Foundation’s commitment to health justice led the foundation to focus on those often marginalized or diminished: oral health, children’s mental health and the reduction of health disparities. The struggle and the promise of this decade is how to transform the health system as opposed to a discussion explaining why the Clinton plan failed. As the debate on how to transform the health system takes place, the opportunity to integrate care not just medical but oral and mental health, promote evidence based health care, and create a more effective, efficient, and accountable system is at hand. The question is what are we going to do with it? Is fear and self interest going to drive the decision-making, or are leaders, stakeholders, and residents going to place the health and well being of all Connecticut residents as the primary objective.

I was told when the foundation first started its work on the elimination of health disparities that this was a topic that should not be discussed in politics because it was so polarizing. Well, we now speak of the inequities of a system that perpetuates or accepts racial and ethnic health disparities. The next decade must be about solutions. This requires a true partnership between the health system and public health. This integration is the next frontier which is why the work of the Connecticut Health Policy Project and many others is so important. The stories of those most affected must be told. The data and evidence must inform, and change must come.

Congressman Joe Courtney

Question: What has been the most promising (or troubling) development in health care over the past decade?

Over the past decade, many components our health care system have eroded. The cost of care has become increasingly more expensive and the number of those without insurance has grown to unprecedented levels. These struggles are conveyed to me every day by my constituents—each story unique, but each with an unsettling familiarity underscoring core failings in our system. The status quo has failed too many people.

Question: What is your biggest worry/best hope for the next 10 years?

My biggest hope now is that our nation can form a collective agreement to work to overcome these failings and lay foundations for sustainable improvements in our health care system. This new system wouldn’t deny coverage based on a pre-existing health condition, rescind coverage after an agreement has been made, or cause financial ruin following a catastrophic health event.

Former Congresswoman Nancy Johnson, Senior Public Policy Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz

Question: What has been the most promising (or troubling) development in health care over the past decade?

As I have watched our health care sector evolve and struggled with its governance issues as a Subcommittee Chairman in Congress, I have been most troubled by the inability of public programs to reimburse providers fairly. On the state level, as Medicaid absorbed an increasing share of the state budget, reimbursement rates sank abysmally, even as state employee plans, negotiated with the private sector, paid going rates. As House author of the SCHIP bill, I provided for coverage through private plans or Medicaid to prevent creation of another cost-shifting plan, but in the end, Husky paid Medicaid rates. Medicare has now taken the same road and pays less than cost in most states, though it used to be the best payer. Tricare is following suit. While cost shifting by some leading experts is now 25%, the greatest harm is the reduced access to care that underpayment causes.

In terms of the most promising development, I would sight the absorption of the power of care management to improve the quality and reduce the cost of care for patients with multiple chronic illnesses. Private plans and select public plans are demonstrating the enormous power of this approach, though a way to adopt it systemically evades us in the public sector and simply isn't required of the private sector... yet! A deep understanding of care management has, however, enabled us to grasp the possibilities inherent in aggressive preventive care and self care and changed our communal vision of health care from an illness treatment model to a true health model which includes illness treatment as part of a far more holistic approach to health.

Question: What is your biggest worry/best hope for the next 10 years?

My biggest worry is that we will try to create the future using the models of the past that have failed to deliver integrated care or involve patients in their illness or wellness. For example the old model of health care plan requires a deductible and co pay every time you access care. The new model wants you to access care for preventive care and "dumb little questions" to catch symptoms of trouble early. New plan designs actually reward such responsible behavior. Likewise, adherence to treatment regimes reduces ER and hospital use but takes discipline. Shouldn't such discipline be encouraged, supported and rewarded? New plans do. There is so much to learn about how we share responsibility in a health system! And yet that is the only path to affordable care for all. The other alternative is rate cutting and rationing which is modeled for us the world over. If we succeed, it will be yet another great American invention: A HEALTH SYSTEM!

Senator Edith Prague, Co-Chair Aging, Labor and Public Employees Committees

Question: What has been the most promising (or troubling) development in health care over the past decade?

The past ten years have brought us many mandated benefits that make health care coverage more comprehensive and beneficial for many individuals and groups. Benefits such as mental health parity, coverage for mastectomy, medical decisions directed by patients and physicians not insurance companies, coverage for autism spectrum disorders, and many more have improved the quality of life for thousands of Connecticut residents.

Question: What is your biggest worry/best hope for the next 10 years?

My biggest worry for the next ten years is that the number of uninsured people will grow and the cost of health care will “break the bank.” I’m truly worried that the federal health plan will not pass our hopes for the future will be dim.

Representative Betsy Ritter, Co-Chair, Public Health Committee

Question: What has been the most promising (or troubling) development in health care over the past decade?

Answer: I am pleased to see the reform movement back in the national spotlight. In the most recent years we have seen a greater emphasis on research, oversight and monitoring aimed at strengthening the case for reform; and these efforts are producing increasing, overwhelming evidence of the necessity to do so if we are to have a vital and vibrant health care system able to serve the county.

Question: What is your biggest worry/best hope for the next 10 years?

Answer: I am particularly concerned that with each passing year we see a decrease our ability to deliver adequate and consistent primary care to the general population. The current education and financial reward systems provides few incentives for professionals interested in primary care to stay in primary care; in fact, the disincentives to do so are huge. This loss is devastating to preventative medicine, appropriate utilization, cost management, and future viability of our health systems, to name just a few consequences. We will not be successful unless we reverse these disincentives and build a foundation for primary care that supports our health system for the future.

Gary Spinner, Physician Assistant

Question: What has been the most promising (or troubling) development in health care over the past decade?

Answer: The past decade’s greatest disappointment, but not surprise, was the passing of another decade without universal health care in the United States. During the Clinton Administration, health care costs as a percent of GDP were 14%, with annual l health care spending at about 900 Billion dollars, and 44 million Americans lacked health insurance. Today, we spend 17% of GDP, about 2 trillion dollars per year on health care services, and there are now 46 million Americans lacking health insurance. While a few States have taken bold measures to address the problem on a state level, (including Connecticut’s very recent passage of SustiNet as an attempt to position CT towards health reform) little has been done nationally to assure health care access for everyone in the U.S. I am especially heartened, however that we have another opportunity to enact some meaningful health reform that will test the forces for social change against the powerful mobilization of special interests intent to keep their fiefdoms intact.

From a global health perspective, it has been exciting and significantly promising that access to HIV treatment with anti-retroviral medications for millions of people in the developing world has finally begun. With 33 million people living with HIV world-wide, the past decade has seen a 10 fold increase in the number of people in resource-constrained countries now being offered treatment. While the actual numbers of people being treated are still small relative to the vast numbers of HIV-infected people world-wide, it is a highly encouraging change, and one that should lead to a great reduction in mortality from AIDS, as well as a reduction in the transmission. This development, coupled with new HIV prevention efforts, has contributed to a world-wide decline in new cases of HIV in the past year

Question: What is your biggest worry/best hope for the next 10 years?

In Connecticut, one of few states to have long offered state-funded health insurance to a select group of low income adults (SAGA), it is likely that this program will become a part of the state’s Medicaid program in the coming years, which will reduce the state cost of the program by shifting partial cost to the Federal government. Depending on how expansive national health reform legislation will be, assuming its passage, it is possible that a the growth of health insurance from public options like Medicare and Medicaid could make them the predominant way that most, if not all of the currently uninsured people in CT (with the likely exception of undocumented residents) will be receiving coverage for health care in the years to come.

Hillary Waldman, Hispanic Health Council, former health reporter for the Hartford Courant

Question: What has been the most promising (or troubling) development in health care over the past decade?

Answer: To begin on a promising note, I am encouraged that the president and the Congress have at least re-opened the conversation about health care reform and that we have a president who seems to truly believe, as I do, that health care is a right and not a privilege. Another glimmer of hope has come from a handful of states that have at least taken a stab at filling the health insurance gap at a time when Washington was so opposed to any government intervention. On the other hand, I believe that most of the state efforts have fallen short so far and that even in states where near-universal care is offered, the cost remains a major barrier to many of those who are most in need. It will be interesting to see if the tanking of the national economy turns out to have a silver lining as people who were once well employed and well covered with employer-paid health insurance now join the ranks of the unemployed and find out just how difficult it is for an un- or under-employed individual to get decent health insurance.

The most troubling development of late have been the lies and distortions swirling around the national health reform efforts and the apparent willingness of so many to accept the critics’ claims without question. I also was disappointed to see the Democrats so quick to pull any public option from the table. I know there is a lot at stake here, but I do hope that it will not take too many more decades for somebody to recognize that with equal access to health care our entire country will be stronger.

Question: What is your biggest worry/hope for the next 10 years?

Answer: My fondest hope is that nobody will ever have to worry again about barriers to health care created by pre-existing conditions, immigration status, ability to pay, ability to work, etc. I would also wish that social determinants of health _ poverty, educational gaps, food and nutrition issues, lifestyle choices and other social and environmental forces that influence health _ could be addressed so that the cost of health care could be reduced simply by improving the overall health of our population. I hope that the nation embraces the principle that everybody deserves health care and the nation would be healthier as a result. I especially wish the nation would take a more active approach toward preventing and reversing smoking and obesity _ two of the leading causes of health problems _ and costs. My biggest fear is that nothing will be done and we will continue spending billions of dollars without improving the health of so many.

Nancy Wyman, Connecticut State Comptroller

Question: What has been the most promising (or troubling) development in health care over the past decade?

Answer: I applaud the work of the Health Policy Project and Ellen Andrews for their passionate advocacy on behalf of Connecticut’s residents. A decade of attempts at reform has proven the complexity and challenge of initiating fundamental change in our healthcare system. We have, however, come a long way in reaching broad consensus on the need to embrace common sense cost saving solutions such as prioritizing electronic medical records, initiating preventive and wellness care and establishing medical homes. Organizations like the Health Policy Project have been crucial in efforts to research the effectiveness of these reform measures and educate the public and our elected officials on the need to find innovative solutions.

Question: What is your biggest worry/best hope for the next 10 years?

Answer: We are at the brink of seeing real healthcare reform both in Washington and here at home in Connecticut. Whether or not you believe, like we do, that healthcare is a fundamental right, policy makers on both sides of the isle understand that skyrocketing costs have made our current system financially unsustainable. The financial realities of our times coupled with the undeniable need to offer individuals and family’s quality and affordable care dictate that reform is imminent. I am confident that the debate ensuing in Congress and in state houses across the country will result in a uniquely American healthcare system that offers every citizen the care they deserve.

Jill Zorn, Program Officer, Universal Health Care Foundation of Connecticut

Question: What has been the most promising (or troubling) development in health care over the past decade?

The passage of a major piece of health care reform legislation in Connecticut, the “insurance capital of the world”, including overriding the Governor’s veto was a huge accomplishment for the cause of health care reform in our state. Equally promising is HOW it was done, through a combination of grass roots efforts and unlikely allies working together. I hope this spirit of cooperation can last through the planning and implementation of SustiNet.

Another encouraging trend is the growth and development of community health centers. They have received significant state and federal support, even when other programs were being cut. They have great potential to implement the medical home model, electronic health records, and other key delivery system reforms and serve as an example of how health care should be delivered.

Question: What is your biggest worry/best hope for the next 10 years?

My best hope is that there actually WILL be significant delivery system reform, with a renewed emphasis on primary care, so that people receive coordinated care that promotes health. I also hope for reform that will focus on setting health goals and then measuring and monitoring outcomes so that we can strive for improving the system.

My biggest fear is that the profit motive in health care will work against needed reforms. On the delivery side this means emphasizing boutique and specialty medicine, overtreatment and unnecessary procedures for those who can afford it, while fewer resources are available for primary care and prevention. On the coverage side it means structuring health insurance plans to insure shareholder return, not health and health care.