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A Test For Health Care

March 14, 2007
Commentary By LARRY DEUTSCH

Connecticut's hospital emergency departments are overloaded with patients, a situation that creates delays, waste, discomfort and crowding. People who lack adequate insurance and who have limited access to health services arrive with problems that might have been prevented or handled more effectively earlier and elsewhere. The crush in emergency rooms is a key symptom of the need for a new primary care and public health structure, with a universal health plan for all state residents.

Bills designed to bring better health care to state residents are now being raised in the General Assembly. Apparently the need and demand for change is so clear that a simplified, single-payer universal plan is now emerging from committee for further debate.

How can we evaluate proposals from experts, insurance lobbyists and providers? Important factors have been missing during all the debate about who will be covered and who will pay. Here are 10 questions to grade proposed bills. Score each 0 to 10; over 90 gets A; under 60 fails. Try it as you read about new plans.

No.1. Is it a universal plan including every person in the state? (Has legislature included everyone, regardless of income, employment, pre-existing conditions, immigration status?)

No.2. Does it emphasize primary care and prevention? (Is spending adjusted through an independent health authority to emphasize primary services, including school, family, offices and community health centers?)

No.3. Is it a universal plan which is comprehensive in benefits and mandates, identical for all individuals without pre-existing exclusions, low caps, provisos, opt-ins, opt-outs or discriminating co-pays? Does it recognize and remedy disparities and inequities in services and outcomes? (Do state regulations authorize a single sufficient benefit package and quality standards for all?)

No.4. Does the bill provide for a well-trained, diverse health workforce with capacity and expertise throughout the state, giving real access especially in shortage areas? (Are there funds for training and guideline programs for health providers and other workers, and incentives or licensure requirements for participation without discrimination based on status, plan or payment source?)

No.5. Is there equitable financing recognizing health as a human right, with the burden of payment distributed fairly throughout society in a just and progressive manner? (Does legislation redistribute savings of simplicity and efficiency, funding universal care and community services instead of excess profit and bureaucratic waste? Does it create a Medicare-like single-payer mechanism with fair provider compensation and quality guidelines? Does it capture federal, state, employer and employee payments and out-of-pocket costs and adopt a democratic progressive tax structure or surcharge with protected health system funding?)

No.6. Are there strong local and statewide public health structures with universal quality standards for disease prevention and health promotion, to diminish political, court and legislative wrangling in special cases? (Is there adequate funding for health departments, evidence-based guidelines and modern electronic records for continuity of care with safe public health data collection and action?)

No.7. Does it recognize that more is needed for good health than just medical services - that social determinants of health include housing, nutrition, poverty, environment and education? (Does the state budget address homelessness, poor nutrition and other real health hazards?)

No.8. Are dental and behavioral health services granted full and adequately-compensated status along with medical services? (Do legislators study and remedy shortages and waiting times throughout the state?)

No.9. Are communities empowered to govern their health services, with democratic, local control over the health budget? (Does legislature grant some authority over health dollars to district or community-based health boards with local consumers and providers?)

No.10. Are health care workers at all levels (nurses, attendants, clerks, aides, technicians, doctors, dentists, therapists) adequately paid and involved to evaluate and adjust working conditions? These questions aren't so difficult. Now, tell your legislators which proposals get satisfactory grades and what you think.

Larry Deutsch, MD, MPH, a community and public health pediatrician, is on the Tobacco and Health Trust Fund board of trustees, University of Connecticut Department of Pediatrics, and staff of Generations Family Health Center in Willimantic.