I wish I could be more enthusiastic about Gov. Kathleen Sebelius' chances of helping to fix our badly broken health-care system by going to Washington to run the U.S. Department of Health and Human Services, but being a person who has spent quite a lot of time on that issue in the state, and judging by her record in Kansas, I cannot.
First, no state alone is going to "solve" either access or cost of health care. Oregon, Tennessee, Maine — one state after another developed programs, and each collapsed due to cost. The best any individual state can hope for is to ameliorate the problem, not solve it, and the best approach to do that is to slice the problem into manageable parts and bring as many diverse resources as possible to bear. I chaired the Kansas Legislature-created Business Health Partnership, which specifically addressed accessible affordable health care for lower-income employees of small businesses. In Kansas, that means over half of the working uninsured.
Our approach was to encourage insurance companies to design lower-cost lower-coverage plans, require some employer cost participation, and get the Legislature to double the refundable tax credit for employers to $70 per employee per month for premiums. The plan was marketed by local insurance agents, who are most familiar with, and most familiar to, small communities throughout the state.
Instead, the governor developed a whole new bureaucracy, which C.J. Janovy's article correctly describes as accomplishing not much of anything. The difference in approaches? Accomplish a targeted goal in a practical way or try to do everything through the bureaucracy and end up with nothing.
I trust someone else will be the real decision maker on this issue in Washington. We really can't afford to screw it up again.
Bill Kostar, Lee's Summit
C.J. Janovy's article was very good and very thorough, as well as very depressing. She did a good job of documenting the influence of rich and powerful companies and professional organizations on legislators, which is even worse in D.C. I have long said that the problem with poor people is that they just don't contribute enough money to legislators! Oh, yeah — they're poor.
The insurance expansion proposed by the Kansas Health Policy Authority was only one model among those put together by Steve Schramm of Schramm-Raleigh consultants, the company that several foundations funded to perform KHPA's research. The whole report, available on the United Methodist Ministry Health Fund Web site (healthfund.org) looked at several options. One was single-payer. It was one of only two that covered all of Kansas' 280,000 uninsured. The other was "universal" (essentially "pay the insurance companies to cover everyone"), but single-payer cost less. A lot less. Single-payer saved at least $800 million. And, Schramm said, he used conservative numbers, so it could be as much as $2.5 billion.
Also of note is Janovy's coverage of the safety-net clinics. Safety-net clinics are nice but do not, as Janovy notes, solve the problem. They are small Band-Aids on a huge wound. Unlike Texas (that model of progressive social policy), where I lived before coming to Kansas in 2002, Kansas does not require counties to pay for the care of the uninsured. In San Antonio, there is a county hospital and six huge, gorgeous county-owned clinics for the uninsured in addition to two large safety-net clinics. In Kansas, no public hospitals. No county money spent — even in wealthy Johnson County, where the raw number of uninsured exceeds that of Wyandotte County.
For readers who are interested, I blog about medicine and social justice at medicinesocialjustice.blogspot.com.
Joshua Freeman, M.D., professor and chair
Department of Family Medicine
University of Kansas School of Medicine
Kansas City, Kansas
I enjoyed reading "The Cure From Kansas." C.J. Janovy did an excellent job of explaining a crucial, complicated topic in a compelling way. Health-care reform was the issue that grabbed me the most when I covered health care on the business desk of The Kansas City Star, and Embarq's Ned Holland was one of my favorite people to talk to. Janovy's work is important and appreciated.
Kansas City, Missouri
Correction: "The Cure From Kansas" incorrectly reported the hometown of Kansas Senate Majority Leader Stephen Morris. He is from Hugoton.
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