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Show nature. HealthPrint has proven that moving slowly and carefully is preferred over rapid action that must be undone because of adverse outcomes. Lost on the Road to Reform by Bill Crim I remember sitting with a group of uninsured Utahns shortly after Governor Leavitt unveiled his "flexible master plan" for health care reform. Most of them were too poor to afford private insurance, yet unable to qualify for Medicaid. Their disappointment was crushing as I explained that HealthPrint would not be an immediate solution to their problem. Despite its promise to establish "a rational process for providing affordable health care coverage for all Utahns," I could see their hope fade as we analyzed each person's situation against the multi-year time frames and questionable assumptions of HealthPrint. Now, three years later, we find ourselves trying to figure out what effect HealthPrint has had. There is no doubt about the countless hours of well-intentioned hard work put in by the Health Policy Commission staff and numerous volunteers. But has HealthPrint had a noticeable impact on those uninsured Utahns it was designed to help? I'm afraid not. As much as I'd like to look optimistically at the small gains that have been made, I can't help but notice that there are still between 150,000 and 200,000 Utahns who don't have any coverage at all-and prospects for their future coverage seem dim. HealthPrint has produced its annual quota of legislation-some of it quite beneficial to small groups of people. But without exception, accomplished "reforms" have been politically easy and relatively insignificant in their effect on the central problem of providing affordable coverage to the bulk of uninsured individuals. The "golden child" of market based health care reform-the Medical Savings Account (MSA)-has failed to produce a single properly filed MSA tax form. Open Enrollment requirements were effectively delayed by the insurance industry and then manipulated to allow the exclusion of even more Utahns from the insurance market. The main hope for the uninsured working poor-Medicaid expansion- has been indefinitely delayed because no one wants to pay the cost. HealthPrint only mentions, but does not assume state responsibility for covering the very large segment of working poor Utahns who earn between 100% and 150% or the federal poverty level. With the main tools for expanding coverage having proven ineffective, "too expensive," or both, the original vision behind HealthPrint has become obscured by a myriad of study items which tinker at the edges of health policy, but do little to make insurance affordable for the working poor. The fact that HealthPrint has not reached its primary destination, and in fact seems lost altogether, leads me to ask if it was ever on the right road at all? Several of HealthPrint's basic assumptions seem problematic. Most obvious is the assumption that large numbers of working poor families can be covered under Medicaid and paid for entirely with savings from capitation and administrative efficiencies. To be sure, there were savings generated in the Medicaid system-but never enough to cover the bulk of the uninsured population. The fact that the Legislature raided the savings for three years straight highlights another problem-using Medicaid as the means to insure the working poor is, at best, a temporary fix. Without stronger state and federal leadership, Medicaid will remain a vulnerable program which cannot be counted on from year to year to provide coverage for low-income Utahns. Second, cost containment strategies in HealthPrint rely almost entirely on faulty assumptions about the ability of enhanced market forces to control costs. In order for competition to control costs, a truly FREE market must exist, in which the laws of supply and demand are operative, and in which the consumer can be fully knowledgeable, has the ability to pay the entire cost of the goods, and is free to choose not to transact (i.e. does not lose money, health or life by choosing not to transact). None of these basic market principles applies to the health care situation. Finally, HealthPrint perpetuates the myth that figuring out how to reform our health care system is a complex task. The Health Policy Commission and its numerous Technical Advisory Groups (TAGS) are mired in endless discussions of policy minutiae, which taken individually are worthwhile, useful discussions 26 Two Perspectives on Utah's Health Reform |
