Kids Can’t Vote but Health Reformers Should Still Listen

Alan_L._Goldbloom

Depending on who you listen to, health care reform in Washington is either closer to reality than it has ever been, or it’s on life support.   Competing ideas are all over the map in terms of how health care should be delivered in America, and how we should pay the tab.  About the only thing everyone seems to agree on is that the current system doesn’t work, and that we need to get something – anything – done.

But with all the energy and effort going into reform, getting “anything done” isn’t good enough.  This is a chance to change the core values of our health care system to deliver access to high quality, low cost care.  It’s time to “invest” in the health of our nation.  We can’t settle for anything less.

As president and CEO of Children’s Hospitals and Clinics of Minnesota, my number one concern is the health of children, and I feel a responsibility to be a voice for children in this debate.  The simple fact is, children don’t vote.  They don’t have political action committees and they don’t make campaign contributions.  But the decisions that elected officials will make about health care will have a huge impact on the health and well being of our children.

If we want to provide the best quality care for children, a few key principals must guide any and all health care reform decisions.

First, we need to address issues around Medicaid reimbursement.  Medicaid is the single largest insurer of children in the country. In Minnesota Medicaid reimburses only around 80 percent of the cost of care, and in many other states, it’s less.  In fact, for all the talk about poor Medicare reimbursement levels, Medicaid pays providers at rates 20 to 30 percent lower than Medicare.  That’s why more and more doctors and clinics are declining to treat Medicaid patients, leaving families without access to proper care.

The current House bill recognizes this inequity and proposes to increase primary care physician payments under Medicaid to 100 percent of Medicare by 2012.  However, it does not address inequities for other key providers such as pediatric hospitals and specialists.

At Children’s of Minnesota, we served more than 42 thousand children on Medicaid in 2008.  We treat all children regardless of insurance status, but Medicaid reimbursement rates do threaten our ability to provide the kind of high quality, specialized services we believe children in our community deserve.

The second key element to reform involves a simple philosophy: we need to reward quality rather than quantity.   My state, Minnesota, has a well-deserved reputation for delivering high quality, low cost health care. Because of this, our reimbursement rates are among the lowest in the country.

We are very concerned about any reform proposals that would apply across-the-board cuts to existing reimbursement rates, without taking into account the value of care already being delivered.

We need reform that provides incentives to caregivers to be innovative around efficiency.  We should be rewarding providers who develop unique care models that eliminate waste while delivering excellent results.  Only then will we see the cost savings that health care reform advocates are promoting.

Finally, we need to change the way we think about health care for children.  Providing health coverage for all children should not be a luxury in this country.  We have already acknowledged that every child has a right to an education, and as a society, we pay for it.  Children’s health care deserves the same support.  After all, the money we spend on children’s health is an investment that pays off for 70 or 80 years, not only in productive lives, but in avoidance of long term health costs. No other health care expenditure has that kind of return on investment.  The needs of children must be front and center in this debate.

There are no easy answers for health care reform.  Honest and thoughtful people can disagree on how we should go about changing the system.  But by sticking to these core principals around Medicaid reimbursement, encouraging efficiency, and investing in children, we will have a good foundation to build on.

Alan L. Goldbloom, MD, is president and CEO of Children’s Hospitals and Clinics of Minnesota, the 7th largest pediatric health system in the United States.  Previously, Dr. Goldbloom was executive vice president and chief operating officer at The Hospital for Sick Children in Toronto, Canada’s largest children’s hospital.  After graduating in medicine at McMaster University in Hamilton, Canada, and training in pediatrics at Boston Children’s Hospital, Dr. Goldbloom practiced General Pediatrics and served as Director of Residency Training at both Dalhousie University in Halifax and at the University of Toronto, before becoming involved in hospital management.

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faizanGoMotionBrian FlemmingRachel HolmgrenRussell Abravanel Recent comment authors
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faizan
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hi
i am totally agree with you , i am also a bloger my blog is related to healt so try it out
http://www.its-about-health.blogspot.com

GoMotion
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Brian Flemming
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Brian Flemming

I found you, Alan, and will now become a regular reader. Best, Brian

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Russell Abravanel
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Russell Abravanel

I believe that children should also have a say in their health care. If they are almost 18, why not give them the opportunity to voice their opinions?

Debra
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Debra

Rates of asthma are increased in areas where pollution of transportion is high, adult-onset diabetes is starting at an earlier age, because of diet and lack of exercise. Why are polluters and companies that have received huge tax breaks not being asked to step up to the plate and help pay for insurance reform (this certainly isn’t health care reform, just another way to maintain the status-quo)?

Dr. Jack Lewin, CEO, American College of Cardiology
Guest

An excellent post, Dr. Goldbloom. Often lost in the haze of heated rhetoric, disagreement and political posturing surrounding health care reform is that which matters most – our children. They truly are the silent voice in this debate, and our efforts to lower costs, increase quality and improve outcomes should be championed with children in mind. To continue addressing the health care needs of our children, and patients across the country, the American College of Cardiology recently launched a national clinical data registry known as IMPACT (IMproving Pediatric and Adult Congenital Treatment). This groundbreaking registry will be a central hub… Read more »

Phil
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Phil

I enjoyed the article, but I agree with a previous statement, prevention def needs to be mentioned in here. If this reform bill is passed, prevention education must be a theme for health care in the U.S.

MD as HELL
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MD as HELL

Children can’t vote. If they could they would vote all of you pols out of office for bankrupting them before they are out of preschool. We want our children to be addicted to government and to healthcare? After welfare and Medicaid destroyed all common sense and family values, we were left with millions of people who had not a clue how to take care of a cold or minor diarrhea or a minor scrape or even a bug bite. We moved from insurance to prepaid care, which is discretionary and which is why we spend so much more in this… Read more »

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Health Plan Veteran
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Health Plan Veteran

Dr. Goldbloom’s emphasis on the importance of children’s health should be a basis principle of the US health care system. Children who grow up healthier are much more likely to be healthy and productive adults. A clear indication of how the values of the US system are out of whack is the difficulty we have in providing incentives to improve children’s health, while at the same time giving hospitals strong incentives to put dying terminal elderly patients on ventilators. This is what needs to change in the US.

Dr. Pandey
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Not just for children but for adult also. Why? A sick person is a emotional burden to children, they may not be able to earn and feed the child, and so much more. When it comes to healthcare, we need to just do it. It is good for all to have a healthcare system that does not break your back. It is just the fear that is creating the panick in many. We have advocated that is the near and far term, healthcare reform will even do good for providers, insurers, etc. It is possible to create a system that… Read more »

happyinhawaii
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Another point we aren’t hearing much about in the debate about health care is that in the US we pay more for health care than any other country in the world. The data is a little old, but in 1997 we spent $3,912 per person on health care expenditures (undoubtedly it would be at least double that today). In comparison, Germany was $2,364, Canada $2,175, France $2,047, Japan $1,760, U.K. $1,391, and Korea $870. Other countries on average spend about half what the US spends per capita on health care. And what do we get for spending twice as much… Read more »

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Educational and healthcare system is the same in the aspects of learning but the thing in healthcare system is the improvement is not that fast.

Margalit Gur-Arie
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If we want to do the right thing for our children, we need to do more than covering them with the best health care we have available. We need to at least make an attempt to change the behavior of the next generation of Americans, so they take better care of their health. We need to encourage sports and physical activities in schools and pay for that. We need to have nutrition education to counteract the barrage of commercials for sugary foods aimed at young children. Maybe even try to regulate those ads somewhat. We need to do something about… Read more »