Kids Can’t Vote but Health Reformers Should Still Listen


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

  3. 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?

  4. 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)?

  5. 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 of quality-driven, evidence-based data on the management and outcomes of patients with congenital heart disease.
    IMPACT is designed to do one thing – build knowledge, the foundation of quality. Little is known about the patient population suffering from CHD, particularly children. But, by giving physicians the knowledge they need to provide sound cardiovascular care, cardiologists can further improve the health and well being of children living with CHD.
    To learn more about the IMPACT Registry, and everything the ACC is doing to put quality first, visit the Lewin Report at

  6. 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.

  7. 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 country. We spend more on everything in this country. Why should healthcare be the exception?
    Discretionary spending and no common sense; since patients are spending dollars to which they feel no attachment, the spending is rampant.
    Our children are going to hate us for spendiing their America into oblivion.

  8. medicines have to be controlled mainly by the different situations that can determine, is known to the world that much addiction to drugs such as Vicodin, Lortab, OxyContin, codeine, which are anxiolytic and may cause collateral damage from this situation, why care and prevention, and self says we should not resort to findrxonline but specialist.

  9. 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.

  10. 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 is win-win-win and win.

  11. 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 per capita than anyone else?….(From the Down to Earth blog by Mark Fergusson. Read the rest at

  12. 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 our tax money that goes to subsidize all those sugars and saturated fats, but that’s another war altogether….

  13. let me add that only applies to adults capable of making adult decisions. All children and mentally disabeled should be covered no matter what.
    don’t want anyone getting any wrong ideas about the temp of my blood

  14. My preference would be to deny people that can’t pay for care or that refuse to purchase/sign up for subsidized insurance health care. This would have the left wailing non stop and calling me a murderer so just mandate they have insurance. I would prefer people have the right to opt out of the system but only if they suffer the consiquences. One battle at a time. It’s my own person incremental approach to reform

  15. Nate,
    Interesting that you want government to butt out of providing insurance, but you are all for having them mandate that people buy it.

  16. I sure hope we do better by kids then what we have with education. When kids are getting beat up, shot, and killed at school and less then 50% graduate most city schools we need to be aiming a lot higher. The comparison to education is another good example of what happens when you rely on the governemnt to accomplish something so important.
    Parents need to be required by law to have their kids insured just as they are required to educate and feed them.

  17. Dr. Goldbloom
    Congratulations on your advocating for children.
    I agree we need to equate health to what we already do in education.
    But I was dissapointed that the word “prevention” did not appear in your post?
    What better population than children would benefit from sound investments in prevention?
    Dr. Rick Lippin