Getting health reform right the first time

Jan Hudson

Policymakers in Michigan will soon have key decisions to make as health reform implementation progresses. Will they choose to do it right the first time, or follow their current strategy of remedial public policy?

When programs require a financial investment, policymakers say the state has no money to invest, and yet there are always funds to cover remedial services. Will the current approach of cutting programs in the name of fiscal restraint only to fund those necessary services in higher-cost settings be their guide?

For example, children are eligible for Medicaid or MIChild, but are not aware or enrolled because outreach funds and efforts have been eliminated. They are then treated in hospital emergency rooms instead of doctors offices. Or, Medicaid services are eliminated “to save funds” and untreated illnesses become life-threatening, resulting in intensive care stays that could have been avoided.

Early childhood and education programs have been cut or weakened through continued state disinvestment. A Casey Foundation report ranks Michigan ranks 34th among the 50 states in children who are proficient at reading by the end of third grade. Colleges then spend considerable time and cost on remedial education to correct the deficiencies.

Community mental health services are inadequately funded and were severely cut in this budget year. This means services are not provided until a crisis occurs, resulting at times with a person entering the corrections system. Wayne County Prosecutor Kym Worthy recently called for more aggressive mental health, preschool and drug treatment funding.

Federal health care reform presents the opportunity to make dramatic changes in the health care system and the way it’s delivered, defined and funded. A key question is: Will policymakers take advantage of these opportunities — pass needed legislation, and provide the necessary funding and staff for a successful implementation, or will they try to “do more with less” and skate by on the cheap?

If policymakers choose the short-sighted approach in the name of fiscal restraint  then we cannot expect to see the full potential of improvements to the current systems and health outcomes. It is critical that they acknowledge the need for additional resources and supporting public policy so that health reform implementation can be done right the first time.

We can pay now, we can pay later – or both. Will health care reform be more of the same, or will it be implemented right the first time?

— Jan Hudson

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