We live in cynical times. We believe principle is rarely part of the process in politics. We question the sincerity of our elected leaders; we assume the worst of them and, unfortunately, some of them, too often, give us good reason.
I remember the rancorous partisanship surrounding Hillary Clinton's 1993 health care proposal, and I remember wondering: Will we ever find common ground on health care again?
I believe we will; I believe we can. Historically, we have solved big problems here in Rhode Island. Even during a budget crisis, we led the country with the formation of RIte Care, a national model for health care reform. And I know we can do more.
In these last nine months as lieutenant governor, I have become more committed than ever to continuing my work on health care, to cutting through the red tape, knocking down the barriers, bridging the gaps and working with hospitals, health care providers and insurers to address the fears and frustrations of so many Rhode Islanders who see a health care system that is cumbersome, complicated, and too often inaccessible.
I applaud the governor for taking a necessary look at our state departments and crafting a plan to streamline government. But I am concerned about an underlying theme: It's time to reduce government.
I think we need a bigger vision. It's time to transform government.
Yes, we have a serious budget shortfall that we must address now. But simply taking out the budget axe will not transform the way we deliver services. I know we can provide a better government at a better price, and Rhode Islanders will see the difference.
Call me optimistic. But I believe, with the right leadership, we can take on that challenge, balance the budget in the long term, and make affordable health care a reality.
By thinking beyond the next budget cycle, we can make a pledge that starting in this legislative session and continuing through the next five years:
• All Rhode Islanders will have access to the highest-quality health care at a cost they can afford.
• Every senior and disabled citizen will have access to a modern, redesigned statewide service network that helps them stay in their homes and live on their own.
• All of our hospitals, both community and teaching, will be well financed, well equipped and well positioned to serve our state, our neighbors and our families.
• Every small business will benefit from a new, more realistic, well-thought-out, comprehensive economic vision for Rhode Island that includes health insurance that companies and their employees can afford.
We can pledge that in five years we will have reinvented government and transformed the way it serves all its citizens. That is my pledge.
• • • •
When I graduated from college we had entered the last quarter of what many have referred to as “America’s Century.”?
It was a century in which our parents and grandparents suffered through the unimaginable tragedies of the Depression and two World Wars. But they not only endured; they turned their hardships into opportunities. They created Social Security, built the Federal Reserve system, established the United Nations, and implemented the Marshall Plan.
They believed America could do anything and, on their watch, it did.
When I graduated from college, there were still thousands of families in Rhode Island working in factories and mills. They worked in big and small factories from Westerly to Woonsocket.
Those factories were the backbone of Rhode Island’s economy. Workers were loyal to the company and the company was loyal to them – companies like Cranston Print Works, Gorham Manufacturing, Uncas Manufacturing – along with hundreds of smaller companies.
That was also a simpler age of health care.
People did not worry about choosing among 1,000 health plans. When they wanted to see their doctor, they did. For most of them, affordable, on-demand health care was a given, guaranteed by a Blue Cross/Blue Shield card provided by their employer. And they trusted the system because it seemed fair, honest, affordable and readily available to anyone who needed it.
It wasn’t cumbersome. It wasn’t complicated. It did not include words like pre-existing condition or participating pharmacy or health maintenance organization or single payer.
Looking back, communities were also closer. Access to affordable health care was part of the broader community ethic.
What – specifically – can we do now to fix the health care system in Rhode Island?
We must cover every single Rhode Islander. We must insist that an insurance card is in each of their hands, and we must make access to high-quality care our main focus and goal.
In my view, it begins with a four-part framework for comprehensive health care reform.
• • • •
First, we must maintain and strengthen what works in the current system. Rhode Islanders know we have some of the best doctors and hospitals in the world and that we receive world-class care when we need it.
But to continue to access that level of care, we must help employers find a way to offer the health insurance we know they want to provide. That means making sure employers do not have financial pressures to drop employees who are currently covered, and it means enrolling those eligible for RIte Care who are not currently in this federally matched program.
Second, we must broaden access to health care coverage by allowing individuals to buy insurance that is affordable and portable, regardless of their health or employment status; allowing small businesses to buy insurance on a level playing field with large employers; letting Rhode Islanders shop for a health plan online, on the phone, or in person in a transparent environment; offering coverage to low-income families priced on a sliding scale; maintaining minimum coverage criteria for insurance companies; and ensuring affordable coverage to any Rhode Islander who applies for it, regardless of age or health status.
The third part of the framework is to contain health care costs and increase health care value. To do that, the state should work with medical providers to ensure they have access to electronic medical records systems that are compatible with each other and protect patients’ privacy.
The state would also work with insurers to make sure doctors get paid to keep their patients healthy, using the best evidence-based proven treatments, and prevention-focused medical practices available, and that they work as partners, not adversaries.
It would also require hospitals and providers to release quality and cost statistics to the public, collected, tracked and reported by the state to ensure the highest quality of care and allow patients to make educated choices.
Fourth, we must have a system that strengthens hospitals and primary care providers and supports individuals and families in finding the best, most affordable coverage.
Those in state-subsidized plans should be asked to choose a primary care physician, and we should ensure the plans emphasize wellness and chronic care management, passing along the savings realized through wellness initiatives in the form of more affordable premiums.
We also need to create a more rational system for delivering care. Community hospitals need to deliver services their communities need, not those for which insurers pay most.
The bottom line is: Everyone should have the care they need, when they need it, and in the most effective and low-cost setting.
Earlier this month I visited Taiwan to meet with health insurers and health professionals there to see their universal health insurance coverage approach. While doctors and bureaucrats do not agree on all the details, they all agree that universal coverage is essential to rationalize health care delivery.
This is the basic framework for what I believe comprehensive health care reform could look like if we have broad community participation.
It is only a beginning. I do not claim to have all the answers, but I know one thing – we have to start somewhere. We need to engage the debate and move forward.
Yes, Hillary Clinton has a health care plan. Even President Bush has preferences for changing our system. We are watching the Massachusetts plan closely to see where it would take us. Now the time has come for us in Rhode Island to set our own course and insist on a comprehensive Rhode Island Health Care Reform Plan.
It will require patience and it will demand strong leadership – someone willing to bring everyone together. Someone willing to listen to all sides. Someone who can convince Rhode Islanders of the difficult choices we must make – if we are to reinvent state government, fix systemic fiscal issues that prevent us from balancing the budget year to year, and find the funding to make our vision for health care reform a reality.
Let us begin today, right here, right now. I ask you to join me in that effort. •
Elizabeth H. Roberts is the Rhode Island lieutenant governor; she can be contacted at riltgov@ltgov.state.ri.us. This article is adapted from a speech she gave at the University of Rhode Island last Tuesday.
The Lt. Governor is right on the broad concepts of what must be done in RI. Perhaps understandably, she may be a little light on the “how”. That invites cynics and apologists for the status quo to be critical, but they are wrong and she is the one showing some leadership, not them. Those in a position to effect such change, as well as sincere regular citizens wanting to make a difference should work with her to fill in the details of her bold new world. Where do we sign up?