Affordable Coverage for Everyone v. Wealthy Special Interests

I went to the fancy conference put on today by the NC Health and Wellness Trust Fund – the arm of state government that gets and distributes 25% of the tobacco settlement money from the lawsuit between the states and the tobacco companies.  HWTF has done some pretty good things, such as funding a drug assistance program for low-income seniors and devoting money smoking prevention efforts among middle and high school students.  The point of the day was to examine solutions for expanding health coverage and how to put more emphasis on prevention like eating right and getting exercise.

 These are good ideas and the highest-ranking official there – Lieutenant Governor Perdue – certainly has a demonstrated commitment to these health issues.  However, as I heard all the good ideas from some of the most distinguished folks in health in North Carolina I couldn’t help thinking about a  major barrier hard for many to acknowledge.  Money and special interests have a huge influence on our current political system and health interests are some of the biggest players.  For an illustration look no further than my colleague Rob Schofield who just wrote a great article on the current effort by some of the most powerful special interests in health to kill the mental health parity bill in the House.

 Rob’s observations are the inevitable result of a political system where some of the most powerful interests in the health industry – especially health insurers and pharmaceutical companies – are among the top donors to politicians and political parties.  Check out this list from Democracy North Carolina.  You’ll see that personal giving by lobbyists to General Assembly and Council of State races is well up and that a significant number of those lobbyists giving the most represent the biggest health interests in the state.  Blue Cross, the Association of Health Plans, insurance agents, big hospitals, the Medical Society – the list goes on.

 If the NC General Assembly can’t get it together to pass something as simple as requiring the same coverage and limitations for schizophrenia as for a heart attack – what mental health parity is all about – then how can we ever think that the same General Assembly will be able to tackle the major changes to our health system required to make sure everyone is covered?  In fact, it’s taken an enormous lobbying effort and substantial compromise just to get past one chamber a health care high risk pool bill that is one of the most conservative health reforms conceivable.

 The big changes we need aren’t that hard to describe.  As Pam Silberman, the head of the NC Institute of Medicine, pointed out at the conference today, multiple states are moving towards universal coverage using a mixture of public and private strategies.  This keeps health insurance much the same for those already covered while using tax dollars to fund more public coverage for those pushed out of the private market.  Dr. Silberman was clear on one point though – you can’t do this for free and talking about taxes has to be part of the equation.

 Polling is clear.  It is now a majority position among the public here in North Carolina (and nationally) that we should have affordable health coverage for everyone and that funding for this coverage should be borne by taxpayers, insurers, doctors and hospitals, and others in the health system.  In fact, Dr. Silberman cited data that among the majority who support coverage for all, most are willing to pay $500 in extra taxes to achieve this goal. 

Unfortunately, despite the good work of many smart health policy people and the clearly expressed desire of the public, I’m afraid that the wealthiest interests in the health industry will continue to stymie real reform.  We need a statewide leader and we need a statewide movement.  We need to create an environment where the craven behavior among politicians towards people suffering from mental illness and substance abuse problems simply isn’t tolerated.  We need an environment where covering all children in the state with sliding scale affordable health insurance isn’t a dream to be deferred by the special interests but a top priority for all state lawmakers.  Most of all we need a commitment that affordable coverage for everyone, even in a relatively poor state like North Carolina, is a goal that we are actually taking steps to achieve – and not shrinking from the challenge.