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Economy, health care hot topics |
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Wednesday, 03 March 2010 |
Mike Beebe — Governor
I recently returned to Arkansas after attending the winter meeting of the National Governors Association in Washington, DC. The economy and health-care reform dominated our discussions, but the tone of these conversations was very different than we have come to expect out of Washington.
These sessions were focused, pragmatic, insightful, and respectful. And almost always, they were bipartisan.
America's governors often work well together because we face similar challenges: Balancing budgets during tough times, helping our citizens find jobs, and reining in exploding Medicaid budgets. These problems aren't very different from those facing the federal government, but governors deal with them on a more direct and everyday level, and that crafts our responses to them.
Most governors are prohibited from deficit spending, as none of us can print more money when we run short. As a result, governors of both parties tend to look for common-sense solutions to problems. Most important, neither party's governors claim a monopoly on good ideas, especially when it comes to fixing health care.
Ask any governor how to fix the health-care dilemma, and you will get the same answer: We have to control costs. Washington has focused its debate on health insurance reform, but governors understand that how we pay is less of a priority than how much we pay.
Arkansas's Medicaid budget doubled between 2001 and 2009, growing from $1.9 billion to $3.7 billion in less than a decade. It has been expanding at an average of six percent a year for the past three years, and if left unchecked, Medicaid is anticipated to grow 8 to 10 percent a year for the next two years. This is unsustainable, because we cannot provide the revenue for the state's share of Medicaid costs without cutting critical funding for schools or prisons, or by imposing new taxes.
We have to slow this growth, and we can't wait for Washington to do it. To that end, I have tasked the Department of Human Services and our Surgeon General to work with hospitals, doctors, nursing homes, dentists, and mental-health providers to devise strategies for containing costs and slowing Medicaid growth while preserving services and our quality of care.
I believe that the "fee-for-service" model that we are using to pay for health care accelerates the rise in costs. It doesn’t provide doctors or patients with any incentive to improve efficiency or quality of care. We need to encourage and reward doctors for focusing on prevention, thereby reducing the need for hospitalizations.
We need to use technology to avoid unnecessary tests and improve diagnostics; but above all, we need to change the payment model for some of the care we're providing – particularly for chronic diseases. We need to stop paying fees for the process of treatment, and instead reward the successful results of that treatment. This, I believe, will lead to a more efficient use of our resources and improved care.
As one of the doctors who spoke to us in Washington said, we need to "Pay well to do well, not pay more to do more." The states are not going to wait for Congress to begin pursuing this approach. Arkansas will look to our sister states for good ideas and share our best practices, too. It won't be easy, and it will require tough choices; but it's time to move beyond rhetoric and find real solutions to a problem that affects us all.
(Gov. Mike Beebe writes a weekly column)
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Last Updated ( Wednesday, 17 March 2010 )
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