Watson Wire

Take Heart

Thursday, September 11, 2008

Let's get right to it.

I have written and talked – and drawn pictures, used crayons, talked in my sleep, sung songs, and done interpretive dance – about the state's need to do a better job keeping Texans healthy.

This is more than just a moral issue.  It's more, even, than a plea for fiscal sanity – for getting people treatment they need before they end up in emergency rooms with the most expensive of maladies.

This is about our economy.  For all the talk about economic development, all the prideful boasts about Texas' competitive position, and all the numbers everyone throws out about how well we're doing, it's actually pretty easy to figure out how effectively Texas is investing in prosperity.  Just ask three easy questions:

1. Will Texans have all the schooling and training they'll need to make newer and bigger companies hum?
2. Will they have the transportation networks, power grid, broadband lines, and other infrastructure they'll need to grow their businesses and have comfortable lives?
3. And will they be healthy enough to be productive?

These questions provide the foundation for nearly everything I hope to accomplish in the next legislative session.

Part of the Problem

The state's struggles with the uninsured are pretty well-known, but here's yet another cold cup of coffee about what we're looking at.

• We have the highest percentage of uninsured people, and uninsured children, in the country.
• Texas has the fifth-highest health care premium rates in the nation.
• While our small businesses comprise more than 70 percent of all Texas employers, just a third of them can afford to offer health benefits to their employees – and only about a third of those businesses' employees can afford to enroll in health plans.  In other words, roughly seven out of eight Texans who work in our neighborhood stores, restaurants, and other small businesses can't afford or even find health insurance.

But there may be an even bigger problem than any of these statistics.  The most discouraging part may be how overwhelming it feels whenever you bring up the issue of health care. 

Folks who want more funding for health care too often describe it as a massive cataclysm with one prescription: a huge amount of new money.  This causes the other side to treat the problem as too big and insolvable, which provides too much cover for doing nothing at all.

Part of the Solution

In fact, there are a few things – contained, targeted, and not terribly expensive – that could make a massive difference in the health and productivity of Texans.

1. Small Business Initiatives:  There is widespread agreement that small business owners need help affording health coverage.  These are fundamentally good, responsible people who care about their employees and want to provide insurance – they simply can't afford it.

The Legislature has created initiatives – including my Three-Share proposal in the last session – to make small business coverage more available.  The state needs to start engaging small businesses and developing alternatives to expand coverage.  If it can't, then legislators need to know why their wishes are being ignored and what more they need to do.

2. Focus on Customers, not Insurance Companies:  One of the biggest problems with health insurance in Texas seems to be that our state focuses more on making things easier for insurers than customers.

The Legislature needs to make sure consumers can rely on the system as much as companies do.  There are a number of ways to do this, and you can be sure that insurance companies aren't going to like them.  But, at some point, the state and its people are more important than the insurance lobbyists and special interests that often dominate on health issues.

3. Emphasize Technology and Education:  Code Red, a must-read study of Texas' health care system, all but demands that the state save money by innovating the way it keeps and utilizes medical information.  This seems certain to save money in the long run.  Oh, yeah: it also could dramatically improve service and cut down on bureaucracy.

It goes without saying that we need to be very, very careful to protect people's privacy and medical records.  But this is a common-sense approach to making the system more economical and efficient; it would be nuts not to explore it.

Code Red has also argued passionately and effectively for expanding the number of doctors and nurses in this state – their numbers are already inadequate, and it's not going to get any easier when they start retiring right at the time that we aging Baby Boomers need them more and more.  If our medical schools and nursing programs are overcrowded, we need to expand them and create new ones.  It's that simple.

4. Seek Full Federal Funding:  It remains unbelievable to me that the state with the highest percentage of uninsured kids continues to leave federal money for children's health insurance – the dollars we send to Washington through our income taxes – on the table.  Over the last five years, Texas has turned its back on about $1 billion by refusing to provide a relatively small match.

So, for the sake of argument, let's forget about the generation of Texans who would learn more, be more fit, and get less sick if their parents could periodically take them to a doctor (which insurance would pay for) instead of an emergency room (which taxpayers pay for) when things get really bad.  Let's think about it in purely economic terms.

For every dollar we put up, the federal government gives us $2.60.  And for every $3.60 that we spend on health-related services (doctors visits, medicine, etc.), there's an economic impact of another $3.60 – yes, health-spending creates twice as much activity in terms of jobs, wages, tax revenues, business profits, and other economic indicators.

So for every $1 we invest in healthy kids, we get $7 in benefits to the economy.  That's a better return than corporate subsidies can provide.

Seriously, what's hard about this?