Nibbling the edges


Published: Thursday, January 29, 2004 at 6:01 a.m.
Last Modified: Wednesday, January 28, 2004 at 9:45 p.m.
They gave it the old college try, but Democrats in the Florida Legislature were unsuccessful this week in their attempts to force an extraordinary special session to put more money into KidCare and provide health care coverage for 100,000 additional children.
It was a rabbit-in-the-hat trick, to be sure. Democrats dug up an obscure and little used provision that forced the polling of individual lawmakers to determine if a special session should be held. Since there are still more Republicans than Democrats in the Legislature, the outcome of that polling was predictable.
Still, even Gov. Jeb Bush gave the Dems a backhanded compliment when he allowed that the stunt served to sharpen the focus on the health care debate in Tallahassee. At the very least, the special session ploy probably will shame Bush and the Republican Legislature into spending more on KidCare than they had planned to this coming session.
The truth is that health care is probably the single toughest and most important issue on the public's agenda this election year. Health care costs are eating up federal, state and local budgets. Private employers, confronting double-digit annual premium increases, are finding it more difficult to provide insurance for their workers. And taxpayers wonder why they have to pour more and more money into a system that still leaves 32 million Americans without coverage, including 2.8 million Floridians.
In Florida alone, Medicaid costs, at $13.8 billion this year, eat up nearly a quarter of the state's budget. Moreover if current trends continue, Florida's Medicaid budget will triple within the decade.
And yet, despite the billions being spent by federal and state governments for health care, voters here in Alachua County will still be asked to raise taxes on themselves this year in order to help fund indigent health care locally. Passing that tax figures to be a hard sell for advocates.
It's becoming increasingly clear that health care cost increases in America will sooner or later become unsustainable. The problem is that any effort to debate comprehensive health care reform runs into an impenetrable wall of influential special interests - each group intent on protecting its own piece of the health care pie at all costs.
In the absence of comprehensive reform, perhaps the best that can be hoped for, then, is that smaller-scale, piecemeal reform efforts will have the effect of nibbling away at the edges of the health care cost monster. In effect, the 50 states, and thousands of cities and counties, have the opportunity to become laboratories in which to test innovative approaches to increasing access to health care while holding down costs.
In that regard, Gov. Bush deserves credit for unveiling this week a number of modest experiments in health care reform. Some of his initiatives show more promise than others. One or two will undoubtedly fail to pan out. But all are worth serious consideration by the Legislature.
Among other things, Bush wants the Legislature to spend $2 million to establish an electronic medical records database that will allow doctors and hospitals to more easily share patient records and treatment histories. The idea behind the database is to eliminate mistakes that can lead to misdiagnoses and poor treatment. While technology tends to be a factor that drives up health care costs, it is unacceptable that many hospitals and physicians offices are sadly behind the times when it comes to computerized record keeping and information sharing.
Bush also wants to create regional insurance purchasing pools - an approach that has been tried before in Florida - that may allow small businesses to negotiate for lower cost insurance rates. The governor also wants to authorize "flex" health care plans; low cost, "bare bones" insurance policies that would allow patients to obtain basic, preventative care but not cover higher cost items such as hospitalization.
Bush also wants Florida to experiment with Health Savings Accounts that would allow people to put away money for health care without incurring a tax liability. And he has called for creation of an alternative insurance pool to cover Floridians who have chronic health problems and who, as a result, often cannot qualify for insurance. (While it's an interesting idea, an alternative insurance pool will almost certainly require tax subsidization, and Bush has not yet put a price tag on it or identified a funding source.)
Democrats were quick to criticize Bush's recommendations as too little, too late. But while the governor's health care initiatives may represent a minimalist approach to reform, each is worth examination as a modest experiment in containing costs, improving quality and expanding access.
Bush is a realist about the health care monster that threatens to eat Florida's lunch. "We can't sustain what we've got," he said on Tuesday. "We can either raise taxes or cut services, and neither is a good option."
Toward that end, Bush wants federal permission to restructure Florida's Medicaid program, which is increasing by about $1 billion a year. Attempting to do something meaningful about Medicaid, however, will require scaling that brick wall of entrenched special interests - something that's not going to be achievable in the near term, and certainly not a realistic goal for this coming session.
Meanwhile, Bush says he thinks that Florida is in line to receive another $132 million in federal money that would allow the state to expand KidCare. Reducing, or even better, eliminating the list of children awaiting coverage should be the top health care priority of the legislative session.
Beyond that, however, we think that Gov. Bush is right; that Florida should continue to experiment with new and innovative ways to contain costs and widen access to health care. The governor's initiatives, modest though each may be individually, are worth trying.

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