GRAND FORKS — The health reform debate continues to wind its way through a complicated policy process. As North Dakotans, we can be proud and thankful that we have had such strong leadership from our congressional delegation—Sens. Kent Conrad and Byron Dorgan and Rep Earl Pomeroy, all D-N.D.
They have been pushed and pulled from the left and right, yet they have developed positions that reflect a true North Dakota common sense approach.
It would be easier — and maybe more politically sound — to acquiesce to either a purely liberal or a purely conservative viewpoint. They have been strong enough to vote against ideas that are politically popular but also harmful to the North Dakota health system and our ultimate goal of true access to care.
They put the interests of North Dakota and the country ahead of special interests. (We do not often see this in contemporary politics.) They have offered practical public policy solutions that would apply the best elements of a private market health system structured with additional public resources and appropriate oversight.
They articulate moderate and practical steps that can, over time, reform the system of care, offering more equity and fairness to citizens and lessening the arbitrariness and capriciousness of a health system that can force financial ruin on families.
Many Republicans and Democrats in Congress have worked hard to include rural health provisions in health reform, and Conrad, Dorgan, and Pomeroy have been champions in this regard.
Much of the controversy of health reform is associated with the issue of coverage — how we improve and increase financial access for Americans. From the perspective of the media, this appears to be the only real issue.
But real reform includes many other issues, such as the availability of and access to care, and improvements in the quality of care, cost structure and overall system.
North Dakota is a rural state with significant issues associated with an adequate health workforce and the actual maintenance and viability of local health systems.
About two-thirds of rural North Dakota hospitals are losing money. The federal government has designated more than 80 percent of the state as a primary care physician shortage area and more than 90 percent is classified as a mental health shortage area. We also have significant shortages for nurses and other health professionals.
Some of the reform proposals, while attempting to improve coverage, actually would have taken more reimbursement out of North Dakota.
Thus, one challenge as we think our way through reform is how to increase individual coverage in a way that helps rather than hurts the delivery system.
In North Dakota, the rural health delivery system is vulnerable. Thankfully, Conrad, Dorgan and Pomeroy have pushed back against ideas that, while well meaning, actually could hurt the state’s hospitals and clinics.
The delegation has supported efforts to increase our supply of health care professionals, improve payments to hospitals and clinics and improve the quality of care.
This latter point is as pivotal to real health care reform as is coverage. We already have seen the start of linking provider reimbursement to performance measures, such as quality indicators, and it is important to continue this process. Better care monitoring and management, with greater emphasis on prevention, and the resources to initiate health information technology are essential elements in congressional reform bills, and they need to be part of the final legislation.
With so much media attention on the issue of coverage, I have been concerned that the opportunity to truly improve our system of care through reform would be lost. If we’re not careful, we actually could increase coverage while essential rural hospitals and clinics could disappear.
If we fix the coverage problem, but people lose their physician, nurse, hospital, home health agency or ambulance, have we really accomplished the broader goals of health reform?
I’m confident that our delegation understands the paradox found in reform and will continue to champion practical, common sense solutions. Yes, health reform is indeed complicated.
Gibbens is co-interim director of the Center for Rural Health at the UND School of Medicine and Health Sciences.
