Health care in Colorado and nationally has reached a tipping point, nudged by unsustainable cost increases and an economic crisis that has exacerbated the challenges of uninsured and underinsured, critical provider shortages, stark disparities based on income and ethnicity, fragmentation of services, and a payment system that discourages quality and efficiency.
Our nation’s cities are disproportionately impacted by these challenges, as home to large concentrations of low-income, elderly, special needs and historically underserved populations. But as “crucibles of creativity,” in the words of urban historian Peter Hall, our cities and metropolitan regions also have the capacity and responsibility to play an important role in developing and driving the solutions to our health care crisis.
Health care costs in the U.S. have doubled every 7 1/2 years since 1960, and are projected to reach $4 trillion in 2016. As noted by David Osborne, author of “Reinventing Government,” the fiscal squeeze on local and state governments has been debilitating. “Every time [the cost of health care] gobbles up another percentage point — every 1.2 years — we lose the equivalent of 150,000 teachers.”
A report by Families USA reflected the significant role that cities and counties play in the financing and delivery of health care, “ranging from public hospitals and community health centers to school-based health centers and family support services … .”
Cities have experienced increased demand for health services at safety net clinics and hospital emergency rooms as well as for mental health and substance abuse treatment. Denver Health — whose hospital and emergency care, public health and community health services (including a model program for treating at-risk populations) have earned national recognition for integration and continuity of care — serves more than 150,000 of Denver’s resident. One-third of those are uninsured.
With more working families impacted by the health care crisis, cities surveyed by Families USA were unanimous in supporting increased eligibility for public health insurance programs, and ranked childless adults and parents as the groups facing the largest gaps in health coverage. In Colorado, a proposed hospital provider fee developed in an innovative collaboration between Gov. Bill Ritter’s office and the Colorado Hospital Association would expand eligibility for Medicaid and Child Health Plan Plus (CHP+) beginning in 2010, providing much- needed support for working families who are not currently eligible for public programs.
Cities are uniquely situated to promote prevention and wellness policies for our communities, including physical fitness and nutrition in our schools. Poor diet and physical inactivity combined are second only to smoking as the leading cause of preventable death in the U.S.
According to state labor data projections, the health care and social assistance sector will generate more new jobs and total employment through 2016 in metro Denver and statewide than any other industry. A metro region that helps solve the urban health care challenge in a fiscally responsible manner will gain an advantage in economic development far beyond any incremental costs.
The most important reason, of course, for cities to elevate health care as a top priority is because of its fundamental and profound impact on the quality of life of our residents. This is why the Denver Healthy People 2010 initiative, a coalition of more than 70 private and public sector partners lead by the Denver Department of Environmental Health, has dedicated itself to making Denver a healthier place. America’s cities, like its rural communities, are only as vibrant and healthy as our people.
John Hickenlooper is Denver mayor. Shepard Nevel is the Colorado Health Foundation’s vice president of policy and operations.
