In about a month, if events continue down the path they are on now, Colorado’s Congressional delegation will make a historic vote on national health care reform. And, between now and then, they will likely be voting on scores of possible amendments about issues both big and small.
When Colorado’s nine members of Congress (two senators and seven representatives) decide how they will vote — on the overall package as well as all the minute details leading up to the final bill — they are representing each of us. And, if they do their jobs well, they are connecting values with public policy.
But what are Colorado values when it comes to health care? As energetic as they were, the town hall meetings of August did not provide much help. Fear and anger are not values, and the crucible of debate is often not the best place for meaningful expression of values.
Well before the health care reform debate became super heated, last year’s “Governor’s Dialogue on Health Care Vision and Values” was an attempt to understand what Coloradans want from their health care system.
While health care is built upon many values, the Dialogue focused on two that are fundamental — personal responsibility and the common good. Questions were designed to probe what each of these means to Coloradans. Instant keypad polling devices were used to ensure 100 percent participation and to provide quantitative results about what participants believe.
Many people might assume that in our once — and in some places still — frontier state personal responsibility would be very important. They would be right. Large majorities of participants said that individuals have responsibility for making sure they have access to the care they need. Most people also thought that smokers should have to pay more for insurance because they use more health care.
However, participants also were strongly opposed to people who are older, obese or with a genetic predisposition for disease paying more for insurance. And only about half agreed that personal responsibility meant individuals should be responsible for paying for their own health care.
The common good is no less an important value. Eighty-five percent agreed with the statement, “The common good means that I am willing to subsidize the care of others.” One hospital CEO summed it up nicely when he rhetorically asked, “Insurance? Isn’t that what the common good is?”
However, while eighty-seven percent of participants agreed that the common good meant everyone should have access to the health care they need, that number dropped by thirty percent when asked if government should pay for care for those who cannot afford it. There are some sharp differences about what institutions (public, private or both) are best to support the common good.
In the course of discussing values, Coloradans identified a number of features they want to see in reform. The following had high levels of support:
* Cover Children Now: Ninety-six percent agreed that all children should be covered by private or public insurance (like Children’s Health Plan+). When it comes to kids’ health, how they are covered is less important than that they are covered.
* Place a High Priority on Wellness and Prevention: 94 percent agreed with the idea of providing publicly funded access to preventive care and wellness programs. Enroll those who are Currently Eligible for Public Programs: 84 percent of community leaders supported increased efforts to enroll those who are currently eligible.
* Rural Health Care has Unique Challenges: Many in rural Colorado are without access to providers even if they have insurance.
Education is Fundamental to Health: Investments in creating better health care consumers and people who take care of their health are some of the best we can make.
* Improve the Delivery System: Health information technology, better integration of care, improved utilization of providers such as advanced practice nurses, physician assistants and dental hygienists must be priorities.
* Include Mental and Oral Health: Mental and oral health were identified by many participants as special areas of concern because they are often left out of discussions about health care reform. Participants strongly wanted these services included. As one person put it, “Don’t separate out the body parts. Focus on the whole person.”
* Adjust Expectations and Face Limits: Many leaders made the point that Coloradans will need to adjust their expectations of health care. This idea was raised with regard to end-of-life care by a hospice administrator. “There is a gap,” she said, “between what people demand from the system and what it is reasonable that we provide. We’re the only society in the world that expects perfection and prolonged perpetuation.”
Will the health care reform bills that are making their way through Congress reflect Coloradans’ careful balancing of the common good and personal responsibility? Will they include the sensible features that are broadly supported? We can only hope. But one thing that is certain is that our elected officials must find ways to respond to Colorado values; and Coloradans, if they wish to have their values responded to, must find a more effective way of articulating them than shouting.
Chris Adams is president of TAG Strategies, a public policy consulting firm—. Adams designed and implemented the Governor’s Dialogue on Health Care Vision and Values. EDITOR’S NOTE: This is an online-only column and has not been edited.
