August 05, 2007
By Senator Dan Foster

The Sunday Gazette Mail

The recent announcement of the renovation of the South Charleston Stamping Plant was a great day for the Kanawha Valley and for West Virginia. Not only was there evidence that individuals from both inside and outside of our borders are willing to make significant investment in West Virginia companies, but there was also the anticipation of hundreds of new jobs. Not bad when you consider the difficult situation we had expected.

I hope this event is an indication that our state is becoming more attractive to commercial interests and is indeed “business friendly,” but I am afraid that there are other alarming signs. It was said recently that the rising cost of health insurance is “the greatest deterrent to entrepreneurship in America,” and this statement should receive added emphasis in West Virginia. With statewide per capita health expenses among the highest in the country, it just might mean that our hope for significant job growth is at risk. Amazingly, it was less than a year ago that the consensus of the business community everywhere was, unequivocally, that we as a nation could not afford to provide health-care coverage for everyone. Yet now, as health-care costs have increased and medical insurance premiums have skyrocketed, leading to more uncovered citizens, the refrain from many companies, even in our state, sounds more like “we can’t afford not to do this.”

There is probably no better example of this philosophical change than in California, where an unusual private coalition has emerged to collaborate with its leaders in Sacramento. The evolving legislation is being heavily promoted by Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nunez, and is supported by an alliance led by Steve Burd, chairman of Safeway. Members include some of the nation’s largest companies, such as PepsiCo, Wrigley Co., Kroger, and Pacific Gas and Electric. Also represented are insurance and drug firms that should benefit from expanded health insurance, like Aetna, Blue Shield of California, Cigna, Eli Lilly and Pacificare.

Just as in Massachusetts, where there was also a Republican governor in a traditionally Democratic state, the Golden State’s initiative is one that attempts to address the wants and needs of both conservatives and liberals. To that end, the proposed plan reflects a sense of shared sacrifice by requiring that all individuals have health insurance, even if they have to pay for some or all of it, that hospitals and doctors subsidize coverage for the poor, and that companies spend a set amount on employee health care.

Across the country in Washington, many were shocked last winter by the sight of the CEO of Wal-Mart and the president of the Service Employees International Union, the nation’s largest, joining raised hands in solidarity and proclaiming their mutual need for health-care reform. Also on board are the likes of AT&T, Intel, Kelly Services and the Communication Workers of America. Although all of these entities have different reasons for their public involvement, it seems clear that this group and the one in California provide examples of the growing number of large and small business employers who have joined labor unions and consumer advocates in saying that our system is broken and is beyond repair as it now exists.

Politically, as well, the culture has changed dramatically since the health-care fiasco of 1994. The perceived toxicity of the concept of universal health care has done an about-face to become almost a clamor. Taking the lead from Republican-led Massachusetts and California, the Democratic governors in Maine, Vermont and Pennsylvania have jumped in with their own programs and gained significant media attention. Many other national and state leaders now seem to accept the issue’s importance and that the politically safe incrementalism of the past is no longer the answer. Clearly emboldened are the leading Democratic presidential candidates, who are all calling for universal, affordable health coverage and are providing detailed pathways they predict will enable us to reach it.

The road to health care for all is incredibly complex, but is really no different than before the business community finally realized that this is a dilemma that can no longer be deferred. To simplify, I suggest that these five questions be considered:

•  What should the basic level of health-care coverage be?
•  Does everyone need to be in the same insurance pool, regardless of pre-existing conditions?
•  Should employers continue to be the main provider of health-care benefits to workers?
•  What is the proper role of government?
•  Most importantly, how can we restrain the overall level of medical inflation while maintaining, and, hopefully, increasing quality?

Despite all the recent publicity about the need for critical advancements in health information technology, including electronic medical records, this is only one aspect of the health-care cost/quality problem. Other equally vital components are addressing prescription drug costs; managing chronic diseases more efficiently; improving the health behaviors of our citizens; minimizing hospital errors; confirming that new treatments, tests and medications are cost-effective; reforming our long-term care system; and assuring that terminal patients receive only the care that they want.

There will undoubtedly be a push back from the dwindling ranks of opponents of change as in years past, but with the growing public and political support and the newly expressed needs of business, it is now far more likely that compromise can be reached for a major overhaul of the way medical services are delivered around this country. What form that takes is yet to be seen, but the stars are aligned for a politician at the state or federal level who can take his or her plan and persuade all the varied constituencies to embrace it.

Almost weekly, the list of states willing to confront the concept of universal coverage continues to enlarge as their policymakers understand that not only is it the right thing to do and that they might be able to stimulate Congress by their actions, but, most compellingly, because they hope to put into place a structure that they feel will be the ultimate competitive advantage over their neighbors. So, for us here in the Mountain State, it appears that it doesn’t matter how much customer service we provide or how many deals we make to attract or retain business. The companies we seek, the ones that give their employees excellent health benefits, will look elsewhere if they see no vision for comprehensive transformation of West Virginia’s health-care system.

I can now see no reason to delay moving aggressively forward. With a legislative study on the issue in progress and with the presence of obvious national momentum, we have a golden opportunity to create a uniquely West Virginia solution as we search for more ways to keep our state “Open for Business.”

Dr. Foster is a Charleston physician and state senator.