By Dr. Jim Tryon
Chairman, N.M. Medical Society Committee on Health Care Reform
Winthrop Quigley's article "Docs Fault Richardson Health Plan" hinted at the importance of an independent health care authority and its role in driving reform in New Mexico. Its focus on physician reimbursement, however, was not an accurate portrayal of our concerns, so we would like to restate our original proposal, made in the spirit of true reform.
With a 30-day legislative session coming in 2008, the development of a sophisticated authority, with power and a legitimate legislative mandate would be the responsible way to lay a proper foundation. The following are some key components that should be included in developing a New Mexico Health Care Authority.
First and the foremost, the form of the health care authority should follow its function. The authority must have a detailed, exhaustive scope of work if we are to truly address the complexities of health care reform, and if we are to truly build the necessary political capital required for such an undertaking.
Included in the authority work list should be financing; defining a set of essential health services; establishing performance standards for insurance carriers and for practitioners/providers; management and consolidation of public sector programs, medical liability and federal waiver issues.
Second, the authority must have a statutorily mandated time line for delivering its detailed recommendations to the Legislature. It would be best to have the deadline for delivery of a plan for full implementation to the Legislature by Oct. 1, 2008.
Third, the authority must have a clearly defined role for implementing long-term reforms, a role defined by its independence from the existing system.
Fourth, the form of the authority should resemble something close to the following: a membership of nine with three business people, two labor representatives, one retiree, one provider, one rural representative and one representative that understands Native American health issues). Membership would be representative of New Mexico's geographic and ethnic diversity. Appointment responsibilities should be split between the governor and Legislature because authority independence is of the utmost importance.
While it is essential that there be a representative who has familiarity with health care delivery systems, that person should not have too strong a stake in the preservation of the status quo. This holds equally true for the insurance industry.
And note that the membership of the authority should have a particularly strong business community representation. It is business people who understand better than anyone how unsustainable the present employer-based system has become. Business representatives should have some financial expertise and be committed to achieving universal coverage for all.
Fifth, the authority must have a series of subcommittees populated by those familiar with finance and delivery. This is the very venue where insurance experts and doctors will have an important role to play. Subcommittees should at least include health care financing, health care delivery systems, health profession training, federal barriers to reform and tribal matters.
The composition of the health authority and its scope of work will ultimately determine our ability to right this sinking ship in New Mexico. It is unreasonable to expect sweeping health care reform during a thirty-day legislative session. Nor is it realistic to expect bold reform during an election year. Accordingly, we must be thoughtful in laying the groundwork for changing direction. A properly constructed health care authority can be an excellent vehicle for charting the right path to reform.
It is not too late for Gov. Bill Richardson's health care authority proposal to include these much-needed provisions. The governor embraced the idea of an authority. Now, his plan must make the necessary adjustments so that the form of the authority follows its critical functions, health care reform and not political appeasement.
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