I’ve read with interest Gov. Michelle Lujan Grisham’s plans to establish a New Mexico Healthcare Authority to “consolidate services in one agency and move the state closer to universal health care.” I am, of course, supportive of this endeavor, and I wish Mr. Pat Allen from Oregon, our new secretary of Health, good luck; but, it may be worth reviewing the history of the idea for New Mexico.
In 2007, then-Gov. Bill Richardson established a task force to investigate different possible health-care delivery structures ranging from single payer options to pure market-oriented ones. Mathematica, a national accounting firm, was contracted to cost out the various proposals for our consideration. The task force was composed of 28 members selected from across the health care “stakeholders” spectrum. As president of the New Mexico Medical Society, I was appointed to the task force. Lt. Gov. Diane Denish was chair. Gov. Richardson was considered a presidential contender at the time, and health care was a hot topic in that election cycle. Interestingly, we also studied Oregon’s initiative on developing a health-care authority.
Nothing came of the task force work, but for the last meeting, Lt. Gov. Denish asked five members of the committee to offer specific recommendations about health care to the administration going forward. My recommendation, endorsed by the task force, was to establish a New Mexico Healthcare Authority. The idea behind the recommendation was that, irrespective of what delivery system structure was chosen, the primary problem in New Mexico’s health system from the state’s perspective was, and still is, the diffuse, decentralized, opaque nature of how we spend our money. No oversight and unmanaged redundancy. Mathematica estimated that the cost of N.M. health care in 2008 was about $6 billion, and the potential savings from consolidating with a cost oversight agency could be perhaps as high as 20%.
So, let the games begin! To start, the administration couldn’t agree on whether the authority should be called an “authority” because that had a specific definition. Then there was the politics of deciding who should be on the governing board of such an “authority.” The original intent was that it should operate as an independent agent, but the governor wanted it to be under the executive branch, and the Legislature wanted to be in control of it. And, then there was Medicaid. Should that be included? Although I was now “immediate past president” of the Medical Society, trying to retain consensus on the idea of an authority among physicians was difficult, and various elements, like physician independent practitioner associations, frankly opposed the oversight. Along with other agencies like PERA, they didn’t want any interference with their ability to do their own contracting. Of course, standing in the wings were the hospital association, the various health plans, the pharmaceutical industry and the medical technology sector, for which cost oversight is anathema, and much gets swept under the rug of their “proprietary interest.” Notice the absence of the one true “stakeholder,” the average New Mexican, the patient.
At some point, a bill was drafted and brought forth by Rep. Danice Picreaux, and supported by then-Rep. Mimi Stewart. It actually made it through a House floor vote, and passed overwhelmingly. But It was then assigned to three Senate committees. People familiar with the legislative process will recognize that that assignation was a signal that the “powers that be”, i.e. “the fourth floor,” didn’t want the bill to advance, so it would “die” in committee. And it did. As Jefferson Davis said of the Confederacy, “It died of a theory.”
Some 15 years later, the healthcare authority is still a good idea. What distinguishes the American health care project — and I say “project” because it is not a “system” — is the lack of an overall oversight process on cost and spending. You know, follow the money. The readers should do their own research on the subject; but, really, all you have to do is try to decipher your health plan bill, or find out how much a hip replacement will cost, or ask about why health plan formularies vary so much, or why drugs that cost $20 10 years ago are now $200, to see the lack of transparency. Or, what about the recent squabble between United Health and Lovelace? One can only imagine how such an oversight process, acting to protect patient interests, could mediate such things. So, I say again, a Healthcare Authority is a good idea. Again.
Jim Tryon, M.D., is a past president of the New Mexico Medical Society and a guest lecturer at the University of New Mexico School of Medicine on “American Healthcare Structure: Why is it so contentious?”
