May 25, 2018
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Need-to-know health care

By Dr. Erik Steele

Watching candidates run for election as governor of the state reminds me that the top job in state government requires the ego of Donald Trump, the hide of a rhino and more guts than a fish-processing factory. Being governor makes you the de facto head of a state’s health care system, whether you want to be or not, so it also requires knowing some important stuff and having some important stuff.

What “stuff” is that? As voters, we should all know the answer, then compare this list to what candidates are telling us about how they will help solve our health care problems.

Among the stuff a governor must know is that the lack of health insurance kills some people because they cannot afford the care they need. That ought to constantly motivate you as governor. In fact, a governor who goes to bed and has not done everything possible that day to help all state residents get affordable health insurance should have such insomnia that even bedtime stories about federal tax regulations cannot induce sleep.

Speaking of things lengthy and federal, the governor must know the new federal health care reform law will not fix many of your state’s health care problems as soon as your state needs them fixed. You are still on the hook to address them, because waiting for the new law to do so is like leaving your state in the great white shark tank while someone throws in chum. The law, for example, calls for a major expansion of state Medicaid programs. That means budget-busting program costs must be brought under control now; otherwise, when the Medicaid programs expand their costs will expand uncontrollably in a feeding frenzy on future state budgets.

You need to know that the governor of a state is, by default, its most important driver of health system change. He or she is the only one who can bring state government to the table, and has the statewide bully pulpit, big budget, political clout, and credibility required for that job. If the governor is not the driver, then the system is not being driven as effectively as needed.

In order be effective at this work, the governor not only needs to know that kind of stuff, but also must have, in particular, organizational resources and expertise to support the governor as the state’s health care leader. For a governor, that means your own health policy experts as dedicated health policy power tools helping you drive system change.

Maine currently has that in the Governor’s Office of Health Policy, which might be tempting for the next governor to cut or curtail in order to meet coming budget pressures. That would be foolish — a governor who doesn’t have strong health policy expertise and resources that work directly for him or her will be a health care minnow in the trout tank. Such a political leader would be forced to rely on information from experts in state agencies, hospital and physician associations, patient advocacy groups, pharmaceutical industry, etc. While those experts are good people who need to give a governor their input, they also have perspectives and agendas driven primarily off their own priorities and cannot replace health policy expertise that works directly for the governor.

Finally, if you as governor are going to be the health care czar of a state, you need an experienced physician — and no, I’m not available — who works for you at the policy-making table because you will, in effect, be practicing medicine on your state’s residents. That physician needs to guide the governor and staff at the origins of policy planning, work with the state’s other health care providers in a goal-directed partnership, help legislators struggling to turn policy proposals into law, and ensure state government makes decisions without harming too many people as the result of poor policy. A state government making important health care policy without a physician at the table is like a brain without a frontal lobe.

That’s just the short list of what should be in the tackle box a state’s governor brings to the job, but it’s a good start.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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