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Health-care reform: It’s not just a national issue

Economic development specialists and local service providers argue the point that American entrepreneurship is dead in a global economy without a national, universal health-care system. That’s because the cost of providing health insurance through the workplace is too great for most people to start new businesses, or the new business can’t employ the people it needs because it can’t afford to offer health-care benefits.

While these consequences are undeniable, our good neighbors in North Dakota are taking actions that recognize delivery of health care is essentially a local and regional matter. What’s more, whatever national system emerges from the current debate in Washington will still need to be delivered at the local level.

This has significance for all Minnesotans and especially for people in smaller, more remote counties in rural Minnesota who always struggle with health care access, costs and geographic distance to medical expertise and facilities.

It is this ground-level reality that prompts us to look at what some North Dakotans are doing and to stress the importance for parallel research here in Minnesota.

N. Dakota entities created collaborative group
In July this year, various tribes, counties, health care groups and individuals from 11 counties in central and western North Dakota formed the Wilson Health Planning Cooperative. It emerged from a three-year research and planning collaborative that sought to rationalize health-care delivery and insurance costs for this mostly remote area of the state and its 115,000 citizens.

The comprehensive study [PDF] from the group, titled The Wilson Report in honor of a long-time medical doctor in the region, established the need for an operating health cooperative, said Bill Patrie, a co-chair of the planning group.

“This isn’t a health-care insurance cooperative like what’s being discussed in Washington,” Patrie said. Rather, it is an operating enterprise linking various private health plans, medical facilities, clinics, doctors and their patients under a cooperative administration.

Western North Dakota has private clinics, government health facilities, military medical facilities and private health practitioners all aligned with different insurance companies and government entities, he said.

Now, these programs tend to segregate people within the different health-care programs. Patrie uses the small city of New Town, N.D., as an example. A Native American from New Town would need to use the Indian Health Service medical facilities at Minot 60 miles away to qualify for federal government insurance coverage, and not the private health care in town.

But if the Native American is a military veteran, the Bureau of Indian Affairs “says he’s a veteran first and a Native American second.” So, the sick person needs to take a government bus trip 340 miles to the Veterans Administration hospital at Fargo. Similar problems arise for Air Force personnel at Minot as well. 

Shaping strategy
Patrie, a nationally prominent cooperative development specialist who now serves as executive director of Common Enterprise Development Corp. at Mandan, has been working with tribal leaders, medical professionals and local government and community leaders to shape the strategy for the operating health-care cooperative. It envisions all if not most privately paid insurance plans and government health care programs will become members of the operating enterprise that could, in turn, pay and bill programs for most cost effective and efficient health-care delivery.

“Nobody really opposes this once they understand what we’re trying to do and realize we’re not starting up a competitive insurance plan,” he said. The medical clinics and professionals want to make maximum effective use of equipment and facilities, he said, and they like the idea that they will get paid when they perform emergency services within their communities.

The strategy grew out of 10 meetings held throughout the 11-county area. Community members eventually agreed on 15 “parameters” for what the new co-op will try to achieve. They include:

“1. Available to all. 2. Local. 3. Abundant providers. 4. Diverse. 5. Affordable. 6. High quality. 7. Family medicine. 8. Efficient. 9. Preventive care. 10. Home health care and hospice. 11. Medical research. 12. Dental care. 13. Passionate providers. 14. Independent. 15. Cooperative.”             

What the North Dakotans are addressing are widespread problems found throughout rural America and are identified by new research from the Center for Rural Affairs at Lyons, Neb. In a study, the center’s rural research and analysis director Jon Bailey argues that rural residents have more to gain than most Americans from correcting the “dysfunctions of America’s health care system.”

The following are among issues in rural health care identified in the report: An economy based on self-employment and small business, an aging population, a more-at-risk population, a stressed health care delivery system, a shortage of health care providers, and an increasing dependence on technology.

A call to action
Both efforts lay groundwork for Minnesota community planners, state officials and policy makers who may want to keep abreast or ahead of changes in rural health care. These changes are certain to come either from federal action or by medical sector disinvestments resulting from inaction.

Regardless, recognizing our health-care needs and assessing our resources are starting points in correcting the “dysfunctions.” No matter how the final version of national health-care legislation turns out, Patrie insists, there will be a local role for implementing national and private health-care plans with local health-care services.

Restricting eligibility in state-run health insurance doesn’t solve health-care problems. Rationalizing use of facilities and local expertise, and easing eligibility in public and private-pay programs are giant steps in treating a national and state health-care illness attacking our economic health.

Lee Egerstrom is a fellow with Minnesota 2020, a nonpartisan, progressive think tank based in St. Paul. This article originally appeared on the organization’s website.

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