Kathleen Sgambati

The increasing costs of health care affects every sector of this state. Business owners struggle with the costs of covering employees. Many municipal officials approach upcoming contract negotiations with dread, in a large part due to double digit increases in the cost of health insurance. Our seniors watch their prescriptions costs consume increasing amounts of their retirement income (even with the government-at-its-worst federal Medicare reforms) and young adults worry about securing or maintaining coverage.

The health care system is in need of treatment. Without action, the rate of employer based coverage will erode and the ranks of the uninsured will grow. The answers are not fast or easy, but it is essential that we begin. Some promising first steps have been taken by the Citizen Health Initiative, an initiative proposed by Governor Lynch last fall. As the former project manager of this initiative, I believe it holds more promise than any such task force in decades. First, it has all of the right players at the table: citizens, medical professionals, business, insurance companies and state officials. Second, it had a ten year agenda. Health care is so complex and fraught with competing financial interests, a long term effort is needed to be successful.

We need a prescription for change. My change agenda has four scripts on it. First we need to cover every child in the state to ensure their health. The structure already exists in the Healthy Kids program. We need only to restore outreach efforts, work with providers and build a volunteer corps to make sure that those who have difficulty completing the application have the support needed to do so. This low cost partnership saves dollars by avoiding care in the most expensive settings and gives our children the healthy beginnings they deserve.

The second area that needs addressing is the reduction of medical errors, more common than most people believe. The Governor recently announced an important first step in this area by promoting the implementation of electronic prescribing. It is the first in a series of efforts needed to reduce medical errors that cause harm and increase costs. Prescription errors alone account for 1700 unnecessary hospital admissions at an average cost of $10,000 per admission. Dollars saved, harmful errors avoided – clearly an area where we could reach consensus and take action.

Third, while more difficult to achieve, is the control of the unnecessary facility expansions that add cost, not value, to our system. We need to make certain that we have the necessary supply and distribution of providers, equipment and facilities across the state. Excess capacity, however will increase the cost of care and threaten the viability of our community hospitals which are important to the economic and social fabric of our communities. A competitive approach to the health care market will not bring costs down; instead the excess supply will, in and of itself, cause costs to soar. The supply will create the demand. Health care is not a normal market. When purchasing a good or service in a competitive market, it assumes choice. In health care a third party often purchases our coverage and they negotiate with insurance company as to the services provided and the prices paid. Another difference: when taken to the emergency room, you don’t ask for their schedule of costs and go elsewhere in the middle of a cardiac crisis because of cost differentials. Finally, the financial incentives for providers are not based on a product or performance, but on volume, an area that also needs examination.

The last component of the prescription for change is an area where immediate action is required. We need to strengthen the safety net. Our community clinics and health centers are struggling to stay viable with the increasing number of uninsured turning to them for care. We need to make sure that people have access to lower cost coverage at the appropriate level of care, at least and until the federal government begins to respond to access issues in a more logical, comprehensive manner. Across this country states are stepping into the gap that has been left by a federal government on health care. We need leaders in this state who have the knowledge and the willingness to act. These four areas of change will help New Hampshire move forward on cost, access and quality.

My opponent has supported a competitive approach. New Hampshire’s market is not large enough to allow competition to work. None of the progress made to date, especially on children’s access to care, has happened because we sat back and “let the market work”. It came about because the leaders, in response to citizens, brought solutions to the table. For 6 years health care has been virtually ignored at the national level. We cannot wait for federal action. New Hampshire needs to move forward for the health of our citizens. It is my hope that in the final week of the campaign, voters will ask candidates, “What will you do about health care?" The House and Senate need experienced and knowledgeable leadership. For voters in District 4, I offer an independent voice and a pledge to work towards quality, accessible care. On November 7th, please vote for the health of it. Kathy Sgambati is running for the state senate.