The political campaigns are heating up and health care is once again a major issue for the candidates to debate. Nationally, the director of Medicare and Medicaid is resigning and in Illinois, debate rages over the advisability of importing prescription drugs from Canada and the cost of a new program that guarantees health insurance for all children.
Dr. Robert F. Rich, director of the University of Illinois Institute of Government and Public Affairs, is an expert on health law and policy. He addresses Illinois' role in shaping the health care debate across the country.
Illinois has enacted several health care policies in recent years, ISaveRx, the Health Care Justice Act of 2004 and the AllKids insurance program among them. What impact have these initiatives had on the national debate on health care?
All those programs have actually served as a national model, in different ways. The Rx program is a national model that's caused a great deal of negative attention from the federal government because Gov. Blagojevich has proposed to import drugs from Canada and the government is opposed to that. The federal government is opposed to it, as are the pharmaceutical firms, because there's no ability to recover their research and development costs. It hasn't reached very many people; we're talking about very few prescriptions that have been filled.
The other programs, the AllKids and the Health Care Justice Act are positive national models, because here the governor is putting Illinois on the map as addressing one of the three biggest health care problems. The three biggest problems are access, cost and quality. The governor has said he's putting the highest priority on access. The Justice Act and the AllKids program are addressing access - giving health care insurance to a broad range of uninsured people.
Do these initiatives have the promise of long-term success, or will they create liabilities that the state will struggle to pay?
It depends on the criteria you use. If the criterion is, 'Do these programs address the access question; do they have the potential to have fewer uninsured children or families?' Yes, they have the potential. The problem is, and this comes out in the gubernatorial campaign, is 'How is this going to get paid for?' There are two controversial issues. The governor would tell you there's a sliding scale. If you're middle class and can afford to pay a portion of the premium, you'll be asked to pay. On the other hand, if you can't afford to pay then insurance will be provided for you. The Republicans would say wrong on two counts. Wrong on the count that we can't afford to provide the insurance to the uninsured and we're not charging enough to the middle class because it's a significant discount than what they would pay for private insurance. If the criterion is financial liability, the answer is the AllKids Program creates a substantial financial liability.
What lies ahead for policy makers? Can health care policy be created that limits financial exposure while still ensuring access?
The answer is no, I don't think we can have a health care policy that succeeds both in increasing access and reducing financial liability. Medicaid is Exhibit A. Every governor in the United States would tell you Medicaid is the single largest liability they face for any program. Yet it is the program that increases access. It increases access and provides health care in a country where health care is not a legal right.