From the practical to the improbable

Recommendations from the meeting ranged from the practical to the improbable, such as when Mark Reynolds, director of TennCare in Nashville, TN, queried, "Do we need something else entirely other than insurance?"

Talking about alternatives and hearing new ideas is crucial to helping solve the state’s problems. If ideas and policies aren’t talked about, if they aren’t kept in range of the public’s hearing also, the system bogs down, NASHP members agreed. Keeping the issue public also helps build steam in local legislatures.

"It’s a matter of political will," said Gordon Bonnyman, an attorney with the Tennessee Justice Center in Nashville. "We need to build a will for what we know needs to be done."

Building a political will means having a vision for the future of the state’s role in health care. There is no clear consensus on the best way to proceed, but James Tallon Jr., president of the United Hospital Fund of New York in New York City, urged NASHP members to set their sights high, such as finding a way to universal coverage where 97% to 98% of people have health insurance. He added that unless there is a federal-state framework for coverage of the uninsured, no system can work.

Mr. Tallon also said that current statistics on the uninsured are lower than the actual number. "The problem is masked by the surge in our economy," he told NASHP members.

Public vs. private

Integrating public and private money into health care coverage is the best way to universal coverage, according to many attending the meeting. Getting the two sources to meet was the problem, some members said.

"We must take advantage of employers helping pick up the tab," Ms. Beyer said. "Small businesses often can only pick up a small bit of it."

Mr. Reynolds shared his theory of what created the logjam: "What’s holding back universal coverage? The private sector."

Ms. Ferguson also saw the combination of public and private funding as the future of health care, but she reminded the gathering that insurance is only a tool for health care. "Is it leading to better outcomes?" she asked. "Are kids entering school in better health than in the past?"

Colliding with funding is the cost of health care, which continues to spiral upwards. That’s a situation that is unlikely to change, Mr. Reynolds said.

"People are now paying more for health care than they ever did," he said, adding that no matter what policy choices are made, the costs of keeping people healthy in America will continue to rise.