Some time ago Benjamin Disraeli admonished us to "read no history, nothing but biography, for that is life without theory." In 2006, a group of policy leaders interested in promoting a serious discussion within the business community of health policy reform in Colorado met over several months at CHI to plot a course to this end. At the request of one member of the group, which fondly referred to itself as Health Care Vision 2006 and Beyond, CHI staff was asked to provide a baseline policy analysis from which informed stakeholders could look to the future based on an understanding of what has been tried in the past. The Colorado Health Foundation provided funding for the ensuing research.

As noted in the introduction to the policy brief, Health Care Vision 2007 and Beyond, the document is an oral history of biographers who have witnessed firsthand health reform efforts in Colorado over the past 16 years. This policy brief is intended to provide a historic review of health reform attempts through the eyes of some of the more active participants in these efforts.

Recently, the SB 208 Blue Ribbon Commission on Health Reform issued a request for proposals for health reform in Colorado that would expand access to basic health care services while containing the rapidly escalating costs. CHI staff, like the rest of Coloradans focused on doable health care reform in the state, is looking forward to the proposals that will be forthcoming from interest groups throughout the state. It is our hope that in some small way the vision paper will contribute to the ensuing dialogue so that Coloradans collectively will benefit from the admonishment that "those who cannot learn from history are doomed to repeat it."

The new Current Population Survey report on income, poverty and health insurance indicates that 16.8 percent of Coloradans were uninsured in 2004-05. This figure is basically identical to that reported the previous year -- 16.9 percent. According to this new report, Colorado had no increase in the percentage of uninsured people over the past reporting year, but estimates of the number of uninsured increased to 788,000 Coloradans, a number that is considerably higher than the 770,000 uninsured CHI reported last winter in our uninsured bulletin. Why the discrepancy?

The discrepancy lies in the ways in which Census data are collected, adjusted and reported to the public over successive time periods. While it’s tempting to take a newly released figure at face value, in reality a one-year estimate as compared to CHI’s estimate using a two-year average is akin to comparing apples to oranges. The Census figures released each August represent a sample of 600 Coloradans reporting on a previous year experience, e.g., being uninsured. Because of reliability concerns, for the past two years, CHI has used two-year averages of these sample data to provide what we believe is a more reliable and stable estimate of uninsurance among Coloradans.

Over the next few weeks, CHI will be examining the 2005 Current Population Survey data and producing a report that drills down in more depth about the characteristics of the uninsured by income level, age group, race, ethnicity and employment and disability status. While overall stability in the numbers of uninsured Coloradans seems probable, we hope to produce a level of detail that identifies risk factors for being uninsured and couples these risk factors with policy options that can address those populations most at risk. In the meantime, here is our first take on the new figures.

This year, as part of CHI’s first five-year business plan, we were evaluated by an outside consultant, Dr. Tom David. The evaluation consisted of an online survey to which CHI’s constituents were invited to participate by the CEOs of CHI’s founding foundations — The Colorado Trust, Caring for Colorado and Rose Community Foundation.

Of the approximate 250 individuals sent a personal letter, Dr. David received a survey response rate of 58 percent. Additionally, he interviewed 17 individuals who are among CHI’s key constituents in a more open-ended format, querying them on the same questions included on the survey.

For a new organization that has only been fully operational for two and one-half years, we were gratified at the survey findings. I am pleased to share the summary results with our readers. I want to assure the community we heard that there are places we could be doing better and our 2007 workplan has incorporated strategies to reach an even broader audience of individuals and organizations with our information clearinghouse and policy analytical resources.

I want to thank each of you who participated in the evaluation effort; it is yet another resource available to us to enhance our commitment to excellent customer service. On behalf of all the staff at CHI, I wish you a very peaceful and fulfilling holiday season as we look forward to working with you in 2007.

The new Current Population Survey report (3.12 MB html) on income, poverty and health insurance indicates that 16.8 percent of Coloradans – an estimated 778,000 people – were uninsured in 2004-05. This figure is basically identical to that reported the previous year — 16.9 percent. According to this new report, Colorado had no increase in the percentage of uninsured people over the past reporting year, though some estimates of the number of uninsured are considerably higher than the 770,000 uninsured CHI reported last winter in our uninsured bulletin (1.48 MB pdf). Why the discrepancy?

The discrepancy lies in the ways in which Census data are collected, adjusted and reported to the public over successive time periods. While it’s tempting to take a newly released figure at face value, in reality a one-year estimate as compared to CHI’s estimate using a two-year average is akin to comparing apples to oranges. The Census figures released each August represent a sample of roughly 750 Coloradans reporting on a previous year experience, that is, being uninsured. Because of reliability concerns, for the past two years CHI has used two-year averages of these sample data to provide what we believe is a more reliable and stable estimate of uninsurance among Coloradans.

Over the next few weeks, CHI will be examining the 2005 Current Population Survey data and producing a report that drills down in more depth about the characteristics of the uninsured by income level, age group, race, ethnicity and employment and disability status. While overall stability in the numbers of uninsured Coloradans seems probable, we hope to produce a level of detail that identifies risk factors for being uninsured and couples these risk factors with policy options that can address those populations most at risk.

Oh the heat! Are we facing the first signs of global warming, or is the latest heat wave just a blip on meteorologists’ tracking systems? A question many of us have been asking lately.

I just returned from a meeting in Washington, D.C., with colleagues from health policy centers around the country where the focus was on “hot” health policy issues facing the states as we look toward a fall election season and beyond. Interestingly, our discussion turned to oral health and the seeming lack of attention to or awareness of the mouth-body connection, not unlike a similar inattention to the mind-body connection.

CHI recently completed a comprehensive review of the state of oral health and health care in Colorado. This review includes an analysis of Coloradans’ oral health status, a discussion of current evidence about the mouth-body connection and a comprehensive inventory of dental health care resources throughout the state. This is a report worth reading, probably over the course of a few days given the amount of information it contains. We are currently breaking the report into a policy brief and a companion report on "Oral Health and Oral Health Care in Colorado." In the meantime, I refer you to the full report just posted (the inventory will follow shortly) and suggest we all begin to consider the mouth-body connection as we turn our attention to hot issues in health policy this fall.

John Kitzhaber, Oregon governor from 1994-2002 and primary architect of the Oregon Health Plan, was in Denver June 12-13 to talk with business leaders, legislators, health care providers, insurers, foundation boards and others about reaching for the possible in health care reform. A former emergency department physician from rural Oregon, Kitzhaber understands firsthand the ill effects of a poorly functioning and bloated health care system. He posed a provocative challenge to all of us when he asked,

If anything were possible, would we create a system that puts our businesses at a competitive disadvantage with businesses in other countries? Would we create a system that forces working families with no health insurance to subsidize the health care of wealthy retirees? Would we create a system so expensive that we can only pay for it by mortgaging our children’s future? If anything were possible, would we use our public subsidies to create the system we have today, or could we imagine a more rational, equitable and sustainable approach?

In January 2006, Kitzhaber launched the Archimedes Movement , which is committed to building meaningful state-level opportunities for civic engagement in health care reform. We in Colorado are fortunate to have a venue for similar engagement about reaching for the possible through the recently passed SB208, which established the Colorado Blue Ribbon Commission on Health Care Reform. The commission will meet over the next 17 months to craft several health reform proposals for General Assembly consideration in the 2008 legislative session. The commission’s workplan includes an avenue for citizen participation, making Coloradans’ collective voices and values heard in this deliberative process. Be sure to let your elected representatives know of your interest in the commission’s work. This is a unique opportunity to be counted in the formulation of critically important policy options.

Another legislative session is over and a final group of health-related bills awaits the governor’s signature (or not). It wasn’t a particularly banner session in Colorado with regard to health and health care legislation; perhaps the strategy is to wait until after the general election in November and see how health reform platforms play during the election season. It has been an interesting year to observe legislative activity in other states such as Kansas, Maine, West Virginia and Massachusetts. It will be even more interesting to see the implementation activities that emerge from those states enacting the boldest policy reforms.

One ray of optimism for Colorado’s aging Baby Boomers is the excellent report that will soon be issued by the SB 05-173 Long-term Care Advisory Committee. This committee was appointed last year by the legislature to recommend to the Department of Health Care Policy and Financing and the Joint Budget Committee ways to make Colorado’s long-term care system more accountable, efficient and centered on the people it serves. The committee has met for the past 10 months and will be transmitting its final report in early July.

CHI had the pleasure of staffing the committee during this period and watching as a group of potentially competing interests pulled together, through a consensus process, an exceptional document that can go a long way to achieve the policy goals of the enabling legislation. The report skillfully examines problems in the current system and makes recommendations to reform a critically important and expensive program in Colorado. The next step is to make sure it doesn’t end up on a shelf somewhere.

I’ve just returned from a national public health institutes meeting in New Orleans, it was a sobering exercise in the integration of theory and practice. In theory, I learned from colleagues at Research!America that the majority of Americans believe that public health programs such as childhood vaccinations, restaurant sanitation and safety inspections, drinking water inspections and the like are either very important (58%) or somewhat important (35%). Further, I learned that we Americans overwhelmingly believe that our communities benefit from these important public health functions. This being said, it is troubling to know that as a country, only one penny of every health care dollar spent in the U.S. is spent on prevention and public health research.

Some interesting statistics that make the point: for every dollar spent on water fluoridation, $38 is saved in dental restorative treatment costs; likewise, a 1% decline in cigarette smoking during pregnancy would prevent 1,300 low birth weights and save $21 million in direct medical costs.

As I viewed the continuing environmental devastation and community disruption in many of the wards that comprise the greater New Orleans geography, it made me ponder how our theoretical support for public health gets translated into practice. The demands being placed on local, state and federal resources for public health and human services are substantial in New Orleans and countless other communities across the country; and yet as a nation, we have an abundance of wealth like no other.

Back home in Colorado, I am struck by the beauty of our state, by our many good fortunes, but also by the job that lies ahead in protecting all that has been given to us for which we are individually and collectively responsible and for which we are called upon to be accountable stewards.