By Adam Linker

For much of its history North Carolina was known as a state with bold leaders and progressive ideas. It built Research Triangle Park, one of the nation’s best community college systems and created pioneering early childhood education programs. The state was even a leader in expanding health care to its citizens.

In the 1940s a group of influential businessmen and politicians came up with a series of recommendations, dubbed the “Good Health Plan,” to boost the number of doctors in the state, create a teaching hospital at the University of North Carolina at Chapel Hill, and expand Blue Cross insurance. At the time, Gov. Gregg Cherry said, “Only less sacred than the right of a child to obtain an education is his right to get a fair chance of health in his youth.”

Despite the work of these early visionaries, there are still more than 250,000 uninsured children in North Carolina.

Our state can’t wait on Washington for reform. Instead, citizens must demand action to ensure that everyone has access to needed care.

The North Carolina Justice Center’s Health Access Coalition has assembled a plan that can serve as a roadmap for reform in the state. It does not rely on the government to provide for all of our care. Nor does it follow the “corporate care” model that strips away consumer protections and caters to insurance companies instead of ordinary families.

Central to the plan is the idea that everyone should have a guaranteed choice of affordable, comprehensive health care options. It is also important that all stakeholders -- hospitals, insurance companies, businesses and taxpayers -- share costs equally.

The first major proposal is to cover all children and parents. To do this, the state should create a sliding scale premium whereby a family of four making more than $63,300 could buy insurance at full cost while lower income households would get a partially subsidized premium. Members of the North Carolina General Assembly get a lifetime right to buy affordable health insurance through the state; shouldn’t families have the same option?

The second step is to create a partially subsidized, affordable health plan, sold on the private insurance market, so that small businesses can offer coverage to their employees. About 78 percent of the uninsured either work full-time or have a family member working full-time. But most people are employed by small businesses that can’t afford to offer insurance. This subsidized health plan would ensure that more working adults can get coverage through their employer.

North Carolina should also set a national example for controlling health care costs. Our state has world-class research universities with extraordinary scientists. We should draw on that expertise to establish an Institute for Health Care Quality, Cost and Research to investigate the effectiveness of new drugs and cutting-edge technologies.

What we often find when novel drugs or medical devices are tested against older, cheaper alternatives is that the existing technology works as well or better than the latest gadgets. Health care providers, public health officials and insurance companies could then make evidence-based decisions instead of relying on marketing hype.

The state should also put a new emphasis on preventive care. Many programs, including colorectal cancer screenings, flu vaccines and smoking cessation counseling, save money over time. But the benefits of prevention extend beyond cost. Prevention helps people to live healthier, fuller lives.

Any reform of the health care system will be complex and expensive. But that is not an excuse to do nothing; in fact, it is a reason to start as soon as possible. For the 1.5 million uninsured residents of the state, every day is critical.

Our state is lagging behind much of the nation in expanding health care coverage. Every citizen should demand reform. With committed leadership North Carolina can make great strides toward building a healthier state. We did it in the 1940s, and we can do it again.
Linker is a policy analyst at the North Carolina Health Access Coalition.
Copyright (C) 2008 by North Carolina Editorial Forum. 11/08