The discussion, held at the Ouray Community Center, was the first of 25 ambitious region-wide health care discussions hosted by CLUB 20 that will take place across the Western Slope this spring, summer and fall.
Why start in Ouray County?
“Ouray County is a great proactive community,” said Stefani Conley, a Grand Junction-based consultant who helped compile much of the data presented by the CLUB 20 Health Care Committee throughout the afternoon. “We knew we’d get good feedback and input here.”
The project is funded by a half-million dollar grant from the Colorado Trust to the CLUB 20 Education and Research Foundation, in cooperation with Colorado Mesa University. It initially started as a project delving into federal regulations of the health care reform bill, but was veering too far into technicalities. CLUB 20 took a step back, and decided the first step should instead be to gather grass-roots information from communities.
“We want to learn from you what challenges you’re experiencing in health care, what’s working in health care, and try to give a voice to Western Colorado (at state-level discussions),” Conley told the assembled group.
Some of the data Conley presented looked at health care issues through a broad lens. For example, the U.S. spends more per capita on healthcare than Germany, Canada, France, Australia and the UK. Yet, we have the lowest life expectancy rate of any of these countries. By the year 2040, U.S. health care expenditures are projected to soar to more than one third of the economy.
Other data presented the state of health care at a local level. According to a Colorado Health Institute analysis of the 2009 American Community Survey, Ouray County is the top-rated county in the state (out of 57 counties) for clinical care, followed by Mesa County, when looking at quality outcomes of the patients being treated in the county.
Ouray County also has an unusually large number of physicians per capita – there are six practicing physicians here in this small county, five of them practicing primary care physicians, and an additional six active licensed nurse practitioners.
However, compared to other communities, Ouray has a dearth of safety net providers providing services to the uninsured, Medicare, Medicaid, CHP+ and CICP populations.
Looking at two measures of wellness, smoking and obesity rates, only 7 percent of the residents of Ouray County smoke, compared to 19 percent statewide and 15 percent nationwide. Yet adult obesity trends at 18 percent in the county, tracking closely with the statewide obesity rate of 19 percent. (Across the nation, a whopping 25 percent of Americans are considered to be obese.)
An analysis of health insurance coverage in Ouray County showed that over 19 percent of residents are uninsured; 56.4 percent are covered by employer insurance and almost 16 percent buy their own private insurance. Only 3.5 percent and 5.1 percent of residents have Medicare and Medicaid, respectively.
Participants were split into moderated discussion groups to talk about what’s working well and what’ s lacking in health care locally, in regard to quality, cost, access and personal wellness.
From the group discussion, various themes emerged throughout the afternoon. Not surprisingly, many community members agreed that health care is simply not affordable, and said they struggle with the fact that 24/7 access is not available in our small mountain community. Some find it is difficult to get a primary care appointment. The medical home concept (coordinating primary care with specialist care, hospital care, and eventually, nursing home care) is something many agreed needs to be further developed.
Participants largely concurred that procuring health insurance is a personal responsibility, and that individuals should be responsible for living a healthy lifestyle and being proactive regarding their health and healthcare. Many however said their insurance doesn’t cover the kind of care they mostly utilize, but still found themselves spending thousands of dollars annually on a health insurance policy, just in case they need catastrophic coverage at some point in the future.
The problem of cost shifting was briefly touched on. Programs such as Medicaid, Medicare and the Child Health Plan Plus provide health coverage to low-income, high-risk populations. These programs are funded through taxes, and providers receive lower payments from these programs than they do from private insurance. This creates uncompensated charges and payment shortfalls at doctor’s offices and hospitals that are in turn shifted to those who can pay (mostly insurance companies), through over-billing practices.
That cost is further shifted by health insurance companies to their customers through exorbitant premium rates.
“The Western Slope is paying more money for their insurance premiums with less choices than the Front Range. We pay more, we get less,” one participant vented. “Does this happen in any other industry? No.”
“That begs the question,” another participant retorted. “Should health care be an industry?”
One of the most provocative ideas floated at the session was the idea of zero-based reform. In effect, the way we access and pay for health care in this country is so broken that it needs to be completely scrapped and built again from scratch.
“It’s a bubble,” one of the participants said. “Something has got to give.”
CLUB 20 will compile the data it collects from all the community discussions over the coming months, and share common emergent themes with the state legislature. CLUB 20, headquartered in Grand Junction, is an organization of counties, communities, tribes, businesses, individuals and associations that shapes Western Slope policy on key issues.