Just thinking about America's health care and insurance system can make your head hurt.
Our system costs too much, doesn't work well enough and leaves too many people out. The new reform law includes more people, but it doesn't do enough to improve care or rein in costs. It was little more than a first step in what is sure to be a long journey toward making health care more effective and affordable.
What should the next steps be? That is what the Friedell Committee for Health System Transformation is trying to help Kentuckians figure out.
The committee is named for and headed by Dr. Gilbert Friedell, director emeritus of the University of Kentucky's Markey Cancer Center. It hopes to do for health care reform in Kentucky what the Prichard Committee for Academic Excellence did for education reform: engage Kentuckians, not just experts, in finding better ways to do things.
Part of the problem is that, unlike education, health care isn't so much a system as a disjointed collection of business sectors. Many profit by exploiting the system's inefficiencies or by providing services, not by making the system more efficient or improving health. Medicaid and Medicare, the government programs for the poor and elderly, have a huge influence on everyone's care — and cost of care.
The Friedell Committee is a non-partisan, non-profit group of 50 people from across Kentucky. Some are health care or social service professionals, but most come from other walks of life. Many are retirees who have expertise, but no vested interest that they must represent. They research problems and possible solutions and urge community education and action.
The Friedell Committee began in 2008, but its creation goes back to 1992, when state and national leaders first started talking seriously about health care reform. Public hearings in each of Kentucky's 15 area development districts attracted 5,000 participants; their recorded comments were collected into a 2,000-page transcript.
Friedell said an analysis of that transcript led to the group's 10 value-based principles for health care reform. Those include making health systems accountable to the public, and making health professionals responsible for providing safe and effective care.
Among the committee's other principles: Individuals and families should have fair and equal access to high-quality, high-value and affordable care. Patients should be treated with respect. Individuals and communities must share responsibility for health and the cost of care.
As with education, Kentucky has many health-care challenges. Kentuckians eat too much, smoke too much and exercise too little, putting the state at or near the top of national rates for cancer, heart disease, diabetes and premature death. The challenge isn't just treating illness, but promoting healthier lifestyles.
Because this is a relatively poor state, one in five Kentuckians is on Medicaid. Because of changes in federal legislation, that number is expected to be one in four, or about 1 million Kentuckians, by 2014.
I attended part of the committee's semi-annual meeting last week in Lexington, where working groups discussed issues they are investigating. One group is working with Kentucky hospitals to track hospital-acquired infections, which kill many patients. Another is looking into team approaches for providing primary care at lower cost. Federal legislation provides incentives for developing such new models of care; 44 states now have demonstration projects, but Kentucky isn't one of them.
The committee just launched an effort to find at least one "success story" from each Kentucky county for improving health care, fitness or nutrition. The hope is that publicizing those stories will inspire other counties to copy or adapt them.
For more information, go to the committee's Web site: www.friedellcommittee.org.
"We don't claim to have all the answers," said Carolyn Dennis, the committee's executive director. "We just want to empower citizens to ask the right questions."
