PART Three

PROVIDENCE – There is a well-known line by comedian Lenny Bruce about how the only justice to be found in the halls of justice was in the halls. The throw-away line was a foil for Bruce to recount his numerous encounters with law enforcement in New York City who took great exception to his language, which they had labeled “obscene,” resulting in his cabaret license being taken away, limiting his ability to perform in nightclubs.

Recounting such legal skirmishes in the courtroom might seem rather obscure, arcane and puritanical and yet, today, we are facing an equally obscure and puritanical approach to the legal definitions around the delivery of health care, particularly when it comes to the rights of women to control their own bodies, their own images, and their own reproductive rights – from abortion rights to birth control, from in vitro fertilization to menopause, from free access to menstrual products in public schools to endocrine disruptive chemicals in our water and food products.

The delivery of health care has become a commodity that can be commercialized as a product, where control of the data surrounding one’s health and one’s access to treatment is not seen as a human right but rather as a costly privilege…

Let’s begin again. Take two. All health care is personal. It is complex. It is about relationships, the ways in which we share our personal stories, our most valuable possessions, with our caregivers. It is about connectedness; it is about a sense of belonging to a place, to a neighborhood, to a community. Our health becomes our identity; health equity is about being in a relationship where we are dependent on the kindness of each other.

Take three. Here in Rhode Island, the health care landscape appears to be in constant crisis. The state’s leading public health advocate, Attorney General Peter Neronha, who along with his expert legal team, ofetn find themselves on the front lines of public health, often in the courtroom.

On Thursday, Aug. 8, Attorney General Neronha filed his comments in response to the opportunity for public comment solicited by the Office of the Health Insurance Commissioner Cory King. The comments were in response to the filings for requested rate increases in the individual, small and large group markets, said to impact “a total of 171,466 Rhode Islanders,” in what Attorney General Neronha called the “furtherance of his distinct role in the health insurance rate review process to represent, protect and advocate for Rhode Island consumers.”

The comments were made with intended relevance to the broader context of the ongoing bankruptcy proceedings underway for the hospitals and physician groups of Steward Health Care, as well as the continuing legal battle over the attempts by Prospect Health to sell of its two Rhode Island hospitals, Roger Williams Medical Center and Our Lady of Fatima, in ConvergenceRI’s opinion.

In the news release accompanying the letter to OHIC, Attorney General Neronha made the following points of emphasis:

•   Continued rate increases have not delivered better health care for Rhode Islanders. “History has shown that significant rate increases year after year have not translated into improved access to and quality of care,” the letter stated.

“Insurers get what they need, while consumers, providers, and our health care system continue to suffer,” the letter continued. “We need systemic reform – not tinkering on the margins – and accordingly conclude that the Office of the Health Insurance Commissioner should deny these requested increases.”

•   “Year after year, as part of this rate review process, Rhode Islanders are asked to pay more and more for their health insurance,” the Attorney General argued. “And yet, while insurers are granted increases in their premiums, we have yet to see gains in terms of access to care or improvement in our overall health care landscape.”

National challenges    
In his letter to OHIC Commisioner Cory King addressing proposed insurance rate increases, Attorney General Neronha emphasized that “Rhode Island’s most significant health care challenges are national challenges.”

•    “How health care is paid for, provided, and regulated in this country has resulted in an expensive system that is incapable of meeting demand or providing quality care to those in need,” Attorney General Neronha wrote.
•    “Not only is our high level of spend failing to translate into health benefits for the American people, but it is also placing an unsustainable economic burden on individuals and families,” Attorney General Neronha wrote in his letter. “This is as unsustainable as it is unacceptable.”

What is needed is “a broader, bolder, and more holistic approach,” Attorney General Neronha argued.

In his letter, Attorney General Neronha pointed out that he believed that the current insurance rate review proceeding offered no mechanism to ensure the fair distribution of health care costs. “Perhaps most significantly in the context of this proceeding, there is currently no mechanism for OHIC to ensure that health care costs across the market are fairly and accurately distributed among all participants – whether insured in state regulated, employer-provided, or governmental plans – because of the fractured nature of our regulatory scheme,” the Attorney General wrote in his letter.

More meaningful reform    
In his letter, the Attorney General called for “more meaningful reform.” First, he explained, the reforms need to be “in the form of independent and robust government infrastructure that has both the authority and the mandate to look at the system as a whole.”

Second, the Attorney General recommended the creation of what he called “bold health care payment reform” that would provide alternatives to traditional health insurance by consolidating larger groups’ purchasing power and risk pools while streamlining administrative costs. “While some of these reforms can and should happen at the state level,” Attorney General Neronha wrote, “perhaps the most promising paths to success, will require national leadership.”

Attorney General Neronha argued that there needed to be an urgency attached to developing a new, holistic approach in how health care is paid for – an approach that he said “can no longer be delayed.”

The Attorney General closed by asking: “Why must we continue to ‘preserve a central role for private insurers?’”

And further, he asked: “Why must accessing health care be one of the most complicated and expensive consumer transactions that people face?”

He concluded by saying: “Investment in the health care system is warranted, but it cannot be accomplished through raising premiums on a small fraction of Rhode Islanders.”