Utah's Vote for the Essential Health Benefits Recommendations
Utah code requires that for purposes of the Patient Protection and Affordable Care Act an essential health benefits package must be designated. That information can be found athttp://www.insurance.utah.gov/docs/rules/266PEHP-UtahBasicPlus8-2012.pdf.
Community Engagement
Governor Herbert has stated:
“Utah has defined a clear vision for health care: We will pioneer health care innovation and reform, harnessing the power of collective efforts and market principles as we become the healthiest people in the nation. Our efforts include solutions for low-income, uninsured and vulnerable populations.”
Now that the election has passed, will the Governor reach out to the community of the low-income, uninsured and vulnerable population to engage these voices in the discussions.
Health Care and American Values
“It is difficult to imagine an institution more historically embedded in a nation’s politics, economy, and culture than health care” (Dutton, 2007, p.9). In America, culturally dense propaganda has been entrench in the concepts of the negative rhetoric of socialization and mistrust of expanded governmental roles in health care (Greig, 1999, p. 178). According to Greig, a convergence of strategies such as managed competition or regulated markets is occurring coupled with “a divergence of organizational principles and instruments (as cited in Greig, p.179). One could equate the problem to attempting to repair a dike when the structure is fractured and leaking in thousands of areas. Dutton tells of the political backroom knowledge that health care policy reform “is outside an organization framework” (p. 167). This is an extraordinary statement, both in its ramifications and simplicity. How can any political body make reforms to an organization that has no framework or organizational pattern upon which to build a policy to address basic human rights? Nevertheless, health care policy is gaining an ideological framework in addition to the economic and political framework of history. We as a nation are on a precipice, driven by advances in medicine and technology, into facing complex philosophical issues regarding how to care for our poor, sick and elderly in a time where economic conditions are the salient barriers.
Does America see health care as a right?
A June 12-16, 2009 poll shows that 64% of Americans say health care should be a right. (105 KB) 
. Another survey shows 57% of Americans would be willing to pay higher taxes so that all Americans have health insurance (101 KB) 
. An Aug. 2009 poll showed that 86% of Americans say they think health insurance should be available to all Americans (536 KB) , although 64% opposed raising taxes to increase access to health care.
ProCon.org
Utah and Health Exchanges
Interest update on the ACA in The New York Times today. According to the Times and the mandate for states to create Health Exchanges:
Most of the remaining states, 22 of them run by Republicans, were exploring their options. At least four of them — Arizona, Mississippi, Nevada and New Mexico — had done enough planning to meet the November deadline should they decide to run their own exchanges, according to officials. Nevada had already created its exchange, appointed its board and hired its executive director. Most Republican governors are waiting for the outcome of the presidential race before making a final decision.
Interested in the history of health care and attempting to address health disparities, go to,
Can Utah Be A Leader? More uninsured this year!
Read Kirsten Stewart’s article in the Salt Lake Tribute; 4,11,926 Utahns had no health coverage this year compared to 380, 921 in 2010This is a state where the unemployment is under 6%
In his 1949 State of the Union address, President Truman noted, “Our health is far behind the progress of medical science. Proper medical care is so expensive that it is out of the reach of the
great majority of our citizens.”
The seminal question Americans face is whether America can “turn health and healthcare from a problem into an opportunity, making it the leading creator of high‐value jobs and foreign exchanges earning American society with an efficient health system” that maximizes accuracy, minimizes errors, and reduces inefficiencies to improve care (Health Transformations, 2008). Currently, our health care system operates under a paradigm that treats “sick people as a commodity and doctors as an investor tool shifting the burden of administration costs on the backs of physicians who attempt to ‘walk a tightrope between thrift and penuriousness” in a business environment where “scholarly traditions of openness and collaboration give way to secrecy and assertions of private ownership of vital ideas, and the search for knowledge displaced by a search for intellectual property (Physicians’ for a National Health Program, 2008).
Robert Rubin in a Brookings Institution report stated “healthcare reform,
including universal coverage, is a critical social and moral issue, but it is
also an economic imperative” for this generation (2007).
Community engagement and political processes and powers can address
these collective challenges, providing a framework for increasing available resources,
easing budgetary constraints on health systems, and providing equitably for
underlying determinants of health (Meier, 2008).
While Governor Herbet is framing the conversation in terms of economics, another discussion needs to be started. How will the Governor be an advocate for the ones who do not have the power or voice in these discussions, yet so desparetly need one?Will the Governor engage the community in this imperative?
Response to Governor Herbert's September 25th Desert News Article
Partnership and participation will improve the chances of success and could be sustainable resulting in better policy development and promotion of effective social capital structures if Governor Herbert is successful in leading a democratic partnership with all of his constituents. The process requires participatory democracy, equity between partners and power structures, and restructuring power relations to engaging the community effectively. The government and governor needs to be aware that partnerships, including healthcare partnerships, face considerable challenges empowering disadvantaged communities and improving their health and may unintentionally ensure continuity of insecurity and dependence for community-led initiatives by forcing communities, individuals, and health care systems to compete with each other for vital resources. Challenges include:
1. Public sector organizations compete for funds and must balance competing interest., such as the governor focusing on economic factors perhaps to the exclusion of the more difficult issues of health inequalities and social exclusions to insure access to health care.
2. Potential conflicts between national policy and state or local priorities/issues advancing Utah as a state that is out of step with humanitarian concerns and how the U.S treats its lower socioeconomic class.
3. Democratic governmental structural limitation to be agile, quick and flexible in responses to issues.
4. Health care partners’ self-perception of “best interest” may conflict with local communities or individual interest.
5. Social capital concepts of trust, reciprocity and respect may be absent due to power structures when dealing with the state and the governor’s perception of “we.”
In Utah, the opportunities for discussion regarding health care and health care policies are limited and do not engage the public in a robust discussions across the socioeconomic sectors. On important policy development issues the discussions shift to venues in which the salient conversations are framed as broadcasting political positions instead of engaging collective actions with the intent of finding a policy solution. In other words, political ideology is dictating the framework for discussions and resolutions in venues where activist has been restructured as announcing a “stance” in lieu of policy debate and solution finding (Lavis, Robertson, Woodside, McLeod & Abelson 2011. The governor, once he publicized that “we” as a state would be looking at the issue of how to launch the Affordable Care Act and integrate the federal law with existing state structures failed to describe how this would be accomplished in the implied “we” of the community.
Modernly, the venues for political debate and the historical town square events are now held in technological forums. “Activists participate through the performance of image events, employing the consequent publicity as a social medium for forming public opinion and holding corporations and states accountable” (DeLuca, Sun, Peeles, 2011).
While academics posit that “a decision-relevant culture can be created among researchers, and a research-attuned culture can be created among decision makers (Huberman 1994; Roos and Shapiro 1999)” through best practices for knowledge exchange in public venues, the technological forums are driving the discussions, framing the issues, and shifting the tone of interventions. In other words, the town square as a meeting place which facilitated a communal venue for a variety of voices to be heard without constraint and with the broadest free speech rights is no longer relevant. Activism, the physical action of wanting knowledge to be heard and acted upon, is now a new technological being, who exhibits associated privileges and powers.
“Dead architectural metaphors, fenced-in pre-approved “free” speech zones, and dusty laws guarantee nothing but moribund public spaces and an apathetic public. Through activist communication acts publics come into being and democracy lives. Focusing on practices moves us beyond “a priori conceptual restrictions of citizenship to certain people, places, and topics” (as cited in De Luca, Sun & Peeples, 2011).
Collaborations in Utah
A new paradigm is emerging in health care, collaboration.
‘The power of collaboration to improve health and the functioning of health systems lies in its ability to establish missing but critical connections ( Lasker et al., 1997 ). Gray ( 1989 ) defines collaboration as a process through which parties who see different aspects of a problem can explore constructively their differences and search for solutions that go beyond their own limited vision of what is possible.’ ’ By bringing people with different perspectives together, partnerships have the potential to identify new and better ways of thinking about health issues.“
A platform where the public, health care workers, politicians, academics, and local businesses can participate in meaningful dialogue that results in policy development "can strengthen these actions in several ways: ( 1 ) by connecting the fragmented array of health and social services that organizations provide to individuals; ( 2 ) by involving additional people and organizations in population-based health strategies; and ( 3 ) by linking individual-level health services and population-based public health strategies” (Lasker, Weiss & Miller, 2012, p. 167).
Utah is at the crux of developing health policies for the next century and beyond. The HiTech Act will drive the harnessing of health priorties, community health priorities and enhancing partnerships.
To Engage the Community
As a scholar, the opportunity to engage is challenging and requires one to step out of a safe and comfortable detached role and look for opportunities to make a salient impact, perhaps more importantly an impact to oneself.
The Association fo Utah Community Health may be such an opportunity. I plan on attending, and perhaps, even engaging in a policy summit at the Utah Cultural Celebration Center and the Utah State Capitol.
“Community engagement and political processes and powers can address these collective processes, providing a framework for increasing available resources, easing budgetary constraints on health systems, and providing equitably for underlying determinants of health (Meier, 2008). Through development discourses empowering individuals, health care systems, health care actors with the political system and leveling the power structures by empowering and allocating rights, both to the individual and the community, and addressing underlying determinates of health, a true enactment of Governor’s Herbert vision could be obtained (Meier, 2008).
Meier, B., Fox, A. (2008). Employing the collective right to development to achieve the goals of the individual right to health. Human Rights Quarterly. (30)2.
