The nation stands poised to dramatically reform our health care system. As Congress considers a major health care overhaul, the time is right for governors to define their roles in developing a more coordinated and efficient system to reduce the cost of health care and improve access to quality care.

The need for reform is critical. Regardless of whether the “payer” is the government or private insurance, we are all going to pay more—in increased taxes, increased premiums, or both—unless we can get a handle on spiraling health care costs. We cannot afford to sustain our existing level of health care spending.

During this current economic crisis, the number of uninsured continues to rise. The cost of care for families without insurance is too great, and they often stand on the brink of economic disaster. When these bills cannot be paid, the costs are passed on to the insured.

Further, we are not guaranteed high-quality, efficient, and coordinated care, even when we pay more. Our current delivery system encourages inefficiencies and duplicative services. The system does not reward for the quality of care delivered, but rather pays for the amount of care provided.

We can begin to address these challenges. Vermont, for example, has successfully implemented comprehensive health reform that incorporates aspects of high-quality, coordinated care along with expanding coverage to the uninsured.

Our innovative Blueprint for Health initiative has developed care teams that provide coordinated services through multiple providers. We are changing the way we pay for care to encourage primary and preventive services, as well as sharing costs across hospitals and doctors to promote coordination.

Along with the promotion of health information exchange and involving Vermonters in their health care decisions, we are changing the way we think about health care by providing our residents with affordable coverage while improving the care they receive.

Other states also have made strides to enhance the quality of care delivered through chronic disease management, care coordination, health IT, and prevention initiatives. These programs have improved the care received and are moving to address the excess spending in the system.

We must come together to deliver on the promise of comprehensive health reform. My initiative offers an opportunity to identify governors’ roles as leaders in addressing the key cost drivers, improving the quality of our system, and providing more insurance coverage. This initiative will inform governors and create a blueprint for broad health reform, helping states to assess their current structure and plan for the future.

Together, we can forge a new outlook on the health system that will lead us to the care Americans deserve.


Gov. James H. Douglas, Vermont
National Governors Association Chair, 2009–2010