Report from Santa Fe; Danice Picraux and Steve Komadina

I don't know if it's true or not, but it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true, it's true it's true, it's true Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future.

I'm Lorraine Mills and welcome to report from Santa Fe. Our guests today are two hardworking lawmakers, representative Dennis Picro, a Democrat from Bernalio County and Senator Dr. Steve Comadina, a Republican from Santa Vall, Santa Vall County. Thank you so much for joining us. You're here in Santa Fe working on the Legislative Health and Human Services Committee and I've asked you to come and tell us what's going on with the committee and your preparations for the upcoming legislative session. Ladies first, we'll start with you representative Picro. Well thank you and I'm glad to be here. The committee is broad ranging, now I must say we have not voted on our priorities yet. So anything I tell you is just some of the things we have discussed and I'll do some of the most recent things. Today for instance we had a discussion of sexual assault programs and we learned a great deal of new information.

There was a time we thought a sexual predator could not be helped, you show signs and you can't be helped. And now they're finding the sexual predators can be helped if you catch them young enough and that we can identify folks by behaviors when they're fairly young, whether they've hurt someone else or just other behaviors. And so that is a program we're going to look at helping because that can make a difference, a demonstrable difference and safety for all of us and a happier life for all, including for the person with a problem. So that remains to be seen on the vote but I assume we'll support that. We had discussion of infants and children and getting them off to a good start in life and again information was brought in that a home visit from someone who knows about infants and young children makes a big difference and it ends for mothers, new mothers of all economic backgrounds and all economic and social backgrounds.

And I will tell you I had a home visit with my third child. So I experienced it and it's a support, it's you're doing fine, your child is doing fine. I mean you've just done childbirth and that these visits can extend on into time on occasion but it seems to bring the family together to support a family that's in a very trying time just because you're not getting any sleep and you don't feel strong. So we'll look at home visitation and if you don't want it you won't have it. I mean it's not going to be a requirement but the information was brought in of its value and if you think of years ago when there was a mother or a grandmother or a community person that came and visited you after a birth you'll see what we're trying to do is recreate those structures that worked also well. You're looking at health information exchange. You've changed doctors or you go to a specialist. Where's your information? And we're looking on secure ways to make sure that information can be transferred at

your request so that the doctor you're seeing has the information about you that he needs not what you'll perhaps forget or think is not important and information will be transferred. So that was some of the things we did today. We talked about daycare. We talked about birthing. We've talked about the importance of children age 0 to 3 having the right start in life and how we can support that for parents. So that was just today. That was just this morning on what we've been doing. Well and you are the chair of that committee so thank you for this. The briefest of synopsis we'll come back to some of the other things that we're doing. But first let's hear from Dr. Senator Kamadina because you are the only physician in the Senate. I think I'm in the only health care person actually in the legislature in the state of New Mexico currently.

Well so you bring a really unusual perspective. Tell us what your priorities are in your work with the Health and Human Services Committee and what you're working on now. Sure. I don't know that I have any priorities. I guess my philosophy is once you get elected suddenly you have less of a personal agenda because you're here to represent the people who elected you. You're not here to run your own personal agenda so often you have to actually put your causes on the side in order to support and allow everyone you represent to have their voice heard. And that's what the Health and Human Services Committee is all about. We literally meet for probably a couple of hundred hours during the interim. Three days every month, this month at six days, we meet for eight hours a day and try to meet all over the state so that we've got access to the people who want to tell us of their needs. And a lot of our work is reviewing what we've done in the past, correcting things that we've done in the past that had unintended consequences, and then trying to dole out the limited resources that are there for the Health and Human needs of the people of the state of New Mexico.

So I find myself on the committee really spending lots of time listening to what people have to say. Out of that we'll come the priorities of the committee as to what things we want to support as a committee, but then there will also be lots of other legislation introduced that doesn't have committee endorsement. So as Representative Picro gave us the summary of just some of the things this morning, what other things we look at during this meeting, you'll probably have one more meeting before the legislature? I'm not actually sure if we're going to meet again. We're meeting of this week, it's Monday, Tuesday, Wednesday, and Wednesday, which is tomorrow. We will make our decisions on what we will endorse, and that will be it for the interim. Well, and then who decides who carries the new as a committee will bring these possible bills forward and say endorse by the legislative Health and Human Services Committee? It's a statement on the bill endorsed by the interim committee and members of the committee

will volunteer to sponsor, and then you may have two or three volunteers who want to be prime sponsors. So it's all very democratic, and you pick and choose what you'd like to do and what and carry forward. So in that regard, you have a statewide vision, but you also have a home vision, what works in your home, what can you tell your constituents? So you blend those two together, and they often blend well. What you pick is meaningful for your district and for the state. Well, in my home, personally, I feel that health care and health issues are one of our hardest nuts to crack when one of our most pressing issues. And I've watched year after year, small little pieces of this puzzle get handled. For example, you had mentioned the health care for children one to three, but now is it not true that now any child under five years old has coverage through one form or another? Didn't we do that in the last session?

Our children are covered. Our children are covered, who's not covered as our adults. Our elders are covered in part through Medicare, and I know Medicare needs supplemental to help with a tremendously broad need, but there's a basic need that's covered, and now our children, our young children are covered. So the issue is coverage for adults, and we've been piecemealing that. We're staying in a private market system, companies who offer health insurance, offer it. We have made an hour committee and working with the governor, and this year, the governor's health coverage initiative, but the health and human services has worked on it for years as well. We've covered the young children, we've covered pregnant women, we've covered certain diseases, we've, on another tact, worked to get health care providers to encourage people to go into the different realms of health care provider so that you have people on the ground you can

go to. You don't have to travel necessarily a long distance to find a health care provider, and that's another thing we are promoting this year in health and human services. We're now looking at disparities who isn't getting care, and seeing why isn't that happening and what can be done. And in the end, you'll go back to the model of insurance or state coverage. The Veterans Administration is a sample of state coverage. You pay your taxes, you were a veteran, you're covered, just as Medicare. You pay your taxes, the state pays your taxes, you're covered. We're looking at models, the governor's looking at models, and we've done, as I said, peace-mealing, and we've proposed that contractors, who are small business people, you contract with the state. Say you wanted to do PR for the state, you would contract with the state. And we're saying, isn't there a way for the state to help or to permit you to buy into some kind of state pool so you can get health insurance, which you as a single person

might find much too expensive to do, so we're looking at that. So we're tripping away at the problem as the governor's health coverage initiative is looking at a broader base, which I can speak to if you'd like, but I'll hold it at that. Well, one thing I'd like to address is the sheer size of this group of uninsured, because these may be old figures, but do we not have about 400,000 New Mexico citizens who are uninsured? That's correct. Is that 399? Well, okay, 400,000. So what would your ideas be since you are in the trenches as a health care provider? What would your ideas be in ways to provide coverage? Is it through putting them under the umbrella of a state program, as you suggested? What are some ideas you have toward this? Well, again, these are certainly my own ideas, but I think people need to realize who these people are, because they're not unemployed. They would fall underneath the Medicaid program. They're not the old, they're not the children.

They're actually people who have businesses of their own, people who work for small businesses who can't afford to offer health care coverage. So it really is the middle-class person that's 400,000 that are not insured, and we see a lot of those in our office, and those people pay for their health care. Many of them have an incentive because they're paying their way to stay healthy. And I've noticed within my patient population, those who are self-insured don't take the risks of those people who have insurance, because they have something to lose if they get sick. They also take good care of themselves. They get their annual visits. They do things that, again, invest in their health because they don't want to have the sickness that comes with unhealthy lifestyles. So it's a very interesting demographic group. It's easy to throw out the number of 400 people are uninsured in the state of New Mexico. 400,000. Got me 400,000. By choice, the majority of those are uninsured. They could get insurance. They just don't want to pay the price.

And often the price is higher because they are in a small group. And therefore, not sharing their risk with a lot of other people's you would have in a large corporation or in the state of New Mexico. I personally think that everyone should have health coverage in the state of New Mexico. But I think we need to stop just trying to fix the system. I think it's one of those things that has to be completely redone. And the problem is too many people are making too much money over the current system. And they really don't want it to change even though they give lip service to wanting it to change. You know, I personally think that health insurance shouldn't be financed by employers. I mean, this is just the tax on people who own businesses. You know, why doesn't the state basically cover everyone's health and let's tax the people rather than tax the employers to cover health care? Just coming out of an employee's check anyway, you know, the employer, you know, isn't just losing money in order to provide health care. He decreases the amount of compensation that employee gets in order to give him a benefit. You know, we've looked at that on other shows how at back at and in the depression time,

the whole issue of the employer playing for health care. And recently, the automobile manufacturers met with President Bush saying, our health care costs add $1,700, $1,500 to the cost of a new car. In Japan, that isn't put on the cost of their new car, help us out here. So do you think that that hook up between the employer paying the employees health minutes? Do you think that hook up can be disengaged? Well, the problem is, again, people know how to work the system. And so there's great inertia to having any change because people have worked, have figured out how to work the system. The problem is there are people that are falling through the cracks. But they get taken care of, you know, nobody gets turned away at a hospital. The hospital just has losses for those people that don't pay. And therefore, that's paid for by other people, another way of taxing people, a hidden way of taxing people who pay for those who don't pay.

So that's why I'd like everybody to sort of pay up front. Let everybody have the benefits, have somebody make the hard decisions as to what is health care that's deserved by everyone? And then what's selective? I mean, is it, you know, to have your nose shape changed, you know, is that something that's necessary or is that elective that you should have to pay on your own, or to have your face lifted or whatever? You know, we're all watching the state of Massachusetts who have done some of a very pioneering healthcare change where they're correlating sort of health insurance, mandating health insurance like the mandate car insurance. So we're all going to watch and see how that, that, see if they're successful with that and then perhaps we can learn from that. But what are we doing here in this state that other states can look at? What do you think, Representative Peacrow? Well, right now that's a premature question, I guess. And that's because we've been working with the governor and there is a study going on it, and it won't be ready till next year.

And basically, and this I find really fascinating. We are putting out to bid to large firms like Lewin and what have you, no healthcare financing and healthcare practices, some models. One is a model which would still keep small business at the center or business at the center of offering health insurance. And I won't go into detail because it's just, it's something we're used to, a business centered model. And it was written by a woman here in the state named Celia Amelene who owns a very small business and she sat down one day and said, we should be able to figure this out. And her model has gone up and to change, I have to change her to, as people have talked with her about it and she's presented it to committee. And that is one of the models that is going to the national firm to, to analyze for us. Similarly, we will have a single payer.

Now, universal insurance is not the same as single payer. Single payer is like the Veterans Administration, it comes from a single source. And usually the government is involved in that, with that source. You may have co-pays or what have you, but you have that source. And we will look at the single payer as put forth by health action in Mexico and written in part by a few different people. So we'll have that go. We're going to look at an expanded Medicaid program. So you go into the middle class. Medicaid is already slightly into the middle class and let's go higher into the middle class and see what that would do. And then we ask that the current program be costed out. Because it's unfair to judge the cost of any of those programs if you don't know the cost with the same terminology, the same kind of analysis of the current program. So we didn't choose what another state had chosen. We didn't have experts write it in the first place and then send it out for analysis.

We took people who have been thoughtful, have been worked through their own programs over the years, modeled it after others, to look at it. And I think that's very fair and we'll see what happens. And then we don't have to take any one, we may pick and choose and decide. But we'll see what happens to costs. We'll see what happens to estimates of use. We'll see what happens to estimates of a healthier society. Because in all of them, there's a push to staying healthy in the first place. I mean, we can't all. You're going to get sick. But staying healthy so that those big costs aren't there. And if something does happen to you, that a cost comes, whether it's a heart attack, even though you go to the doctor and you seem healthy. You'll have that, you'll have regular care, you'll have your prevention care. And let's see what it costs. So it's actually very interesting and exciting time. When is that report doing?

That's going to be, that'll come out next year. So we'll, with any luck, we can go into the 30-day session, I would hope, with something. And the health coverage group has brought a few legislators. It is consumers, it is business people, it is insurance companies, it is healthcare organizations, and very few legislators on it. But people who have been working on this with us for years, we're all coming to the same place. We've got to have universal coverage, which means there's a place everyone can go that they can afford, and not get, you know, if you care, get the same kind of care. We have to figure this out. It's costing healthcare providers, I mean, their rates are high because of one kind of insurance or another, or because of new technologies and the cost of healthcare are just rising. The insurance companies would like to see some help as well.

The other kinds of healthcare provider or monetary, what are they called, it's not insurance per se, but other payment mechanisms. Everyone is seeing these costs rise, and we're interested in a healthy environment. So we're going to push prevention, we're going to have intervention, we're going to have access, so you don't have to get really sick before you get help. And a lot of the advocates of the kind of system you're talking about mention the fact that we're the last industrialized nation to provide a minimum amount of, you know, all these words are so triggers, if you say single-payer universal healthcare, but to provide minimum healthcare for their citizens. I know that from what I've read that you are really an advocate of personal responsibility. So where is the interface between the patient's personal responsibility and the responsibility of the state or governing entity or a physician or an insurer to achieve the same end, which

is a healthy being? That's a pretty hard question. It's actually a really easy question because I think no one should care more about your health than you. Regardless of how compassionate your caregivers are, nobody should really care more about your health than you. And it's why I went into medicine rather than an individuary medicine because I could talk to my patients, they could make choices for themselves and they could change their lifestyle, they weren't in a cage or in a backyard or captive, you know, to someone else to provide everything for them. And I think there's a lot of fallacies that we have grown up thinking were true, which are not true. And that's one of the problems with healthcare in America today. I'm sure you know that there are now 42 countries where people live longer than America. And actually, some of them have socialized medicine that don't live as long as America. So having access to healthcare and a meeting that Dennis and I went to is actually not the key to health.

It's actually one of the things that is one of those fallacies we've been led to believe. It's not access to healthcare. It's really public health that's led to our life expectancy. The life expectancy today is exactly the same as 1966 when I entered medical school. You probably think people live longer in America, but they don't. A few do, but a lot more are dying earlier. And so the average life expectancy is 77, which is exactly the same as 1966 when I went to medical school yet what has happened to the cost of medicine since 1966. So we do really a good job saving that person and the automobile accident, saving the person who has an arm cut off by trauma, you know, saving the person who gets knife to shot. But those aren't the things that kill us. The things that kill us are the chronic diseases, the diabetes, the heart disease, the high blood pressures, which we've not really made any inroads with despite our you know, crazy surgeries that we do and the high tech things we do and the number of tests we can order in reality we're not living longer.

They're third world countries where the life expectancy is the same as America. So I think that's where we need to be and that's actually what many people are saying in America today, you know, the reason we live longer than 100 years ago is because we have clean water and indoor plumbing and put screens on windows and we have immunizations. It's kind of the immunization sterilization, pasteurization, washing hands. Sounds kind of simple, but in reality, it's not antibiotics that makes us live longer. It's the public health issues that we've done just with lifestyle changes. If you took away, again, alcohol, smoking, drugs, what kind of an impact would that have on health care in America and how much disease does that cause? Which is purely by choice that we're making as Americans that other people don't make in other countries. I saw you nodding earlier your thoughts on this. Well, I mean, Steve's right, public health has been the big thing to increase our longevity. The other thing that we have to add is as we are aging and maybe old is later than it

is now, but that's when the body does start breaking down and we keep you alive and we keep you as comfortable as we possibly can. And so as our me, baby boomer generation ages and we're so healthy, right, that you will, you're going to find cancer coming and it could be an environmental, it could be a genetic it could just be age and things happen as as cells divide and you're no longer healthy. The heart disease may still be there. It may be, it may be less, but it may be genetics and it may be diet and it may be lack of exercise. And people will, I'm sure Dr. Cometina will tell me if I exercise more, I wouldn't have heart disease and I'll tell them, well, you know, I can run, I can run now five miles and I may still have heart disease and cholesterol levels, you know, whatever.

And so we're going to this kind of geriatric care is not just for age old people. As we move on into our older years, we're going to have to change our lifestyles perhaps and look at medicine in a different way. You know, one of the key things is that we're now being told that the generation of children in schools today will not live as long as their parents. Now, I think that's really significant, you know, there's no baby boomer who wants to be in a nursing home. You know, we always did it differently than our parents, even though I'm not a baby boomer I'm too old. It's still, that's been the baby boomer, you know, mantra as we always did it our way and we don't want to be in a nursing home. It's quality of life, not quality of life, but it's interesting. There's no cell in your body that's more than seven years old. So my patients say, well, how come they come in reekled? And it's because, again, we're not repairing the cells that we have, which can be done with really simple things. And there are lots of people who I watch on PBS like Andrew Wilde, you know, who can show me that the plaques actually go away in people's vessels just by changing nutritional patterns

because that blood vessel gets replaced. You know, there's things about, you know, mental illness that we now know that are probably related to, again, things that we're doing, you know, in America. It's an area that is, you know, exploding. I think nobody really understands nutrition and prevention, but it's a place we're looking because we'll never have the dollars to pay for the illness that we can create. But we'll probably have plenty of money to teach people how to be in control of their own health and incentivize them to stay out of the system because they're healthy. That's where we need to be, I think. Well, I can see that you both have thought about this so much and I'm so sorry that we're almost out of time. Do you have a closing statement? I mean, that was amazing, again, invoking personal responsibility and behavioral and dietary changes. But do you have a last word to our viewers? Sure.

I think I would just like to let them know the legislative process works. Sometimes it's slow. Sometimes they'll be disappointed that their cause doesn't rise to the top. But it's a process. Things we heard this year, we heard last year and we heard the year before and the time is right sometimes, like universal coverage and other things. You wouldn't want change to take place very quickly because we might make huge mistakes. So it's a process. We welcome the public's input. That's what's so valuable about these interim committees and they just need to stay involved because it is their government. And I think that's important for them to know. Thank you. And I think, you know, there is always hope. We do pass laws. We do fix them if they don't work right. And we move along. But we're committed to issues and health care is a, we have many of us have a tremendous commitment and different parts of it and then it comes together. So the process really does work, it just takes a little bit longer sometimes than we'd like to see.

Well, I want to thank you both for your hard work and I want to thank you for joining us today. Our guests today are Dr. Senator Steve Komadina, a Republican from Sandeval County and the chair of the Legislative Health and Human Services Committee, Representative Dennis Picro, Democrat from Bernalio County, yes. And I'm Lorraine Mills. I'd like to thank you for joining us today on report from Santa Fe. We'll see you next week. Work from Santa Fe is made possible in part by a grant from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future.