Themes that Emerged through our Dialogues

 A dialogue session among the participants of the Access to Care Symposium 2008 was held on Thursday, August 21 around the following premise: “A wise old farmer once said, “Don’t eat the seeds no matter how hungry you get because you are going to need them when the rains come again.”  The dialogue was a call for participants to describe the seeds and relate them to actions that might be taken to preserve vital elements of Nevada’s health care safety-net system.  Framework for the dialogue was delivered by former Senator and Governor, Richard Bryan, inviting advocates for preservation to remember the state’s history in times of economic crisis when seeds of the safety-net were saved and lost and to advocate for the hard choices that must now be made.

A review of the notes from the dialogue session reveals several major themes which we summarize here.  There appeared to be a general understanding that the health care safety-net can be described as those services by government, private and public health care providers which sustain a platform of services: prevention, treatment, public policy reform, etc, that exist for the most vulnerable citizens of our state under all circumstances. In good economic times, the safety-net provides for government backed health care coverage (Medicaid, Medicare, Nevada-CheckUp and other programs for persons of all ages), equal and unfettered access to emergency services, prevention for chronic disease, immunizations, etc. It also includes quality, comprehensive, affordable primary, secondary and tertiary medical care.  In other words, in the good times, the safety-net and the total health care system are very closely intertwined.  However, as economic issues erode the capacity of the health care system to assist all people, the safety-net becomes that level of all the above services, and others that must remain in place so that those who suffer most of the state of the economy do not go without core health care services. 

The task given to the participants in the dialogue was to help identify those core services (seeds) which when they are completely removed because of lack of resources, are not available as building blocks when resources are once again available.  The lack of those building blocks, as history has shown, greatly impedes the recovery of the safety-net and full health care systems.

Children First 
While no one wants to choose among vulnerable populations in terms of who should receive essential health care services, there seemed to be a consensus that sustaining care in the earliest points in ones life had the greatest impact on the long term.  These included not falling behind on immunizations, having adequate prenatal and early childhood programs for wellness, nutrition, etc. 

Primary Care 
Maintaining adequate access to primary care for persons of all ages was identified as a priority in preventing and managing issues so that they did not evolve into chronic diseases that required much greater resources in the long term to treat.  In times of economic downturn, certain faculties will remain in place to treat disease outbreaks to ensure public safety.  Emergency services will remain as best they can to address crisis health care events.  However, if the primary care system erodes to the point where it is not sustainable, it will be very difficult to rebuild it because so many resources will continue to be spent on address current crises rather than preventing them.

Public Health 
The participants identified that one of the primary roles of government in preserving the seeds was to ensure that health infrastructure is in place to see that environment issues not deteriorate to the point where preventable diseases are let to develop.

Middle Class Care 
In response to Senator Bryan’s address, there was considerable dialogue about maintaining affordable health care for the middle class. Without that, we will quickly fall into those who must depend on safety-net services overwhelming that system.  And, as a practical point, when middle class citizens come to learn that their health care is in jeopardy, they are more likely to help create the resources needed to maintain the total health care system.  This theme carried over into the Friday morning work session and has emerged as a working theme for pubic policy education.    

     Thanks to the great entertainment by Hick'ry Switch!

If you have pictures to share, please send to mlevis@gbpca.org