10.5.06
Introduction and Acknowledgements
Thank you… it’s an honor to be here with all of you today to talk about the future of public health here in Baltimore and throughout Maryland.
Doctor Morhaim… Delegate Morhaim – you’re certainly both today…– I want to thank you for pulling us together again… and for all your hard work here and in the General Assembly – making our communities safer and investing in the next generation.
And Doctor MacKenzie and Professor Teret – I want to thank you for your part in opening up this dialogue today… a dialogue that’s really about how we move forward as a people.
Two years ago, we had an opportunity to talk about our vision in Baltimore City, and this year… we get to look back on the last two years… but we also get to broaden our perspective and start to look at the choices being made for us – choices made by those we elect…
… and whether or not those choices are making Maryland a stronger and healthier place, not just for ourselves but, more importantly, for our children and theirs.
As you all know… and as all the research has told us… Maryland is facing a health care crisis…
With 780,000 Marylanders going without health insurance, rising premiums and prescription prices…while more and more physicians are finding it harder to practice in our State.
… Marylanders are watching as our health care system – one of the critical components that determines our quality of life – grows weaker and less effective.
So what does that mean?
It means that, over the coming months and years,… we are going to have to tackle some tough challenges and make tough choices if we are going to stem the tide and make Marylander a leader in health care again.
And I think to do that – to reach our vision – we need to look at where we came from and where we’re going… really by understanding the choices that take us there.
Choices in Baltimore
Now… over the 7 years, for me… those choices were right here in the City of Baltimore…
A city that was once dubbed the most addicted and violent city in America … a city that used to be ridiculed on the Tonight Show.
But, instead of wallowing in a culture of failure and excuses… we came together with dedicated people… like all of you in this room… to take on the tough challenges and make progress.
And together, we reached out to our neighbors and tackled the stubborn public health issues that any big city comes to know all too well.
Issues like HIV/AIDS, that reached their highest point in 1998…now, with the help of our needle exchange program… and our directly observed therapy program for transients – see a 25% decrease in new HIV diagnoses in Baltimore.
Other diseases – particularly sexually transmitted diseases – have also been declining dramatically. Syphillis is down 75% since 1997 and Gonorrhea is down 45% since 1995.
That decline wasn’t inevitable… we had to choose to make it so through accountability, aggressive partner tracking – and proactive innovation… testing for syphilis at Central Booking, rather than waiting for people to come to us.
One of the most stubborn and preventable challenges we faced – and continue to face – was that of lead poisoning which was robbing our children of their potential.
But by implementing a strict program of testing, abatement and enforcement, number of children with highly elevated lead levels has been reduced by 80% since 1999.
And finally, in a city that was dubbed the most addicted city in America every single year from 1994 to 1999… we are unlocking human potential everyday with drug treatment that works… drug treatment that saves lives.
As you know… this scourge on our city tends to fuel the public health issues we just mentioned… and we’ve found that when we face it head on – we can make great strides in improving public health across the board.
That’s why we came together, back in the day, to double drug treatment funding… it’s why, a few weeks ago, we opened a new in-patient treatment center…
And it’s why… despite the deep Federal cuts and State stagnation… we came together, just yesterday, as the first city in the Nation to offer free training to any physician in buprenorphione…
And with the help of institutions like Johns Hopkins… this initiative may very well double, or even triple, the amount of people we’re treating every year.
With this kind of proven treatment… not only do we make lasting progress in reducing drug addiction… but we make our communities and our families safer and more secure.
Over the past 7 years… with the help of better policing, increased accountability and our expanded drug treatment services – we have seen the lowest levels of violent crime since the 1960’s…
And with the help of initiatives like Operation Safe Kids – a partnership between Police, Juvenile Services, the State’s Attorney’s Office and our Health Department – we’ve taken responsibility for our at-risk children and decreased violent crime arrests for youths involved in the program by 44%.
Ultimately… I think one of the things our experience in Baltimore tell us is that… by working together in a spirit of compromise, we can face the toughest challenges… and make progress.
We’re by no means finished… there’s still much more to do – but we’re moving forward with the lessons learned, with compassion and innovation, and with accountability tools like CitiStat… because we share that belief that government should work… that we’re all in this together… and that there is no such thing as a spare American.
Seven Years Later; A Vision for Maryland
And as I stand here today – having traveled all over the State – I’m still finding that 7 years later… the challenges we face aren’t all that different… and the goals we share… whether we’re Democrats or Republicans… are the same goals we share as Marylanders… Americans, even as human beings.
To strengthen and grow our middle class…
To improve public safety and public education in every corner of our State.
And to expand the opportunities for learning, for earning… for enjoying the health of the people we love as well the health of the Bay we love – to more people, rather than fewer.
These are our goals… these are the goals of a diverse and ambitious people – a people who believe their tomorrows can be better than their todays… but only if we make the right choices and act upon them.
And so, today we have that opportunity to look at those choices and to talk about how we go about improving our quality of life – a quality of life that is so dependant on the care we receive.
My running mate, Anthony Brown and I… believe that starts with a holistic approach to health care… one that works to expand access, improve quality, and increase the affordability of health care to all Marylanders…
The crisis we face is complex… and instead of saying the market will take care of it… or that these things are simply beyond our control – we can take responsibility for each piece of the health care puzzle – which taken together – give us a fortified approach to a better future.
So this afternoon… I thought I might use the rest of my time to talk about our 7-point plan and then we’ll get right into some question and answer.
Health Insurance
Now… Anthony and I believe improving health care starts by making health care more affordable and reducing the ranks of the uninsured.
According to the Maryland Health Care Commission, 87 percent of the State’s uninsured live in households with at least one working adult… while, at the same time, fewer than half of Maryland’s small businesses offer health insurance.
But by working to implement tax credits and a statewide purchasing pool… so that small businesses can join together to spread risk and negotiate lower rates… we can start to reach the 780,000 Marylanders who go without health coverage.
MCHIP
Second, we will work to maximize the underutilized potential of Maryland’s Children Health Insurance Program through automatic and streamlined enrollment procedures… and a targeted outreach campaign… to help provide the necessary basic care to those 133,000 uninsured children throughout Maryland… 74,000 of whom live below the poverty line.
Right now… only one state – New Jersey – sets the income eligibility level higher than Maryland. But 17 states have fewer uninsured children as a percentage of all children than Maryland.
In response… Governor Ehrlich suggested placing that burden on emergency rooms, which in the end… is paid for by all of us…
How sad it was to see our Governor try to take away basic coverage from 3,000 legal immigrants – women and children – as a way to ease the Medicaid burden.
There are better ways to responsibility expand coverage, and MCHIP is one of the ways we do it.
Health Care Professionals
Third, as we discuss coverage we also need to talk about the quality of care… and that means recruiting and retaining the best nurses and doctors.
Just a year ago, The Daily Record reported that the University of Maryland School of Nursing turned away 400 qualified applicants during its fall admissions cycle… even as the nursing shortage in Maryland grows worse.
To meet this need, we will expand scholarship opportunities and grant programs for nurses and nursing instructors… while, at the same time… working to make pensions and salaries, many of which have not increased in nine years… more competitive.
In regards to our practicing physicians… we will work for fair reimbursement rates and reformed medical malpractice.
Anthony and I also believe that we need to increase competition in the limited Small Group market that suffers from a lack of choice and concentrated market leverage…
… and that starts with the increased openness and transparency of insurances companies… so that regulators and officials will be in a better position to reach accurate conclusions…and make informed decisions about our rates and premiums.
Another issue that affects our doctors… and, consequently, our families… is medical malpractice…
In 2004, the General Assembly’s Work Group… chaired by Anthony Brown… was able to forge a compromise between insurers… physicians… and patients that prevented severe rate hikes.
Unfortunately, And Anthony and I believe we need to continue to work together, as we did in 2004 in Annapolis… to find the common ground between insurers… doctors… and patients.
We’re fortunate to have Anthony Brown on the ticket because… as the Chair of the General Assembly’s Medical Malpractice Insurance Work Group… and a strong factor in overriding the Governor’s veto… he knows this issue inside and out.
RX Drugs
Fourth… (we’re almost there)… the fourth component of improved health care confronts the fact that our families and seniors still face expensive prescription drugs and confusing assistance programs mandated by Medicare Part D.
In fact, the AARP found that since 2000, the cost of prescription drugs has gone up 40%
And although, the federal government doesn’t permit the importation of drugs… (or new ideas)… there are other options we can pursue as a State to improve ‘prescription assistance’…
Here in the City of Baltimore we consider ourselves clepto-crats… to borrow a term from Governor Rendell in Pennsylvania – we steal good ideas from wherever we can find them… and we found this good idea in Illinois…
The I-Save Prescription program – which has also been stolen by Missouri and Vermont – operates under a stringent system of quality controls and safety checks to pull resources and import drugs from outside the United States.
Participants in the program can save anywhere between 25 to 80 percent off of national retail prices.
But there are also options within our own borders… by leveraging our enormous purchasing power as a State; we can negotiate drug discounts for the Maryland’s uninsured…
In Maine, they’ve found that drug manufacturers have been participants in this program because of their vested interest in retaining their spot on the Medicaid preferred drug list.
Community Care
Fifth… now, in regards to community care, Martin and I believe that our State should be making the critical investments that will strengthen and expand promote community health centers…
Centers that are particularly suited to target conditions like childhood asthma… and other public health issues… that can disproportionately affect some communities.
We also believe we should dedicate state resources to increase access to rural communities, which have been traditionally underserved…
And, to increase the independence afforded by community care, we will restore the Governor’s deep cuts to assisted living programs that fall on the backs of Maryland’s seniors.
R & D
Sixth… Maryland’s intellectual and institutional assets, like those right here at Johns Hopkins, and those a few blocks over at the University of Maryland – really hold the future of modern science and Maryland health in their hands…
All along the 270 Corridor, in Shady Grove… and throughout the research diamond… we have opportunities to develop weapons of mass salvation that bring healing to some of our most fragile neighbors around the world.
With the full support of a State partner… not opposition or hesitation, we could finally harness our strengths and unlock the life giving potential of stem cells… as we lead the research world in a cure for Parkinson’s… cancer… Alzheimers… MS… ALS… and HIV/AIDS.
But, unfortunately… over the past four years… we’ve had to drag our Governor along… and settle for election year promises.
Well, Anthony and I believe we have to do better to build the partnerships that move us forward… and that’s why Anthony and I are committed to $25 million for stem cell research.
Preventative Care
Lastly… number 7…you know, our State has tremendous opportunities provided by the short and long term impact of preventative care.
Research has shown that providing early, consistent access to primary care will improve, not only the long term sustainability of the health care system… but the education, growth… and future potential of the next generation.
It is one of the major factors in the battle against public health issues like childhood obesity… diabetes… and drug addiction…
But in 2004, Maryland ranked 43rd among states in flu vaccine coverage… with fewer-than two-thirds of Maryland’s seniors receiving a flu shot.
We have to do better which is why we’ve proposed our Vaccines for Maryland Initiative – a comprehensive plan that has drawn the praise of the CDC and others – to start meeting the needs of our young… our adults… and our seniors.
In Baltimore, we’ve found that when we work with the many health organizations and institutions… measuring our inputs and outputs… we can make unprecedented progress – in fact we outpaced all other cities in toddler vaccinations
In the end… we should be doing a better job at the State level to plan for the long term sustainability – and that’s mean preventative care.
Conclusion
I know there’s more to discuss on the health care issue and hopefully we can cover them in some question and answer…
… but I do want to say that… in the end… all of our advances in cutting edge technologies… diagnostics… and treatments… can only go so far without a true State partner whose willing to bring us together – as medical communities, business communities… and the many communities across Maryland – to find a way forward.
Because… come this November, we have to decide whether we are going to allow the forces that would seek to divide us… that would try to shock us into inaction –
… whether those forces are going to determine the future of our State… or whether we are going to decide to control those forces… to meet our destiny… and to reach out to our neighbors.
Health care is a complicated issue… if we work with our partners throughout the State like MedChi… concentrating on each component that together… comprise the problem…we can start to make lasting progress.
And thanks to the people in this room – we’re proving that one person really can make a difference…
And I want to thank you all for what you do… as the Talmud says, saving one life is as if you have saved the world.
Thank you all very, very much and now I’d like to turn it back over to Delegate Morhaim for some question and answer.