A New Model for Health Planning

Community health planning has long been carried out with the aim of rationalizing the delivery of health care to make it more accessible, acceptable, efficient and accountable in meeting the full range of health needs in communities. The fullest development of its model (1974-78) saw it as a precursor for a system of national health insurance that would be universal as a matter of right. The political will for such a national program has disappeared, but the vision of health care as a human right has continued to grow.


Montana now furnishes us with a model for Twenty-first Century America. In December 2008, the City-County Board of Health of Lewis & Clark County in Western Montana became one of the first communities in the United States to recognize its obligation to ensure universal access to health care based on seeing it as a human right. It adopted a resolution appointing a Task Force on Local Access to Universal Healthcare consisting of community members, labor representatives, health care providers, public health representatives, senior citizens, and health advocates, charged with conducting a community needs assessment that engages community members in an assessment of their needs, and creating an action plan that:


·    “Identifies and prioritizes specific strategies and action options that the Board of Health and the Lewis & Clark City-County Health Department should consider to address the lack of access to healthcare, particularly local options for universal healthcare, including but not limited to developing a single payer system, establishing a local universal healthcare zone, expanding community health centers into the hub of a universal primary care network, and asking citizens to consider passing a resolution on the right to healthcare;

·         “Sets principles, parameters, objectives, and benchmarks for preferred action options, with due weight given to the community consultation findings;

·         “Identifies specific strategies, actions, and recommendations that local government officials should make to state government, and federal government leaders regarding the best options for addressing the lack of access to healthcare and achieving universal healthcare in Lewis and Clark County.”1


In an interview with The Helena Independent Record on December 12, 2008, Alan Peura, then Helena city commissioner and Health Board member who spearheaded the Task Force's work, described the motivations underlying the project. “Starting with health care as a human right, we thought maybe we can get to places that we never got to before. We said, ‘Let’s see what we can do to change the debate, and maybe end up with some solutions that we don’t even know exist at this point.’”


The Task Force submitted its community needs assessment in October 2010 and proceeded to develop its Recommendations and Action Plan. It completed its Plan in February 2011, updated it in April 2011, and submitted its final report on May 31, 2011.


Here are its recommendations from that report:

St. Peter’s Hospital, in Helena, is the county’s only general hospital. The Task Force recommended that the Board enter into a dialogue with the hospital seeking “to increase transparency in the hospital’s planning processes, and to establish effective mechanisms of community participation in hospital planning and operations.” Specifically, it recommended “raising awareness about St. Peter’s Hospital’s legal obligation to the community, derived from its tax-exempt status, which could potentially be challenged in the courts, if necessary.” The report further notes that additional funds may have to be raised to enable both the hospital and the Cooperative Health Center (a FQHC) to meet the community’s health needs. It wishes to enable the FQHC to make primary care universally accessible, recommending that the “board seriously consider embarking on a process of creating a public hospital tax district.” Such tax districts are permitted under Montana law. Alternatively, the county would need to introduce legislation in the state legislature to acquire the authority to propose a local income tax to fund additional services.


In its conclusion, the Task Force states that “the Board should pursue all recommended options for increasing equity in health care access by initiating an alternative health care plan that is community based or publicly financed, so that receiving needed care no longer depends upon having a certain level of income or wealth in order to buy access to care as a market commodity. Instead, the health care providers in Lewis & Clark County should start working toward the provision of health care as a public good, shared by and directly accountable to county residents.”


Perhaps Sen. Max Baucus, chair of the Senate Finance Committee, should be embarrassed now in seeing his home state leading a movement not just for a single-payer plan, but for healthcare as a human right!


Submitted by John Steen

1 The resolution and subsequent documents relating to the project may be viewed at http://www.co.lewis-clark.mt.us/departments/health/about-the-department/board-of-health/health-access-task-force.html.