From February 20-22, 2010, Senator
Wilfred Moore, Acting Co-Chair, led a delegation from the Canadian Section of
the Canada-United States Inter-Parliamentary Group (IPG) to the winter meeting
of the National Governors Association (NGA) in Washington, D.C. The delegation
included the Honourable Scott Brison, P.C., M.P.; the Honourable Bob Rae, P.C.,
M.P.; Mr. Guy André, M.P., Vice-Chair; Mr. Brad Trost, M.P., Vice-Chair; and
Mr. Jim Maloway, M.P. The theme for the NGA’s activities this year – including
the winter and summer meetings – is "Rx for Health Reform:
Affordable, Accessible, Accountable," which was selected by Vermont
Governor Jim Douglas, the NGA Chair for this year.
Founded more than a century ago when
President Theodore Roosevelt gathered state governors in order to discuss the
nation’s resources, the NGA is the collective voice of US governors from the 50
states, three territories and two commonwealths. It is also a public policy
organization that represents the governors on Capitol Hill and before the US
Administration on federal issues that affect them, and that develops and
implements solutions to public policy challenges.
The NGA is supervised by a chair,
vice-chair and nine-person executive committee, and governors participate on
four standing committees – Economic Development and Commerce; Education, Early
Childhood and Workforce; Health and Human Services; and Natural Resources – as
well as on special ad hoc bipartisan committees and task forces.
At this meeting, each of the four
standing committees held a session, and there were a number of plenary and
other sessions. In particular, the meeting included the following sessions:
·Opening Plenary Session: Childhood Obesity
·Opening Plenary Session: Transforming Health
Care Delivery
·Economic Development and Commerce Committee: The
Future of Surface Transportation
·Education, Early Childhood and Workforce
Committee: ESEA – The New Federal-State Education Partnership for Success
·Health and Human Services Committee: Remaking
Public Health and Preparedness for the 21st Century
·Natural Resources Committee: Advancing a Green
Energy Economy
·Special Session with Governors and Canadian
Premiers
·Plenary Session: Health Care and the Economy
·Special Committee on Homeland Security and
Public Safety
·Closing Plenary Session: Redesigning States in
the Post-Recession Economy.
Members of the IPG have been attending
the winter and summer meetings of the NGA for several years. At this winter
meeting, Canadian delegates were able to continue their dialogue with governors
on issues of Canadian and/or joint interest, including the “Buy American”
provisions in the US stimulus package and other measures, border crossings and
a variety of trade issues. At this meeting, they were also able to speak with
Canadian premiers, who participated with governors in a special session to
discuss areas of common concern, such as the border as well as energy and
environmental issues.
Their interactions with governors
enable Canadian members of the IPG to achieve better the aim of finding points
of convergence in respective national policies, initiate dialogue on points of
divergence, encourage exchanges of information and promote better understanding
on shared issues of concern. Moreover, the NGA meetings provide the Canadian section
of the IPG with an important means to provide input to, and gather information
about, state-level issues that affect Canada. It is anticipated that the IPG’s
attendance at the winter and summer meetings will continue.
This report summarizes the main points
that were made in the plenary as well as selected standing committee and other
sessions.
OPENING PLENARY SESSION: CHILDHOOD
OBESITY
Michelle Obama, First Lady of the
United States
·one in three US children will eventually develop
diabetes; the ratio is one in two for certain ethnic groups
·health care problems cannot be solved unless the
issue of childhood obesity is addressed
·the childhood obesity problem is a relatively
new phenomenon; historically, children walked to and from school, ran during
recess and gym periods at school, played outside after school as well as on
weekends and during vacations, ate sensible and home-cooked meals with
reasonable portion sizes, and enjoyed fast food and desserts as a treat
·somehow, the sense of perspective and moderation
has been lost; now, fresh fruits and vegetables are relatively expensive,
parents may not have time to prepare home-cooked meals, schools may lack gym
facilities and some neighbourhoods are not safe places in which to play
·children did not bring the obesity problem on
themselves; since parents and legislators are “in charge” and make key
decisions affecting children, they must decide to solve the childhood obesity
problem and give children the future that they deserve
·many states have taken innovative measures in
respect of exercise, healthy eating, etc., with positive results
·at the federal level, the Administration is
committed to solving the problem of childhood obesity in one generation, and a
national action plan is being developed under the “Let’s Move” initiative; this initiative has four pillars:
Øgive parents the tools and information they need
to make healthier choices for their children, such as through improved food
labelling
Øprovide healthier foods in schools, including in
vending machines
Øensure that families have access to healthy,
affordable food in their community, thereby eliminating “food deserts” where
families are unable to access a grocery store in their community
Øassist children in becoming more physically
active, since both physical activity and nutrition are important for good
health and high academic performance
·a comprehensive, coordinated approach is needed
to solve the obesity problem, but the approach need not be centralized; there
is no “one-size-fits-all” solution to the problem of childhood obesity, and
different states have different needs, priorities, resources, etc.
·there is nothing liberal or conservative,
Democratic or Republican about wanting children to lead healthy, active lives.
OPENING PLENARY SESSION: TRANSFORMING
HEALTH CARE DELIVERY
Atul Gawande, Brigham and Women’s
Hospital and Harvard Medical and Harvard School of Public Health
·all Americans should have the drugs, diagnoses,
etc. that they need to thrive
·optimal health care must be delivered
efficiently and effectively, without waste; better results, at lower cost, are
needed
·in order to get better results at lower cost,
actions must be taken in at least three areas:
Øtransparency
Øinnovation regarding payment
Øthe creation of collaborative relationships that
lead to higher quality and lower cost
·too many patients receive inappropriate and/or
incomplete care
·across communities, and within and among states,
there is remarkable variability in the cost and quality of health care.
Jack Cochran, The Permanente
Federation
·the focus must always be the patient; after all,
being “a patient” is an involuntary state
·a culture where people want to be a health care
provider should be created
·in the 1980s, the trend was “managed care,” but
questions are arising: was care truly being managed, and – if so – by whom was
it being managed?
·health care providers must make effective use of
information technology
·doctors should be paid to do well and to solve
patients’ problems, rather than to do more; the payment methodology is important,
and proper incentives must exist
·health care delivery and payment systems must be
reformed.
HEALTH AND HUMAN SERVICES COMMITTEE:
REMAKING PUBLIC HEALTH AND PREPAREDNESS FOR THE 21ST CENTURY
Harvey Fineberg, Institute of
Medicine
·over time, there have been amazing increases in
life expectancy; in 1900, the average life expectancy at birth was less than 50
years, a figure that is now nearly 80 years
·every four years, life expectancy at birth rises
by one year
·the priority should be ensuring that people can
“die young” as late as possible
·there are a number of important considerations
in providing people with opportunities for a full life:
Øfocus on things that are already understood to
be working well, such as disease prevention, and apply these things more widely
Øhelp individuals to “do the right thing” by
making “the right thing” easy to do and by providing incentives when the right
choices are made
Østrengthen and use new platforms for
information, measurement and community-based knowledge about how we are doing
Øbuild on and strengthen private-public
partnerships that will enhance public health
Øbring the private practice of medicine and
public health programs together, since personal health and population health
exist on a continuum
·decision makers should identify ways to do more
with less.
John Agwunobi, Walmart US
·in the future, all resources – both private and
public – must be combined in the pursuit of common goals
·Walmart grew to be what it is today by reducing
costs; this approach must be applied to health care, and reducing health care
costs in order to reach more people must be a priority
·health care must be more affordable; with
greater affordability, some of those who are now accessing free care would be
able to afford to participate in the paid system that they prefer
·individuals play a role in ensuring their good
health through the lifestyle choices that they make
·“public health” is evolving with each passing
year.
Alan Levine, Louisiana Department
of Health and Hospitals
·improved health quality, better health outcomes
and a higher level of public health should be the goals
·efforts must be made to move away from “silo
care” and away from “sick care”
·over the next 25 years, the rate of scientific
advancement will be four to six times faster than what it has been in the last
25 years
·Medicaid is the largest failure in terms of
positive outcomes for money spent
·rewards and incentives must be shifted to focus
on performance
·if the principles of choice and competition are
applied to health care, the result should be improved outcomes
·organizations should be held responsible for
their outcomes.
Mary Selecky, Washington
Department of Health
·a crisis creates opportunities for change
·the manner in which a community’s health care
needs are being met should be a focus
·partnerships should be used, whenever feasible,
and existing resources should be used better
·evidence-based prevention strategies should be
implemented
·technology is important, and sound decisions
must be based on high-quality data
·public health challenges will always exist.
SPECIAL SESSION WITH US GOVERNORS
AND CANADIAN PREMIERS: COMMON BORDER, COMMON GROUND
US governors and Canadian premiers
participated in a discussion co-chaired by Vermont Governor Jim Douglas, Chair
of the NGA, and Saskatchewan Premier Brad Wall, Chair of the Council of the
Federation.
US governors noted that:
·the United States and Canada have a longstanding
relationship, with families, friendships and bilateral governmental
relationships
·the US knows that it is not alone; regular
contact with Canada occurs, and the two nations work well together
·our citizens have died together, fighting side
by side during the First and Second World Wars as well as in Afghanistan
·one way in which our nations work together is
through the Southeastern United States-Canadian Provinces Alliance, which will
hold its third annual conference in Biloxi, Mississippi in April 2010
·energy is an important issue for the US, and
there is an increasing focus on renewable energy
·Canada and the United States must work together
on rehabilitation and protection of the Great Lakes as well as of other shared
waterways; in part, the focus must be addressing the problems posed by Asian
carp
·our nations must work together to improve the
quality of the Pacific Ocean; fish do not know about the common border.
Canadian premiers highlighted that:
·Canada and the US share the world’s largest
trade relationship and the largest undefended border as well as water, forests
and other resources
·about 10 million jobs in the two countries
depend on bilateral trade: 7 million in the US and 3 million in Canada;
consequently, the border must be “smart”
·35 US states have Canada as their primary
foreign export market
·no two countries in the world are better friends
than are Canada and the United States
·many families are “blended,” in part because of
US military bases located in Canada during the Second World War; as well,
Canada was a “safe haven” for many Americans when flights were grounded after
the terrorist attacks of September 11, 2001
·Canada wants the US economy to “take off,” in
part because of the positive benefits that would occur for Canada
·recovery from the global financial and economic
crisis is likely to be led by exports rather than by consumers
·energy and the environment are key aspects, if
not the backbone, of the bilateral relationship, and Canada recognizes that the
US sees energy as a national security issue
·some in Canada are concerned about forthcoming
regulatory and environmental changes in the United States
·while Canada and the US must do their part in
addressing global climate change, actions must be taken without harming our
economies
·the International Joint Commission is a unique
mechanism that has worked, and that continues to work, well
·a regional perspective on energy is needed
·large-scale hydroelectricity should be viewed as
a renewable resource
·every common border presents opportunities and
gives rise to irritants
·security threats must be addressed jointly
·this historic meeting of US governors and
Canadian premiers should become a tradition, since we are “in this together,”
we can help each other, and many industries are integrated across the shared
border; face-to-face dialogue assists in understanding one another.
PLENARY SESSION: HEALTH CARE AND THE
ECONOMY
In this session, which was moderated by
Maria Bartiromo of CNBC, governors spoke about a variety of health care issues.
In particular, they said that:
·prevention should be a main focus, and people –
including children – should be assisted in order to avoid the development of a
chronic disease
·primary care and preventative care should occur
at the local level
·identification of the most effective treatment
for the patient must be a primary focus
·the US should not be spending more on health
care than it does on education
·emergency care is costly
·Massachusetts has a hybrid health care system,
and 98% of that state’s residents are insured; the Massachusetts model may be
beneficial for other states as well
·health care practitioners should receive a bonus
when their efforts lead to demonstrated results
·incentives should exist for home and
community-based care as alternatives to institutional care
·the states are relatively more nimble, and can
adapt as problems arise
·how we deliver, and pay for, health care must be
reformed; in particular, payment must be aligned with desired outcomes rather
than with procedures prescribed
·electronic medical records may lead to better
outcomes and reduced costs; as well, telecare and health information technology
have benefits
·pooling is one way in which costs can be
reduced; for example, states could come together in order to obtain discounts
on pharmaceutical drugs.
SPECIAL COMMITTEE ON HOMELAND
SECURITY AND PUBLIC SAFETY
Honorable Janet Napolitano, US
Secretary of Homeland Security
·the US Department of Homeland Security is
working with the states on a number of initiatives, including:
Øa common understanding of the meaning of the
phrase “homeland security”
Øthe sharing of information about threats,
including through greater use of fusion centres
Øefforts to counter violent extremism
Øin the event of an incident, timely and
effective response with a quick focus on long-term recovery.
Honorable Tom Ridge, Former US
Secretary of Homeland Security
·states must be partners with the federal
government in securing the homeland
·information sharing is important, and should be
improved between and among federal, state and local governments
·fusion centres are a great idea; to be useful,
they must share a common platform and common standards
·the manner in which information is classified
should not be used as a means to restrict its use
·relationships should be built at the regional
level, which would facilitate regional collaboration and cooperation
·good-quality information should be provided to
those on the front line and to partners
·there should be a move from a “need to know”
model to a “need to share” model.
John Brennan, Assistant to the US
President for Homeland Security and Counterterrorism
·the US Administration is focused on appropriate
actions in respect of:
Øterrorism and adequate preparation for the full
range of possible attacks
Øviolent extremism and radicalization
Øcybersecurity from a national security
perspective
Øcybersecurity from the perspective of services
to the American people, such as financial services
Øinformation sharing, including fusion centres.
CLOSING PLENARY SESSION: REDESIGNING
STATES IN THE POST-RECESSION ECONOMY
Mark Zandi, Moody’s Economy.com
·the recession is over and the economic recovery
is under way, with a 4% annualized growth rate in the second quarter of 2009,
rising stock values and stable housing values in many parts of the US; the
recovery is, however, uneven across the nation
·the economic recovery will be fragile and
tentative in 2010; while layoffs have abated and the job market has improved,
hiring is dormant and the mortgage foreclosure crisis continues to exist
·the struggle by state and local governments is
epic; in the fourth quarter of 2009, state and local tax revenues were at their
2006 level but these governments faced higher demands for assistance
·the global financial and economic crisis led to
an aggressive and unprecedented response; the fiscal stimulus package was very
helpful in assisting the recovery
·while the US probably will not go back into a
recession, there is a need to ensure a self-sustaining economic expansion, with
more help for governments and for those who are unemployed
·even when the economy is expanding again and
things look better, they may not be good; the job market will take years to
recover from the loss of 8.4 million jobs, personal income tax growth will be
slower, sales taxes will be under stress, and housing and commercial real
estate values will remain depressed for quite some time.
Alan Mulally, Ford Motor Company
·private-public partnerships are important
·there is no reason why the United States cannot
compete with the best in the world
·relevant parties should come together around a
compelling vision
decision makers must identify where they want the nation
to go, and then they must lay out a compelling vision that will unleash the
necessary creativity.
Respectfully submitted,
Hon. Janis G. Johnson, Senator
Co-Chair
Canada-United States
Inter-Parliamentary Group
Gord
Brown, M.P.
Co-Chair
Canada-United States
Inter-Parliamentary Group