Report

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 "R_x 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 21^st 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:

Ø  give parents the tools and information they need to make healthier choices for their children, such as through improved food labelling

Ø  provide healthier foods in schools, including in vending machines

Ø  ensure 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

Ø  assist 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:

Ø  transparency

Ø  innovation regarding payment

Ø  the 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 21^ST 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:

Ø  focus on things that are already understood to be working well, such as disease prevention, and apply these things more widely

Ø  help individuals to “do the right thing” by making “the right thing” easy to do and by providing incentives when the right choices are made

Ø  strengthen and use new platforms for information, measurement and community-based knowledge about how we are doing

Ø  build on and strengthen private-public partnerships that will enhance public health

Ø  bring 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:

Ø  a common understanding of the meaning of the phrase “homeland security”

Ø  the sharing of information about threats, including through greater use of fusion centres

Ø  efforts to counter violent extremism

Ø  in 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:

Ø  terrorism and adequate preparation for the full range of possible attacks

Ø  violent extremism and radicalization

Ø  cybersecurity from a national security perspective

Ø  cybersecurity from the perspective of services to the American people, such as financial services

Ø  information 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,