During my 16 years living with diabetes – and some of the complications that go with it -- I can speak with some authority about the nature of personal health care.
Doctors can prescribe insulin to keep my blood-sugar readings down, and pills to keep cholesterol and blood-pressure levels at bay. They can do surgical procedures to restore vision and bypass surgery to repair the heart. But those are only short-term fixes. Diet and exercise are the long-term solutions.
That’s what I have learned in diabetes education courses provided by St. Luke’s Humphreys Diabetes Center – and the American Diabetes Association says the same thing. Both organizations have a wealth of information about the disease and offer a roadmap for self-management.
Ken Foster, who provides life coaching and mentoring in San Diego, says the principles used by diabetes educators can apply to the so-called “gap” population – the roughly 78,000 people in Idaho who are “the working poor” and cannot qualify for Medicaid or Obamacare. Foster recently met Sen. Steven Thayn, R-Emmett, who warns on a variety of issues that money alone does not solve problems. Thayn likes what Foster says about mentoring, or “facilitating,” and thinks it should be a stronger component of Gov. Butch Otter’s proposed Primary Care Access Program.
Foster says that the gap population is nothing new to him in his 20 years of life coaching. He has seen people go from having money to somewhere below the poverty level.
“They feel considerable stress, a sense of hopelessness, a lack of self-esteem, and IQ levels go down 14 percent on average.” Foster says. “When you are obsessing about paying rent, everything else in life goes away.”
When that happens, diseases such as diabetes become magnified along with mental health issues. A person is more vulnerable to poor life choices, such as over-eating, smoking and drinking. As Foster sees it, that’s where personal coaching comes in – to help people turn their lives in a more positive direction.
“We look at people in poverty and say let us give you money, let us give you food and let us give you clothing,” Foster says. “While all that might help in the short term, I don’t think that’s helping to the point we need. Mentoring is about giving people a hand up, and not just a hand out.”
Thayn is promoting Foster’s ideas with the governor’s office and Health and Welfare Director Dick Armstrong, who has been working with the governor on this issue. Thayn says that although Otter and Armstrong have not signed onto a specific plan presented by Foster, but are open to the concepts.
“Prevention has always been a huge part of the medical home model, but mentoring is probably the wrong word to use,” said Jon Hanian, a spokesman for the governor’s office. “A more accurate word would be ‘facilitating,’ as in, we are facilitating these individuals’ ability to help themselves.”
Anything that can be done on the front end to make people healthier “saves taxpayers money” in the end, Hanian says.
Otter acknowledges that his $30 million proposal is not the “panacea” for the gap population. It does not cover surgeries and other things that would be provided by Medicaid expansion. But Otter’s proposal is the one plan at the moment that has any chance of passing through the Legislature. Medicaid expansion probably is the most sensible and cost-effective solution, but the political reality is there are not enough votes to get it through. It will be challenging enough for him to get through his widely-criticized Primary Care Access Program, which conservatives scorn and Democrats have dubbed as “Ottercare.” Asked about the prospects of passage, Senate President Pro Tem Brent Hill of Rexburg says flatly, “I don’t know.”
Otter says in a recent commentary that the debate has been couched in absolute terms – “a false ‘either or’ choice between expanding Medicaid and doing nothing at all.”
The governor says he does not view PCAP as “the final word on providing Idaho citizens with the opportunities they need to keep themselves and their families healthy. But it is a great start.”
It could be an even better start if mentoring, or “facilitating” becomes a stronger component of the plan for the gap population. Increased access to life coaching would, in itself, be a worthwhile investment for Idaho.