Georgia can lead the nation in transforming health and health care

By Newt Gingrich

The nation’s health-care crisis has infected every state including Georgia, where acute symptoms have appeared. Nine percent of Georgians have spent an entire year uninsured, according to the Georgia Department of Community Health’s Georgia Healthcare Coverage Project, while 1.3 million are covered by a Medicaid program whose budget continues to outpace projections. State officials have been forced to contemplate cuts in spending, and therefore in programs.

Simultaneously, vital services such as obstetric care and emergency room surgery are threatened as doctors decide they can no longer practice beneath a burden of skyrocketing medical liability premiums and the threat of litigation from trial lawyers. The Georgia Board for Physician Workforce, a legislative advisory board, says Georgia already ranks 35th in the nation for the physician-population ratio, which is about one third below the national average of 270 physicians per 100,000. A board study this year projected 2,800 Georgia doctors would stop providing higher-risk procedures in order to reduce their liability exposure.

Additionally, Georgia confronts the same increase in health-care expenditures affecting the nation. The Wall Street Journal reports that in 2003 alone, health insurance premiums have jumped 13.9 percent, making it the third year in a row that the nation has experienced double-digit premium increases.

Workers are absorbing more and more of these premium increases as employers increasingly shift the added costs. The Wall Street Journal reports that the average annual premium for family coverage has risen to $2,412, a 49 percent increase in three years.  An individual’s coverage has increased 52 percent over the same period.

As an employer in its own right, the state faces the same escalating costs and, like Georgia businesses, must choose whether to cut benefits or shift even more costs onto employees, all while coping with a revenue shortfall.

In most states with similar challenges, there is agreement that dramatic changes must be implemented to keep Medicaid from failing and the state from going broke. There are generally two opposing camps of “reformers.” One side typically advocates a combination of higher taxes and more state mandates to business in order to cover currently uninsured employees. Implicitly accepting the hyperinflation of health costs, they claim that the only solution is a radical, harmful cutback in services or the rationing of health care. Some of these reformers support a federal single-payer health system, arguing that only a government-run system can provide the necessary efficiencies, direction and financing resources to provide an equitable health-care system for all Americans.

In the opposing camp are those who typically believe tweaking the current system can bring costs under control, usually a combination of trimming back the recent expansion of those eligible for public programs such as Medicaid, reducing state mandates on business and reducing reimbursement payments to doctors for state-subsidized care.

The problem is that the first camp is trying to make a lead airplane fly by adding lead and the second leaves too many without quality care. In my view, neither path of reform will work for Georgia, or anywhere  in the country.

Only by launching a process of transformation can Georgia hope to create a health and health-care system that results in dramatically better health for all Americans, with more choices and at lower cost. Let me be clear: Reforms make changes to existing systems; by contrast, transformation envisions the design of a new set of systems.

What we need to solve the health-care crisis are leaders in government, business, not-for profits, doctor and patient groups to lead the transformation, and the media to do their part by communicating transformation solutions.

The concept of transformation should not be foreign to anyone living in the 21st century; in fact, it is occurring all around us. Anyone who buys an airplane ticket online after reviewing potentially hundreds of options, gets cash from an ATM anywhere in the world or speeds off from a gas station without bothering to wait for a receipt knows what it is to engage in a recently transformed activity.

The natural order of the 21st century is to continually have more choices, of greater quality, at lower costs. Clearly, health care has been a lagging example of this 21st-century order. While it will necessarily take time, leadership can greatly accelerate the transformation. Governor Sonny Perdue has already stepped up to a leadership role in health transformation, but leadership at all levels is necessary to secure the accumulated advantages of the 21st century for all Georgians in health and health care as well.

This is not some far-off future. The technologies already exist that would make health care safer, more efficient, more convenient, and cost less. From electronic prescriptions to disease management, from telemedicine to a Travelocity-style, consumer-driven drug purchasing model, we simply need to vigorously implement these advances.

These and scores of other transformational solutions will eventually bring us to a 21st-century system of health and health care that saves Georgians’ lives and money.

In its role as the employer of thousands and service provider for more than a million others through Medicaid, long-term care, and other special population services, state government is the largest purchaser of health-care services in Georgia. The state is therefore well-positioned as purchaser and lawmaker to influence various public and private groups to adopt a common vision of transformation in Georgia and to communicate this vision repeatedly everywhere in the state.

I am confident that America will transform its health and health-care system in a way that will lead to better outcomes. With inspired leadership from various groups across the state, it will be Georgia that leads the way.


Newt Gingrich, the former Speaker of the U.S. House of Representatives, is the founder of the Center for Health Transformation and the author of the new book “Saving Lives & Saving Money.” Register at to attend the October 23 conference on “Transforming Health and Health Care in Georgia,” a partnership of the Georgia Public Policy Foundation and the Center for Health Transformation.

The Georgia Public Policy Foundation is an independent think tank that proposes practical, market-oriented approaches to public policy to improve the lives of Georgians. Nothing written here is to be construed as necessarily reflecting the views of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.

© Georgia Public Policy Foundation (October 10, 2003). Permission to reprint in whole or in part is hereby granted, provided the author and his affiliations are cited.