My career in state government and at NASHP has provided me an extraordinary opportunity to work with some of the smartest, most hardworking people, dedicated to public service and advancing efforts to improve the public’s health and assure affordable, quality health coverage. It is almost hackneyed to cite Justice Brandeis’ characterization of states as the laboratories, trying novel social and economic experiments. But in healthcare that is clearly true – states created children’s health coverage; built home care options to nursing facilities, enacted insurance rate reforms and subsidized coverage, mandated mental health parity, eliminated pharmacy gag clauses, launched prescription drug affordability boards, established a public option and so much more before the federal government acted. States are raging incrementalists, pushing for important health care reforms and informing federal action. I am humbled to have been engaged in so many of these efforts.
Public service has been, for me, a noble profession, working close to the ground trying to get policy and practice right to respond appropriately to human need and opportunity. I have split my career, working under five Maine Governors and building NASHP. As a state official, each day I went to work I knew the woman who poured the coffee at Dunkin’, the small businesses like the dry cleaner and the gas station, the workers who scraped by on low wages were paying the taxes that supported my job and the programs we created and ran. That compelled my fiscal conservatism and an urgency to make sure everybody could be as healthy as possible and to afford health coverage and long-term services and supports. That seems to me to be a key part of government’s responsibility – our commitment to care for each other and the common good.
But that work is tough – like Sisyphus pushing the rock up the hill, states keep pushing, even as that rock rolls back. Progress is often slow and hard, but progress has been the watchword of states. Outside of state service, the opportunity to build NASHP as a safe harbor for busy state leaders and a place to provide them the resources and support they need to get that rock over the hill has been a particular joy. NASHP’s mission to work across the usual lines of organizational authority and to bring legislative and executive leaders together to contemplate and craft solutions to the complex issues they face remains an important one. And NASHP’s commitment to be “of states, by states and for states” has meant for me the chance to brainstorm with some truly remarkable leaders and engage a great staff as NASHP set its course.
I take my leave now as NASHP is stronger than ever, thanks to the enduring support of our funders, but as the times make our work more challenging. Beyond the current crisis, there is another pandemic in which increasingly policy takes a back seat to politics and ideology. Anecdote replaces evidence and harsh, bright lines are drawn making it harder to find the middle. A quotation attributed to Margaret Thatcher – not someone I would think to quote – seems relevant again today – “It used to be about trying to do something. Now its about trying to be someone.”
Since its inception in the late 1980’s, NASHP has been a place for the “do-ers” and there is so much left to do. The pandemic’s stark revelation of continued social and economic inequities, the appalling statistics showing health costs still so high and health outcomes still low, cry out for states to lead again, providing the bold experimentation that Justice Brandeis envisioned. I am confident that NASHP with its creative state leaders, dedicated staff, engaged board of directors and new executive director Hemi Tewarson, will help states lead the way. I am retiring from the job but not the fight and look forward to cheering you on and finding new ways to remain a “do-er”. Thank you all for the phenomenal opportunities and friendships in our pursuits.