Gubernatorial candidates discuss how to improve public health

By BRUCE SCHREINER, AP Writer

Monday, September 3, 2007 8:31 PM EDT

Republican Gov. Ernie Fletcher, a doctor, acknowledged there are "enormous health challenges," and said high rates of overweight Kentuckians result in more than $1 billion in medical costs each year.

"Heart disease, diabetes and cancer rates are too high in Kentucky," Fletcher said. "We need to prevent people from getting sick in the first place by encouraging healthier lifestyles."

Democratic challenger Steve Beshear said Kentuckians are struggling to afford health insurance.

"But while families and businesses are paying more and more for their health coverage, all too often, they are getting less and less," he said.

For many Kentuckians, health coverage is out of reach financially, he said. More than a half-million Kentuckians have no health insurance, including about 81,000 children.

Beshear proposes expanding health care coverage to all Kentuckians, first by covering uninsured children through Medicaid or the Kentucky Children's Health Insurance Program. His plan includes helping small businesses afford insurance and letting young adults stay on their families' health plans up to age 25.

To control costs, Beshear proposes emphasizing preventive care, assisting older Kentuckians with prescription costs, accelerating the switch to electronic medical records and cracking down on Medicaid fraud.

Fletcher recently rolled out a health plan that called for assisting more small businesses in paying health insurance premiums under an existing state program, expanding KCHIP to provide more coverage and offering tax credits for businesses offering employee wellness programs.

The governor has touted his "Get Healthy Kentucky" initiative aimed at urging people to make healthy choices, and took credit in helping pass legislation establishing a center for cardiac care best practices.

Fletcher also acknowledged the "serious health consequences" from smoking.

Earlier in his term, Fletcher led the effort to increase Kentucky's cigarette tax to 30 cents per pack. Until then, Kentucky had a 3-cent-per-pack rate -- reflecting the political muscle of tobacco advocates in a state that leads the nation in producing burley tobacco, an ingredient in cigarettes.

Both Fletcher and Beshear say they have no plans to raise Kentucky's cigarette tax.

Dr. Edward Halperin, dean of the University of Louisville's medical school, said he would like to see Kentucky's cigarette tax increased more so it reaches parity with rates elsewhere in the country.

According to a recent survey of state cigarette tax rates by the Campaign for Tobacco-Free Kids, Kentucky still has one of the lowest levies in the country.

An even higher state tax would discourage more people from smoking, Halperin said.

"People will act like rationale economic actors if they have to decide whether or not to buy food or buy tobacco because the price of tobacco actually reflects its societal cost," he said.

Making sure children have health insurance coverage should be another priority for state policymakers, Halperin said. The consequences are long term, in health rates and costs, he said.

"We know that if kids get proper nutrition and vaccination, they lead healthier adult lives, and they cost the health-care system less," he said.

Cavitt said she sees a lot of obese children, and worries that unless they slim down, they'll be more likely to suffer from diabetes, respiratory problems or other ailments.

In her region's health departments, people are routinely found to have medical problems that could have been prevented through healthier choices.

Getting people to switch to healthy habits remains a challenge, but one that's doable, Halperin said.

"If we can figure out within one generation how to go from transistor radios to iPods, then I think we can figure out how to do things which would make us live longer and healthier," he said.