Thread: A year ago my survey of state legislator ultimate goals for health policy highlighted some big differences between Republicans and Democrats and raised various questions... 1/9 ajph.aphapublications.org/doi/10.2105/AJ… 
Were differences in the role of government really that big? Both parties said reducing costs was really important - but exactly what costs? and for whom? Did everyone mean the same thing when they said access was important? 2/9
In a textbook example of how qualitative & quantitative research can inform and enhance each other, the brilliant @dklinejones interviewed state legislators in Kansas and Colorado (2 of the highest responding states to the survey) to dig into these questions... 3/9
His @MilbankFund report showed both the strengths & the weaknesses of the (and any?) survey and his thoughtful deep dive & analysis provides so much food for thought. My main takeaways? (not an exhaustive list!): 4/9
1. Yes the role of government really is that divisive. "Leaders in both states [described] this philosophical difference as the greatest single obstacle to developing bipartisan health policy." he suggests reframing as "maximising value from govt spending" might help 5/9
2. My biggest regret was too little nuance to the survey cost questions. "consensus on the importance of reducing health care costs breaks down when the conversation shifts to solutions because they are not beginning from a shared understanding of [the] problem..". THIS 6/9
3. Access - many types of access. In Kansas and Colorado, access in rural areas was considered so important and represented a real opportunity for bipartisan health policy. Medicaid expansion was reframed as a rural access issue in Kansas. 7/9
4. Talking about "Health" rather then "Health care" could take the partisan sting out of conversations 8/9
Finally, @dklinejones ends with a call for state legislators to be given more space, time & structural support to do the big thinking that will enable health goals to be met. Will/can outside, non-partisan organisations take up the challenge and facilitate this? I hope so. 9/9
PS thank you to @CKollerMilbank for making both pieces of work possible! and to @commonwealthfnd for letting me spend my @harknessfellows year on this
PPS the link the the @MilbankFund report is here: milbank.org/news/new-repor…
