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Fix the health care system
With apologies to Winston Churchill, never before have so many paid so much for so little.
What are we talking about? Health care.
Doctors are demoralized, insurance premiums for business and for individuals have increased drastically. The importance of this issue is not just humanitarian; for those who already have health insurance coverage, the impetus for reform is fiscal -- we cannot afford our present health care system without serious change.
The problem is cost control, especially in western states like Washington, Oregon, and Idaho.
The health care system is not efficient in delivering care to people because of the heavy administrative costs in the system. Today, 15 percent of Washington's population has no health insurance, up from 11 percent a few years ago. In reality, we all pay for these people through increased hospital and doctor rates to pay for "uncompensated" and "charity" care.
For all of the rhetoric against "government-run" health care, the reality is that government is the principal purchaser of health care. Government in America spends $2 for every $1 spent by the private sector on health care. For example, our state buys health care for state employees and their families; K-12 educational employees and their families; higher educational staff and their families; injured workers through industrial insurance; low-income people through the Basic Health Plan; and the poor and their families through Medicaid. The private sector covers fewer people every year.
Because we already have a largely government-paid health care system, this legislative session faces an extremely difficult budget issue -- the escalating cost of health insurance premiums.
Health care cost inflation has been double digit in the past few years, dramatically driving up the cost of health insurance for the hundreds of thousands of people for whom the state buys health care or health insurance. The Legislature now faces a huge budget imbalance as a result. It has two bad options to deal with this problem: significantly increase budget contributions to offset inflation or cut back on coverage. Neither is attractive.
This very same scenario is being played out in the private sector throughout Washington as well. Many employers are cutting back on health care insurance benefits or eliminating them entirely, forcing people to look for whatever health care they can obtain in public or private health insurance programs.
In the early 1990s, Washington Gov. Booth Gardner appointed a Health Care Commission to survey the health care system and health insurance and to recommend changes. The outstanding report became the 1993 health care reform law. That law taxed tobacco, alcohol and insurance to subsidize care for almost a quarter-million Washington kids and working poor adults.
It also protected consumers from managed care profiteering and provided universal access to a decent minimum of health insurance for all Washington residents. The Washington law was very similar to a 1973 Nixon administration proposal. As happened when President Nixon proposed it, just the thought of meaningful government action sent health care costs plummeting. In 1995, the opponents of the act spent millions to get this message across about the 1993 law: (1) One size fits all, government-run health care; (2) You will pay more and get less; and (3) Some government bureaucrat will choose your doctor.
At the national level, hundreds of millions were spent to have Harry and Louise repeat those views in ads in every community across the nation. The result was the election of politicians who rode on a wave of campaign contributions into positions of power bent on stopping health care reform. Now that the dust has settled, what do we have for a health care system? (1) One size fits all, insurance company run health care, with your tax dollars footing most of the bill; (2) You pay more and get less; (3) Some insurance company bureaucrat chooses your doctor.
As if that weren't bad enough, the problems we set out to solve in the early 1990s are now worse. (1) Medical inflation is back; (2) The number of uninsured is up and rising fast, even according to the Health Insurance Association of America, which estimates one more person loses health insurance in our country every 30 seconds; (3) Our medical care infrastructure is being buried under a mountain of red tape, and provider shortages, financial uncertainty and chaotic changes in payment and organization plague our health care system.
Legislators are talking about yet another health care commission to study the problems and make a final report to the Legislature and governor by December 2003. We can't wait for three years to study the problem while costs skyrocket.
Let's actually do something about the cost of Washington's health care system for a change.
First, the Legislature should take steps to improve efficiency and reduce waste in the health care system. We must:
- reduce duplications in coverage from overlapping government and private health plans, worker compensation, and auto insurance;
- improve administrative efficiency and eliminate paperwork duplication for doctors and hospitals;
- unify health care purchasing for the state in a single agency to maximize the state's purchasing power;
- and intensify prevention and public health activities such as immunization, anti- tobacco and drug/alcohol abatement efforts.
Second, we need to consider more long-term steps such as the prioritization of Medicaid resources toward prevention, and offering significant scholarships to doctors who agree to practice in underserved parts of Washington. We also should consider state support for medical teaching and research, the expenses incurred at the end and beginning of life and the cost of the defensive practice of medicine.
Open up the state employees health plan to any individual or business who wants to join. For far too long we have ignored the cost of our health system care, at our peril. The issue will not go away. The problem is not the lack of information, but rather, the lack of leadership in development of a political consensus on health care that serves the best interests of our citizens and helps define the quality of the state in which we live.
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Phil Talmadge is a former justice of the Washington Supreme Court. He chaired the Senate health and Human Services Committee while serving as a legislator.
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