By Lance Dickie
The Seattle Times
February 10, 2006
The nation’s health-care system has not gotten bad enough yet for real change to occur. Just wait.
An increasingly anxious middle class is seeing skimpy insurance coverage, higher costs, diminished quality, fragmented service and the choking feeling no one is in charge. Those frustrations eventually will build enough pressure for change.
Seemingly ages ago, President Clinton banged a drum for a national health-care overhaul, and the state Legislature passed a bold package of reforms. The efforts went nowhere. Hillary Clinton was pilloried and local changes were repealed in a stampede. A smug, comfortable swath of citizens did not believe they had a stake in the debate.
In 2006, people are paying attention as their health insurance erodes with higher premiums, growing copayments, soaring deductibles and unstoppable medical costs. Health-savings accounts and tax sheltering cash for medical coverage? They sound like a cruel joke.
Big corporations bitterly complain about the legacy expense of health care for retired workers. They are potential allies with the middle class for national changes. Yet, other employers watch to see if the brazen parsimony of retail giant Wal-Mart becomes the new operating model.
A frightened middle class makes things happen.
Legislators in Olympia, disgusted by Wal-Mart’s cynical willingness to point its employees toward tax-supported health coverage, want a bill that sets a “fair share” minimum health-care contribution for large employers. If employers do not spend a required percentage on health care, they would pay into the state’s health-service account.
“In a sense, they’ve figured out that they can outsource their benefits (at no cost) to government and the taxpayer,” Craig W. Cole told legislators last month. “And, by so doing, they have created a very low competitive cost structure that punishes ‘good’ employers.”
Who is this troublemaker? His Bellingham-area supermarket chain was founded in 1909 and has 1,500 employees. He is also a University of Washington regent.
But even solid citizens such as Cole sound too radical for skittish legislators who recall the health-care upheavals of a dozen years ago. Fair share is not likely to get a fair shake this session. Even state Senate legislation to study access to insurance and health costs and develop a five-year plan has been pulled in favor of an under-the-radar budget proviso to accomplish the same thing. A list of recommendations would be due back by December before the next session.
Health-care reform is not going away in Olympia.
Pressure builds from another direction. King County Executive Ron Sims heads the Puget Sound Health Alliance, which has attracted national attention with efforts to improve health-care quality and lower costs.
Sims leads a five-county, independent, nonprofit, nonpartisan effort to identify the best medical practices in five initial priority areas: diabetes, heart disease, low back pain, depression and pharmacy issues. This ambitious consortium of providers, consumers and insurers wants to learn how to get medical care done right the first time.
More pressure for change. U.S. Rep. Jim McDermott, D-Seattle, has steadfastly introduced legislation in Congress to create a single-payer health system financed with a broad national tax. Health care stays private and local, but Uncle Sam does the paperwork and pays the bills.
The tenacity and ideas of this lawmaker and physician stirred a rousing ovation from doctors and medical students at a standing-room-only inaugural meeting of the Seattle chapter of Chicago-based Physicians for a National Health Program. Hundreds braved a Sunday-night downpour to hear McDermott and a panel discuss reforms.
Physicians across the country see the system not serving their patients. Health-care providers are driven to distraction by the time and expense of working with 1,200 insurance companies.
Good people with a commitment to the local delivery of health care are leading efforts to find solutions very close to home.
Put it all together. Legislative stirrings. Nation-leading explorations of evidence-based medical savings. Leadership for a national single-payer insurance plan. Pressure builds as middle-class confidence and coverage erode.
Lance Dickie’s column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com
