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Copyright © 2001 The Seattle Times Company
Editorials & Opinion: December 14, 2000
Guest columnist
Health care’s strange bedfellows needed here
By Kathleen O'Connor
Special to The Seattle Times
Strange bedfellows breezed into town recently with a workable solution to expand insurance options for the uninsured. No less than the heads of the Health Insurance Association of America (HIAA) and Families USA, formerly arch enemies who are now tromping around the country showing how they found mutually agreeable ways to get affordable health insurance for the 43 million uninsured Americans.
We need that kind of risk-taking leadership here. We were a leader in finding ways to offer affordable, accessible, public and private health care solutions. The state's Basic Health Plan is a landmark program, as is the Employers' Health Care Purchasing Co-op. Not to mention other interesting alternatives, like the First Choice and Cost-Co Health Insurance option. But now, we have few innovations and virtually no leadership at a time when existing health care services are desperately under funded.
Initiative 601 and the new initiatives mean we don't have enough money in the state budget to pay for existing programs. So, programs have to be cut. This means the poor and the vulnerable will be hit big time.
The Charred Landscape
Flexibility in the health care market is gone. Managed care eroded the providers' financial infrastructure. Federal and state payments cut providers' income so there are no funds to cover the uninsured. We pay caregivers a pittance, which means they would rather flip burgers than help bathe and dress our elderly or disabled sons and daughters. Which means we will have a crisis in long-term care at home or in institutions.
Health insurance premiums are raising their ugly double-digit heads again for employers, especially small employers.
Individual policies are back, but with a 13-page health status questionnaire to screen the new applicants. We have no idea what the results of that screen and the new rates will be.
Healthy Options is basically dead. Come January 1, the largest managed care plans won't continue their Medicaid managed care patients because the rates they get from the state are too low. This means over 100,000 Medicaid patients will be on their own again to navigate an incomprehensible system. The managed care plans that will still take them could be overloaded with patients and/or will provide services with payment rates from the state that may or may not cover their costs.
Add to this, the state Department of Health's intent to cut the AIDS Health Network budget by some $600,000, the DSHS decision to drop adult dental, and their decision to close some hospital mental health services and let the patients fend for themselves in unsupervised out-patient settings. Not to mention the fray over who takes the rate discounts so seniors can have affordable prescription drugs.
All this is on top of a precarious medical financial infrastructure. Physician practices are losing money because of low reimbursements from commercial insurers and public payers. Many counted on a volume of managed care that never materialized and have closed their doors. Rural communities are especially hard hit.
And then, the issue of trust. Everyone is vilifying everyone else for costs and rates. All are in danger for carpal tunnel from the finger pointing alone.
Who is doing something about this? No one. Not the governor. Not a divided state Legislature. We need some leadership here.
We need leadership that gives voice to our needs and can articulate our vision of what a system of health care should do. What goals do we want to reach?
We need leadership that is not government driven, but offers a fresh approach like the attempt being carved out by HIAA and Families USA. We need a voice that advocates a system of care that works for consumers, providers and employers, as well as the cities and counties that have to meet the needs of those who rely on the safety net.
It doesn't take rocket science to do this. We have never sat down to figure out how we can get all the various parts to work together. Right now not only is our system riddled with holes and gaps and lacks, it is just as riddled with redundancy, duplication and often needless and costly competition.
We can't rely on stakeholders because they have stakes in the outcome. We may or may not need more money. But, more than money right now, we need to say what we want the money to do and define our expectations.
If HIAA and Families USA can find common ground, can we not risk a systematic public dialog to define what we want a health care system to do and build a path to get there?
So, what will it take to get some action here? If the governor wants to be a leader, now would be a good time. And, this would be a good issue. Lives are at stake.
Kathleen O'Connor is publisher of the O'ConnorReport and is a health care industry analyst, consultant, speaker and writer based in Seattle. She has over 22 years' experience in the health care industry.
What do you want researched? Contact us now about custom articles, research or help with story placements. Kathleen@oconnorhealthanalyst.com or call: 206-217-9430.
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