Health care reform, front and center
Cantwell, health care officials discuss issue at Vancouver forum
By Kathie Durbin
The Columbian
Thursday, July 2
A boisterous audience of more than 100, including a large contingent of seniors, packed a Vancouver hospital auditorium Wednesday to hear U.S. Sen. Maria Cantwell, D-Wash., and a panel of health care providers dissect national health care reform.
People saved their loudest applause for speakers who expressed support for a single-payer system of national health insurance, such as Dr. David Baughan, a family care physician with Group Health Cooperative in the Puget Sound area.
Citing the battles that preceded passage of the 1965 Voting Rights Act, Baughan said, “Political will was mobilized after a lot of people died. In 2009, people die every day because they don’t have health insurance.”
The public would not tolerate a police or fire department that serves only two-thirds of a city, he said, but the nation continues to accept a system in which one-third of Americans lack adequate health coverage.
Some in the audience tried to pin Cantwell down on where she stands on a government-run “public option” that would compete with private health insurance and cover the uninsured.
“We need something like a public plan to purchase health care,” said Cantwell, who has sent mixed signals on the issue over the past two weeks. Members of Congress are still wrestling with how such a public plan would work and how to pay for it, she said.
Cantwell sits on the Senate Finance Committee, which is drafting a bill to spell out how the federal government would pay for a plan to cover the nation’s 47 million uninsured while reducing health care costs through efficiencies and a focus on disease prevention.
Single payer
Asked “what happened” to the single-payer option, which would cut private insurers out of the picture altogether, Cantwell said, “I don’t think that single payer has vanished from the discussion.”
She said she expects amendments to the Senate bill calling for a single-payer system to be introduced on the Senate floor.
A single-payer bill introduced in the House by Rep. John Conyers, D-Michigan, has 79 co-sponsors but has stalled and has little support from House leaders or President Obama. Conyers’ bill would create a publicly financed health care program, modeled on Medicare and funded through a payroll tax, that would cover all Americans without charging co-pays or deductibles.
“I think a public plan represents many of the same elements” as a single-payer system, Cantwell said. For example, she said, both would use the power of the federal government to drive down health care costs through its power to negotiate with hospitals, doctors and drug companies.
However, a government plan would not guarantee that people could find physicians, she added. Cantwell is pushing for financial incentives to train more primary care physicians, who are in short supply in many parts of the country.
Diverse views
Speakers at Wednesday’s panel at Southwest Washington Medical Center represented a range of views on how health care reform should be structured. Most agreed, however, that the nation no longer can afford an open-ended “fee for services” system in which insurance companies pay doctors for whatever drugs and procedures they prescribe, without, they contend, regard to cost or effectiveness.
Ross Baker, a lobbyist for Regence Blue Shield, which insures more than 1 million Washington residents, said his company is moving to control costs.
“We would all admit that the system has major problems and change is needed,” Ross said. Regence supports improved primary care, evidence-based medicine, more use of generic drugs, and elimination of medically unnecessary tests and procedures, he said.
But whether the nation chooses a public plan or tweaks the current plan, he said, real reform won’t happen until Americans take responsibility for their health through changes in diet and exercise.
Dr. George J. Brown, chief executive officer of Legacy Health Systems, said his concern is the growing burden hospitals are shouldering in treating the uninsured. Legacy treats 75,000 people annually in six hospitals in Oregon and Southwest Washington.
“The economic crisis facing our nation has drastically increased the demand for charity care,” Brown said. Further cutting Medicare reimbursements to hospitals, as some in the Obama administration have proposed, is not a solution, he said. “National health care reform is the ultimate solution.”
Charles E. Reed of AARP said his organization, with 40 million members, insists that any health care reform bill address coverage for people in the 50-to-64 age range. Those people are vulnerable, he said, because they are not yet eligible for Medicare, and if they lose employer-provided coverage, they’re often unable to buy private insurance because they have pre-existing conditions.
AARP also supports programs to keep seniors out of expensive nursing homes and development of generic versions of expensive drugs such as those used to treat cancer.
Lack of will
Dr. David Ruiz, a board-certified family physician who now directs a residency program that trains others in his specialty, offered some historical perspective on health care reform. He said the failure of the nation’s leaders to pass universal health coverage is a story of a lack of political will. Presidents Franklin D. Roosevelt, Harry Truman and Lyndon B. Johnson all were afraid to tackle it, he said, and President Bill Clinton’s reform never came to a vote in Congress.
“You have a window of opportunity that opens infrequently,” Ruiz said. But he admitted his skepticism, borrowing from the 15th-century Italian writer Niccolo Machiavelli, who wrote in “The Prince:” “He who innovates will have for his enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.”
Community health
Dawn Doutrich, who teaches in the community master’s program for nursing at Washington State University Vancouver, urged a greater investment in public health to prevent disease and reduce the wide disparity in health care that exists between rich and poor.
“We need to re-examine the assumption that health care fits into a corporate model,” she said.
Barbe West, the new executive director of the Free Clinic of Southwest Washington, urged a shared community responsibility for health care. Every major public decision, from whether to close a community grocery store to whether to site a school where all children will have to ride the bus to school, should be analyzed for its impact on public health, she said.
Joe Kortum, president and chief executive officer of Southwest Washington Medical Center, summed things up by urging Americans to have a “dramatic cultural conversation” about what health care means to them.
People in other industrialized countries find it immoral that millions of Americans have no health coverage, Kortum said.
The United States has the capacity to deliver world-class health care, he said, “and yet we have a shipwreck in this system.”