Report From the States
Washington State Battles Socialized Medicine --- Again
Thomas J. Mueller, MD
Describing what is currently happening in Washington State can be categorized as the good, the bad, and the ugly. First the not so good news: If you're in a state bordering with our neighbors to the north it doesn't take much effort to determine that the single payer (Medicare) system of Canada is faltering in a number of areas. Physicians are leaving Canada in droves and settling in many northern locations like Bellingham, Washington. Patients can escape the clutches of the statist system where waiting lists are typically twice as long as the government admits and come to U.S. border towns either under Canadian government contract or the totally private system of our fee-for-service model. Yet with the plethora of examples indicating how stifling the Canadian medical system is, there are a growing number of physicians here in Washington State who want to import that same system.
The group sponsoring the initiative to turn all Washingtonians into the same medical slaves as those in all of Canada were at the recent Washington State Medical Association (WSMA) House of Delegates meeting held in Spokane. There they argued for their effort to create the utopian government model of the ages, giving not only all private insurance monies to an "accountable TRUST" but also all public monies as well, including Medicaid and Medicare, thus requiring fundamental changes in both state and federal legislation before their system can be implemented. Thankfully, arguments against their initiative abounded. But they haven't disappeared. They will merely regroup and resurface in time to put their initiative out and try to have it placed on the November 2000 ballot. Can you imagine the entire free medicine crowd coming out to vote at that election?
But wait, there's still more: These same people plan to simultaneously try and push the plan through the state legislature, thus increasing the chances of getting their wish. And their reason for such a mammoth effort? Why, perversion and inequities in the "free market," of course. They charge that the "free market" has failed. Unfortunately, these tend to be the same liberal Americans who have never learned from historical mandates that 1) central control does not work, and 2) government meddling has played a huge role in precipitating the rising tide of insurance nightmares we are becoming all too familiar with.
At this same meeting in Spokane, results from a recent patient and physician survey were revealed. Not surprising was the notion that patients trusted insurance companies and government little, if at all. Patients tend to trust themselves most and physicians a close second when it came to delivering their health care. Since 1991, patients have seen considerably less need for fundamental reform in the health care system, whereas physicians have seen a great need for significant reforms. The survey asked some basic questions about what kinds of reforms physicians thought would help the most and about a third said that patients need to have much more control of the health care dollars and decisions.
A resolution was passed at the House of Delegates meeting to explore opportunities of offering each member of WSMA medical plans which include MSAs. This particular resolution was an eviscerated version of the original one submitted. Perhaps the incubation time is truly ripe for the birth of MSAs in some arenas. If physicians won't lead in truly responsible, compassionate health care reform, who will?
Too much effort, though, is still given to the business aspects of extracting, in ever increasing ways, money held by the insurance companies. Courses on coding and reimbursement are offered by a growing number of "specialists." Truly an example of rearranging the deck chairs on the Titanic, if ever there was one. Another tactic has been physicians joining forces and creating "clinics without walls" in order to have economies of scale as well as the (false?) notion of somehow gaining bargaining strength over the insurance companies.
Insurance companies have responded in kind by attempting to raise premiums if allowed by the Insurance Commissioner. If the profitability is in doubt, the insurance companies have simply pulled out of the markets altogether, where in most counties of eastern Washington, no individual policies are currently available except for catastrophic insurance. This could certainly present a unique opportunity for the free market in medicine to flourish throughout this geographic location.
If it is truly darkest before dawn, perhaps dawn has arrived here in Washington State. About a year ago, a couple of enterprising primary care physicians just south of Seattle noticed that they were in a financial fix due to the fact that they were treating patients only to find out that it cost them more to actually extract what was owed them from the tight fists of the insurance companies. The most risky of decisions was before them: Should they continue in this safe harbor of treating insured patients, only to spiral down fiscally, or offload all insurance companies and accept cash only? Soon after they decided to go cash only they were once again operating in the black. They thought that only working poor people would use their services but have surprisingly seen that a growing number of insured patients also have decided to entrust their health care to them. And, as is typical of successful ideas, it has spread in phenomenal fashion to where there is a national movement afoot to accomplish exactly what they have done for not only primary care but also specialty and surgical physicians. Visit their website at www.simplecare.com and consider joining what could be a real medical revolution. They did it without legislation. Perhaps the real reforms needed will blossom not so much as a direct result of legislation but as an indirect one, as seen here.
So, as you can see, the race is now on in earnest. Will we end up with a totally socialist system or a much-needed free market system? The importance of physician leadership has never been clearer or more necessary. Let us move ahead to achieve what we know to be right.
Dr. Mueller is a otolaryngologist in Everett, Washington. E-mail: firstname.lastname@example.org.
Originally published in the Medical Sentinel 2000;5(1);27-28. Copyright©2000
Association of American Physicians and Surgeons (AAPS)