Healthcare Reform in Washington state – Book Review

Like the rest of the country, Washington State has a health-care crisis: costs are out of control, quality of care is uneven, and many state residents go without coverage.

In “Dear Governor: About That Healthcare Crisis“, Edmonds editor and publisher D.J. Wilson has put together a highly readable collection of articles by 20 people with expertise in Washington’s health system who provide a variety of ideas on a way forward.

By an large, the contributors are not academics but rather people working on the ground, in clinics and hospitals, with community organizations, unions and patient groups, or for health plans, consumer advocacy groups and nonprofits.

As a result, their arguments tend to be direct and their proposals practical.

Dear Governor: About That Healthcare Crisis
Edited by D.J. Wilson
Paperback. 195 pp.
Edmonds Publishing Group
$24.00 

In his introduction, Wilson notes that health-care reform ideas coming out of universities often prove to be “ideas without a constituency.” As a result, he says, they carry no weight with lawmakers and are unlikely to succeed.

For this book Wilson wanted ideas with a constituency, so he went to people who represent different interest groups in the state, though he uses the more politically correct term “stakeholders”, and asked them “If your had 10 minutes with the Governor, or any one individual, what would you say?”.

The result is highly, readable collection of short, to-the-point articles that focus on problems that are specific to our state.

The articles address the issues many of us may already be aware of, in particular: the high and increasing cost of healthcare, the perverse incentives that promote high-cost, high-tech procedures over low-cost preventive care, and the generally chaotic, fragmented nature of our current health-care system.

The changes proposed by the contributors, however, are not radical but instead tend to be modest and incremental.

A great deal of faith, for example, is placed in the promise of electronic medical records, for the most common recommendation is for the institution of incentives and subsidies to speed the adoption of information technology.

But while electronic medical records will no doubt greatly reduce costs and improve care, one has to wonder whether there is something more fundamentally wrong with a system that at this late date still hasn’t embraced a technology that almost every other industry has adopted and, indeed, been revolutionized by.

Among some of the other issues discussed are the need for more primary care providers, for improved rural services, for better outreach to under-served minorities, for more health education and promotion, and for more support of efforts to improve quality and reduce medical errors.

All the ideas seem good, some stronger than others,  but as you read along, you did begin to hunger for someone to cut the Gordian Knot that seems to be binding up the system so much that it can’t seem to implement many of these changes spontaneously.

The contributor who came closest to that was Kathleen O’Connor, founder of CodeBlueNow!, an advocacy group trying build a popular consensus on health-care reform.

O’Connor called for setting up a health insurance pool similar to that offered to Federal Employees, including members of Congress, from which everyone including individuals could purchase insurance.

As with the Federal Employee Health Benefit Plan, insurers who want to be included would have to agree to provide a certain basic set of services and would not be able to refuse to insure individuals with pre-existing medical conditions as they can now. The system would also force insurers in the pool to compete on the basis of price and service and, thus, would likely help control costs and improve quality.

Most of the contributors, however, call for less far-reaching, more middle-of-the-road, incremental reform. For example, the most conservative voice was that of the conservative blogger Eric Earling, who gave fairly high praise for the recently adopted Massachusetts health reform plan, which is, afterall, a plan adopted by arguably the bluest state in the Union.

Indeed, it would been nice to have at a few contributors representing the “extremes” of debate, say, one contributor arguing for single-payer Canadian-style system and one for a market-based voucher system. 

But, that said, “Dear Governor” provides a fresh, engaging collection of articles by people who are likely to have a significant voice in the upcoming health-care reform debate in Washington state.

It’s good to know what they think.

A list of the contributers is below:

Forward:

• William H. Gates, Co-Chair, Bill & Melinda Gates Foundation

Introduction:

• D.J. Wilson, Editor, Edmonds Publish Group.

Contributors:

• Karen Keiser, member of the Washington State Senate
• Jesus Hedrnandez, executive director Community Choice Healthcare Network
• Renee Beebe, Founder & Lactation Consultant, Northwest Association for Postpartum Support
• Rick MacCornack, Executive Director South Sound Health Communication Network
• Larry Loo, CEO, Puget Sound Health Partners
• Ted Bridge, Pediatrician , Federal Way Pediatric Clinic
• Rose Cantwell, President of the Board, South County Senior Center
• Stan Flemming, President, Pacific Northwest University of Health Sciences
• Greg Vigdor, President & CEO, Washington Health Foundation
• Peter Gelpi, CEO, Clarity Health Systems
• Patricia Briggs, CEO, Northwest Physicians Network
• James Hereford, Executive Vice President, Group Health Cooperative
• Eric Earling, Contributing Editor, Sound Politics
• David Rolf, President, Service Employees International Union, Local 775
• Donald Fisher, President & CEO, American Medical Group Association
• Kathleen O’Connor, Founder & CEO, CodeBlueNow!
• Tom Fritz, CEO, Inland Northwest, Health Services
• Richard Cooper, CEO, The Everett Clinic
• Russ Sarbora, CIO, Community Health Plan of Washington
• Mary McWilliams, Executive Director, Puget Sound Health Alliance.

Tags: Book Review, Health-care Reform, Washington State

Category: Book Review, Health-care Policy