Health-Care Reform, Washington Style




Home \| Elder Rights \| Health \| Pension Watch \| Rural Aging \| Armed Conflict \| Aging Watch at the UN

	SEARCH	SUBSCRIBE
			Mission \| Contact Us \| Internships \| Donate Now!

Health-Care Reform, Washington Style

By Scott Armstrong, The Seattle Times

June 26, 2007

Michael Moore's documentary "Sicko" will create a perfect storm for the emerging health-care debate. It joins the high winds and thunder coming from the shift to Democratic control of Congress, early electioneering in the 2008 presidential campaigns, consumer and employer exasperation at increasing costs, and the tantalizing possibility of new solutions being piloted around the country.

The intensity of the hype threatens to obscure policy decisions currently being made here in Washington state, in other states and in that other Washington . Health care demands shared responsibility and a common vision. We will not fix our broken health-care system by dividing and pointing fingers.

In Washington state, new programs are being rapidly assembled to add detail to a comprehensive package of health-reform legislation signed by Gov. Chris Gregoire this spring. This includes extending health-insurance coverage to uninsured children, providing affordable health insurance for employees of small businesses, increasing transparency and quality reporting, and supporting an emphasis on preventive health, particularly with a pilot program for state employees.

At the federal level, House and Senate committees are each working to develop a proposal to reauthorize the State Children's Health Insurance Program (SCHIP). This reauthorization promises to partly correct a long-standing funding imbalance that has shortchanged Washington state, while adding momentum to our own Legislature's commitment to cover all kids by 2010.

However, from the perspective of Washington state, work to build SCHIP could be wiped out by grabbing dollars through cuts to Medicare Advantage programs that will disadvantage seniors and disabled. That's right, due to "pay as you go" guidelines, our elected officials face paying for children's care by cutting funds for elder care.

The cuts Congress is considering would hurt Washington — and our seniors — more than almost any other state. A more-conservative and whole-person approach to medicine is part of our culture. This has kept federal Medicare costs low. Across-the-board percentage cuts will take a bigger bite out of smaller federal dollars.

On the Senate side, a consensus bill is expected to be announced and marked up in the Senate Finance Committee just a few days before "Sicko" hits theaters nationwide. As they say, that's politics — or is it show business?

In 1976, Group Health proposed sharing risk with the federal government to create incentives for improving the health of patients in a program that came to be called Medicare Advantage. Instead of the traditional fee-for-the-services-provided approach, we asked for set monthly payments to provide comprehensive health services to patients who signed up.

Thirty years later, that approach includes the use of information technology to share medical records easily among doctors and directly with patients. Patients can use secure e-mail to ask for advice. The technology also enables us to proactively contact patients based on an analysis of their medical records.

By more effectively engaging patients — through preventive health outreach and better sharing of information — we know we can increase immunizations, cancer screenings and other healthy activities. For patients with chronic conditions such as diabetes, this focus on maintaining health every day can help avoid catastrophic costs.

The federal government spends significantly less money for Medicare Advantage in Washington state than it spends for the fee-for-service approach in New York state, according to a recent per-beneficiary spending comparison. That's because the fee-for-service approach is laced with perverse incentives focused on providing sick care, instead of health care.

Most health-care "reforms" at the federal level focus on financing mechanisms. The health-insurance industry has been absorbed by the same exercise — shifting money from one bucket into another, first tapping business, next tapping employees. An across-the-board cut to Medicare Advantage to pay for insuring children is more of the same.

Instead, what we should be demanding is a commitment to a set of agreed principles that will lead to better care. If we believe preventive health will save lives and money, we should apply this to the elderly as well as children.

There are problems with the way the Medicare Advantage program has grown and been implemented nationally. Let's make the changes true reform: bringing the performance of the programs and services being funded into alignment with a set of principles that describe quality, cost-effective health care. And let's not do it in a way that arbitrarily shortchanges states like ours that have made progress in delivering health care more cost-effectively.

Scott Armstrong is CEO of Group Health, the nonprofit, consumer-governed health-care system based in Seattle .