Taking Health Care To The Voters

Health Care 2000 asks: is universal health care a right or a privilege?

by Stuart Jeanne Bramhall, M.D., Free Press Contributor

ccording to a recent opinion poll by GLS Research of Santa Monica California, 83% of Washington voters agree that people have a basic right to health care regardless of their ability to pay. Yet, as with other issues pertaining to the common good, we as a society seem paralyzed when it comes to translating our values into public policy. Health care technology in the Pacific Northwest, with the medical miracles it delivers for traumatic injuries and a variety of acute and chronic illnesses, is unsurpassed anywhere in the world. At the same time, the high cost of care places many basic medical services beyond the reach of nearly one fifth of Washington residents.

The fact that most Washington insurance companies have ceased to sell individual health insurance (as opposed to "group" insurance that businesses purchase to cover their employees) received wide publicity during the 1999 legislative session. The virtual collapse of the individual insurance market--along with other factors, such as welfare reforms that leave former welfare recipients ineligible for Medicaid and economic dislocation forcing many residents into early retirement - leaves more than 630,000 Washington residents with no health care coverage whatsoever. A recent study by the Kaiser Family Foundation estimates another 470,000 Washington residents have insurance but are unable to access needed care due to high deductibles or copayments, or because Medicare and private health insurance commonly exclude or reduce coverage for prescriptions, mental health services, prescription eyeglasses, hearing aids and other basic medical needs.

More and more become uninsured

The ranks of the uninsured in Washington State, which includes more than 100,000 children, increases by 10,000 to 20,000 people every year. Employers continue to cope with escalating insurance costs through downsizing and lay-offs, by using temporary and contract employees to avoid paying benefits, by eliminating family coverage, by shifting premium costs to employees or by transferring them to restrictive managed care plans.

The current health care system in Washington state is actually a non-system: a fraying patchwork of hundreds of governmental and private health insurance programs. With the current fragmented nature of health coverage, even middle and upper-middle income families feel insecure about losing their insurance. People with good insurance coverage are laid off, change jobs, leave work to start a business or become disabled from a serious injury or illness and suddenly find they have no health coverage. At the same time, hundreds of Washington families with "good" health insurance discover they have managed-care exclusions and limitations that make them financially responsible for their own treatment--and they make the painful choice between leaving treatment or going deeply into debt.

In spite of this clear social emergency, the Washington State legislature remains virtually paralyzed--thanks in large part to opposition from the powerful insurance lobby--in implementing even minor reforms, such as the Patient's Bill of Rights, mandated parity for mental health services (prohibiting insurance companies from discriminating against patients needing psychiatric as opposed to other medical services) and expanded coverage for the uninsured.

The solution must come from the people

Health Care 2000 (formerly Washington Single Payer Action Network) is an statewide, non-profit coalition of individuals and organizations created in 1993 to mobilize support for a national, single payer health care system. The failure of the 1999 legislature to address the health care crisis in a meaningful way has left many health care activists more convinced than ever that the solution must come from the people. At present, Health Care 2000 is preparing to file a universal health care initiative destined for the November 2000 ballot. The Washington Comprehensive Health Care Reform Act of 2000 would create a single Washington State Health Care Trust to guarantee basic medical coverage for all Washington residents.

By streamlining and consolidating health care payments, the Trust would recover $2.3 billion lost under the current system to excess administrative costs. This figure, which represents 15-20 percent of total health care expense in Washington state, includes millions for insurance profits, stockholder dividends, advertising, marketing, political lobbying and exorbitant CEO salaries. By eliminating administrative waste, duplication and fragmentation, we in Washington state can expand coverage to the uninsured, offer everyone more comprehensive benefits and still cost Washington businesses and taxpayers less. Benefits offered under the Trust would include prescriptions, mental health care, eyeglasses, hearing aids, licensed alternative care and a phase-in of dental and long-term nursing and home health care.

The Trust would be funded through a payroll tax on the employer and employee, along with either a flat tax or a fixed health premium for the self-employed, seniors, unemployed residents and those with unearned income. In addition, all current federal and state payments for health care, such as Medicaid and Medicare benefits, would be added to the Trust, creating one publicly accountable fund to provide reimbursement for all health services.

What you can do to help

Owing to potential opposition from the powerful health insurance lobby, the grassroots activists in Health Care 2000 face a monumental task. To qualify for the November 2000 ballot we must collect 250,000 signatures between January and July 2000. To win, we must reach 1.5 million voters by November 7th. We already have more than a hundred volunteers in 15 counties, but we will need thousands. We need hosts to sponsor house parties to educate their friends and neighbors, envelope stuffers, phone volunteers to help with fundraising, and signature gatherers to circulate petitions starting in January 2000. For more information please call 206-903-9723 or check out our web site at www.users.tss.net/hcn.

Stuart Jeanne Bramhall, M.D. is a psychiatrist in private practice in Seattle and the Washington State organizer of Physicians for a National Health Program.