Opinion: Universal Health Care Commission makes progress on process, not much headway on ‘how-tos’

Elizabeth Hovde of the Washington Policy Center believes we need lawmakers talking more about how our third-party payer system is a large part of the current problem

Elizabeth Hovde
Washington Policy Center

Other states have failed at the mission impossible of figuring how to provide government-run, universal health care without sacrificing access or quality — or sending taxpayers into shock over the tax bill. So how is it that we’ll be able to do it? Hold, please.

No one seems happy that this year’s Universal Health Care Commission (UHCC) meetings, and a report that’s due to the Washington state Legislature on Nov. 1, mostly provided a historical look at health care efforts in Washington state and a process for coming steps, rather than diving into the who, what, when, where, why and how of getting the state to implement a government-run, single-payer health care system.

As Rep. Joe Schmick, R-Colfax, rightly said at the UHCC’s Oct. 13 meeting, where he was the only commission member who didn’t approve the commission’s first required report to the Legislature, “I would have liked to have gotten to a little bit more meat on the bone.” He explained, “We’ve not talked about expectations. Who’s in charge of what’s going to be covered and what is not?” He added, “I think that if people believe that anything and everything is going to be available, I just don’t see that happening.”

Schmick was in the last group directed to work on a health care system overhaul that came up short. This is not his first rodeo. Having those discussions might save the commission a lot of time.

In response to Schmick’s concerns, Liz Arjun, a senior consultant for Health Management Associates, said, “It is a bit of a frustrating report. It’s not giving you everything you want at this point. It’s really just about setting up the process. But we’re hopeful that we can design next year to be all about these kinds of discussions and decisions and establishing common vision.” More than once, she and others expressed that now that the first report — created by consultants, approved by the UHCC last week and required by the Legislature — is done, it’s time to get to the exciting part.

I’m not sure “exciting” is the right word. Especially if next year brings discussion of other states’ failures (Vermont, California and Colorado) and the mission impossible that is cheaper, better health care via the state. I’ve been urging that. And thankfully at least one commissioner, Vicki Lowe, the commission’s chair, listened. “I know we had a public comment one time about making sure we learned from failures of other universal health care systems. And I wasn’t aware of any,” Lowe said when asked by Arjun what they wanted to know more about and discuss in upcoming meetings. “I think Vermont did something,” Lowe added.

Yes. Vermont did something. Despite being a small, progressive state, it tried and failed in its attempt at single-payer health care. The numbers never worked.

Third Way, a national think tank that champions modern center-left ideas, wrote that the estimated cost of the new system would be over $5 billion in 2021. “For context, the entire budget for the state of Vermont was $5.01 billion for 2012-2013. Officials in the state determined that an 11.5% state payroll tax and a 9.5% income tax would be necessary to pay for the new health care system. ‘In a word, enormous,’ is how Governor Shumlin described the tax hikes needed to fund single-payer.”

Over a dozen financing concepts showed that the only way to set tax rates as low as Vermont officials wanted would mean giving residents “skimpier coverage that most insured Vermonters already had,” Third Way writes.

That’s not a realization limited to Vermont. Many lawmakers throughout the nation have left government-run health care hopes in talking points because they realize there’s not a reasonable financial mechanism to pay for it. And it’s hard to convince state residents who have quality health care to get excited about being at the mercy of the government to receive medical care. Medicaid enrollees might see only small changes in their health care, but seniors enrolled in Medicare, workers who receive employer-paid health insurance and those who purchase their own insurance should be hesitant to give up their current plans and be forced into a state-run plan.

Unfortunately for the UHCC, all the process in the world won’t make a state-run system look good. Rainbow thinking doesn’t produce unicorns.

Even if taxpayers wanted new, substantially higher taxes instead of insurance premiums, the pattern of universal, government-run health care in other countries shows decreased access and quality are often a tradeoff. In a 2019 policy brief, we write, “The demand for health care far outstrips the money budgeted for it in all other countries, and rationing of medical care by the government is common. Some patients are denied care to save money.”

A fundamental problem with a single-payer system is that government bureaucrats get to decide who gets care and how much; patient-centered health care is not the priority. Schmick’s comment about expectations is right on.

Universal, government-run health care is misguided. When even fewer people pay for health care — as is happening with federal and state efforts, and matching the goals being discussed by this commission — we get lower quality and more stress on the system.

The state should quit putting its faith and money into commission after work group discussing a single-payer plan for the state and get busier strengthening government safety nets instead of widening them. We need to see increased Medicaid reimbursement rates in our state, which is one promising direction in which the UHCC is headed with its recommendations.

And we need lawmakers talking more about how our third-party payer system is a large part of the current problem, separating patients from knowledge about health care costs. We need educated consumers who shop for health care and who demand a responsive market.

Making it attractive for people to be in charge of their health care dollars and encouraging more competition in the system, rather than less, has a real shot at tackling the increased, unsustainable health care costs we’re all concerned about.

Watch the latest commission meeting here, watch for upcoming meetings here, and see the report that was approved to send to the Legislature here (page 60).

Elizabeth Hovde is a policy analyst and the director of the Centers for Health Care and Worker Rights at the Washington Policy Center. She is a Clark County resident.

Elizabeth Hovde of the Washington Policy Center believes we need lawmakers talking more about how our third-party payer system is a large part of the current problem

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