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A Sick System 

by Cara Gardner


The healthcare system in our country is sick. One out of 10 Washingtonians -- and 41 million Americans in all -- are without health insurance. The costs of medical technology and prescription drugs are at historic levels. Physicians say they're spending too much time and money on excessive paperwork, defensive medicine and negotiations for payment with insurance companies. In some ways, practicing medicine has become secondary to working through all the red tape.


For years healthcare experts have tried to pinpoint the obstacles and offer solutions. What they've found: a system so complicated and tangled that the problems aren't always clear, let alone the solutions.


"There are pockets of people trying to do the right thing," says Greg Vigdor, the president and CEO of the Washington Health Foundation. "But they can't, because the system is so fragmented. We believe the health system doesn't work."


The Washington Health Foundation (WHF) is a Seattle-based nonprofit that connects healthcare providers and policy leaders with community members in efforts to transform the state's ailing healthcare system. The organization collects healthcare data in Washington and provides services and outreach programs for rural communities.


Despite the fact that many consumers report being confused and intimidated by the system, WHF believes the path to transforming healthcare will originate with people who are working within the state's healthcare communities, not politicians or industry heads. With this outlook, WHF is hosting community roundtable discussions in all 43 counties in Washington. This format, WHF officials say, will collect the most important healthcare data yet: people's opinions.


Last Wednesday, WHF held Spokane County's community roundtable discussion. For two hours in a boardroom at Deaconess Medical Center, community leaders, physicians, hospital administrators, healthcare reform activists and other representatives from Spokane's medical community sat down to hash out what is wrong with healthcare and what can be done to transform the system. Though WHF has already held meetings in 20 counties, Vigdor admits each roundtable discussion is up in the air.


"We never quite know what to expect," he says with a laugh. "We just hope people show up."





Roundtable Talk -- In a large Spokane boardroom, James Whitfield, director for Transforming Health Care, Washington Health Foundation's reform plan, addresses a room filling with community leaders and healthcare professionals.


"We see a healthcare system that is disconnected; it's fragmented; it doesn't fit together very well," he said. "It would be a bad day if they called a meeting to discuss your future and you were not invited. The folks planning healthcare policy have been planning your future for a long time, and you have not been invited."


Whitfield, heading the team from the WHF, is trying to get a genuine dialogue going, but first he's got to get people thinking about their problems with Washington's healthcare system.


"A lot of people may be saying, 'Who cares what I think?' " Whitfield told the room of participants. "A few more people care that you should know about. They are interested in what you have to say. Whether or not they'll listen is a different discussion for a different day."


In fact, WHF already has healthcare experts lined up to listen to what people have to say during the roundtable meetings. Each of the 43 meetings is well documented; the information will be presented to state leaders next fall.


In a format similar to many grassroots-oriented brainstorming sessions, the room is given an outline on which to base their discussions.


Dan Jordan, an administrator with Spokane Neighborhood Action Programs (SNAP), started the dialogue.


"I think one of the most important things," he said, "is that there have to be some limits in terms of cost. There needs to be equitable redistribution of resources. We've got enough resources to give [healthcare] to everyone."


"I agree," said Mike Hilbrom, a planner for Aging and Long-Term Care for Eastern Washington. "The thing that kills us is self-interest. It's time we change the paradigm and the way we do it, and I hate to say this because there are insurers in the room, but a system not ruled by a corporate mindset is what we need."


"There are a number of components," said Elaine Engle, director of health promotion at the Spokane Regional Health District. "It's going to be tort reform, pharmaceutical involvement, health care cost containment and individual responsibility. It's the whole big sphere that has to come together. Until those pieces gel, we're not going to have what we call 'affordable' healthcare. We are a society that wants the best, now, at the cheapest cost, on demand."


"It's a societal problem," Jordan agreed. "It's systemic, and that's why society needs to solve it."


Shelley Scheller, medical office specialist and volunteer with Spokane's Health Improvement Program (HIP), was quiet during this time, listening and nodding.


"I was a nurse for many years and part of the community health outreach," she said finally. "I'm a patient advocate. We need to bring back [healthcare] to the consumers -- to the people who are hurt by this. The community [regards] this issue as taboo. People think they don't understand."


Indeed, much of WHF's efforts have been to involve rural communities and consumers in the healthcare reform discussion.


"Lawmakers don't know what people in Washington state want," says Vigdor during an interview earlier in the day. "Some of the gap is just getting leaders to lead. The politicians use the public as an excuse -- 'Oh, they don't want to get involved' -- but our polls show the public does want to get involved."


In February, WHF released the findings of a poll that showed respondents wanted to take responsibility for transforming healthcare in Washington. According to the poll, about 60 percent of respondents said they definitely or probably would spend more on co-payments in order to maintain current levels of government-subsidized healthcare. To help pay for healthcare coverage for low-income residents, 52 percent said they definitely or probably would be willing to increase state taxes. In the same poll, however, 59 percent of respondents reported health insurance was only some of their responsibility, and felt that employers, the federal government and the state government should all share responsibility for making sure people are insured.


Though WHF's poll shows people will take an active stance in transforming healthcare, there was a different viewpoint at the roundtable.


Chris Mietus, business development manager for the Spokane Area Economic Development Council (EDC), said people aren't involved in the reality of their healthcare.


"Most people don't even ask, 'What's this going to cost?' It's the only arrangement that people enter into without asking what it's going to cost them," Mietus said.


In fact, a video WHF played to the group contains interviews with several employers who mention the lack of understanding employees have about their healthcare. A vice president at Puget Sound Energy reports that employees are "shocked to find out the cost [of healthcare] on their own." It's this lack of knowledge about the system that makes many think education is a good place to start.


Though the discussion is thought-provoking, there is a general sense of uncertainty about the direction it's heading. Dialogue seems to cycle around the commentaries on prevention, cost and individual responsibility. Solutions don't seem any clearer.





Working Together -- "Roundtables are major listening opportunities," says Vigdor, noting that the goal for WHF is to document people's thoughts and feelings at the meetings, not to leave with specific plans. Once all 43 counties have been visited, general themes may emerge.


"We get leaders together, we get people talking about what they think," Vigdor says. And though some may find it unlikely that politicians and policy makers would listen to what citizens have to say, WHF wants citizens to feel that their solutions do matter.


Vigdor adds that what captures the attention of most politicians is ultimatums. "If you don't lead, someone else will," he says; "Others will act, and it may be a citizens' initiative," as has been the case in other states.


WHF has managed to get a variety of healthcare organizations, from conservative medical boards to liberal citizens' action groups, on board with the community roundtables. In October, WHF plans to meet with about 20 partner organizations to share the information from the roundtables and hash out further plans for healthcare transformation.


"We've worked with [WHF] in the past year and find that they are a pretty good fact-finding group," says Don Brunell, president of the Association of Washington Business, a right-leaning business advocacy organization. "From our perspective, information is power, and we're trying to figure out what the problems and citizens' views are and what can be done at the federal level and the state level," he says.


"My understanding [of the roundtables] is it's an opportunity to discuss what's happening; to get people's experiences and share those with others," says Barb Flye, executive director of Washington Citizens Action, a left-leaning citizens' organization.


Despite being on different sides of the political spectrum, both Brunell and Flye agree that WHF's roundtable forums are an important part of healthcare transformation.


"We all share a common goal, but just have different ways of getting there," Brunell says. "Having accurate data is the biggest step. I think the Washington Health Foundation is the most accurate vehicle for getting that data."


But when WHF brings the citizens' opinions to its partners, will the organizations be willing to listen? Even more, will they be able to transcend party lines and work together?


"[Washington Citizen Action] would be willing to do that," says Flye, carefully. "The policy options would have to be something our organization would embrace, but I think it's important to bring a variety of backgrounds."


"Oh, I think we're willing to sit down with anyone. We have to sift through it together. The most important thing is to go in with an open mind," Brunell says assuredly. "The problem is so great, no one has a solution -- we have perspectives."





Publication date: 05/15/03
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