As executive director of the Community Health Association of Spokane (CHAS) — which serves low-income as well as uninsured patients — Peg Hopkins believes she is at the front lines of health care reform.
What does reform look like to you?
It looks like a major concept shift from a commodity to thinking about it as a piece of infrastructure such as the interstate highway system. The thing about the interstate highway system is the construction and financing and management is all shared among the states. You have basic rules and regulations that everybody understands. Everybody has a right to get on, but you get on how you please — riding a motorcycle or a semi-truck. But getting from here to there is the challenge.
CHAS was among the first to implement electronic records. Why is this important?
Currently, almost all the information we have about the health of the American populace comes from two sources: 1) billing information, which is incredibly flawed and money-driven, and 2) studies which need to be extrapolated and expanded and the results of which take 14 years to be implemented in the medical system.
So we really have no database of the health of the populace. Your doctor won’t release the information as long as people think of health care as a commodity, and insurance companies don’t want to share data they have because they are all competing.
A big piece of reform has to be an electronic database because then you can figure out what works and what doesn’t, and we can save a lot of money.
What about complaints about socialized medicine?
We already have socialized medicine. The two highest-quality delivery systems are run by the government — Medicare/Medicaid and the VA. We’re already in the business. To me, [critics of reform] are using wedge words to scare people.
How is CHAS more like infrastructure?
It really is regardless of a patient’s ability to pay, so that first barrier about proving you qualify for care is removed. Everybody qualifies for care. Is that socialized medicine? I guess maybe it is. We also want to have a lifelong relationship with patients. We want to be their medical home.
We have 300 employees and six clinics and some patients who have been with us for 15 years. We are doing it.
What factors are holding back reform?
A lot of institutions are not going to change until they are coerced. The pharmaceutical industry and insurance companies and the durable-goods providers — a lot of businesses are built up around the fee-for-service model [of health care].
One major hurdle is: How do we help them change? How do we help them figure out a way they can still stay in business?
– INTERVIEWED BY KEVIN TAYLOR
DR. DEBORAH HARPER
Dr. Deborah Harper is a pediatrician working for Group Health in Spokane and is president-elect for the Washington State Medical Association. Soon she’ll be busy meeting with doctors around the state as part of her role as an advocate for better health care in Washington.
What do you see as the largest problem in health care today?
We need to have universal access to a basic level of protection. There has to be a safety net for people, whether that’s funded by the government, or whether it’s something like Project Access that we have here in Spokane.
What is the link between the need for health care reform and our current economic problems?
Access to health care is governed by insurance, which is almost entirely dependent on your job. When there’s a downturn in the economy, a couple things can happen. The obvious one is that you can lose your job and then lose your health insurance. The other thing is that health insurance is expensive, especially for small employers. When times are tight, they may eliminate health insurance.
In terms of actually initiating health reform, a lot people think only of policy, but it sounds like you think that we also need some kind of education.
There needs to be personal responsibility on all of our parts. One of the things that’s killing us is that Americans are not very active and we’re not eating the right things. I think 60 [percent] or 70 percent of Medicare money is spent on the top five diagnosed diseases. Four of the top five — congestive heart failure, high blood pressure, diabetes, and kidney disease — are due to not exercising and not eating right. The other one, asthma, is directly related to pollution.
In Washington, D.C., there’s been talk of passing a bill that would allow states to…
… become incubators. It’s a neat idea. There are federal regulations that have stopped states from being able to do that in the past. One option is to let each state come up with its own reform plan, see which three work and then institute those on a national level.
What would you say to people who think that universal health care is socialism?
People are screaming about this one $3 trillion price tag that President Obama’s original plan had, but they have no idea how much they’re paying already for the uninsured. When a hospital serves an uninsured person, which they are required to by law, we lose $25,000 on that stay.
Are there any alternative ideas for health care you think should get more attention?
Something I’m not hearing people talk about is the public health departments. They are so unfunded. Of what our Legislature thinks the public health department actually needs, they’re getting less than 10 percent of it.
There are a lot of reasons why the public health department is important. When you look at bird flu or swine flu, those happen wherever you have urban and agricultural interactions where people don’t have access to health care and nobody’s monitoring. It’s really important to have better monitoring and access to public health.
— INTERVIEWED BY CAREY JACKSON
RALPH DE CHRISTOFORO
As the coordinator of a Spokane project called Health for All, clearly Ralph de Cristoforo promotes universal health coverage. Yet while he advocates health-care access as a universal right, he also views health care as an individual responsibility.
What’s the biggest problem facing health care today?
We have to understand that health care is an economic development issue. I equate it to education with children. When we started public education, it was for the economy, not because we cared about children. It was to build an educated work force. Health care serves the same purpose — support for a ready-to-work workforce.
What does reform look like to you?
We need to look at transparency in the health care system, and in the health care finance system. We need standardization across the board — not government control across the board. So that people could look at a policy, and it [would be] understandable and would be the same in Washington as in Florida. As it is now, even two policies from the same company are hard to figure out.
The key is to develop a system with more primary care doctors and nurses. We’ve known there’s a shortage for the last 10 years. We have to convert a sickness system to a wellness system.
Say you can’t accomplish all those things. What are the most important incremental steps in the right direction?
We need to regulate and monitor transparency and standardization. That forces competition in cost and customer service. With the pharmaceutical industry, there’s already a lot of behind-the-scene handshakes going on. We need to work on those. We should also remember that it’s the people of this country who are often supporting their research. A lot of their money comes from the National Institute of Health and the research comes from public colleges, which are financed with our tax money already. So we’re actually paying for medication again after we paid for its development.
How do we measure the success of health care reform?
Well, a lowering of the use of the emergency room for primary care. That would be a standard right there. A lessening of intensity of some of the treatments needed because of the primary care that the uninsured don’t get. They’ve waited too long, so the level of care is always higher. Catch the cough on the first day, rather than the fifth day when it’s walking pneumonia.
Are you optimistic for reform?
I was optimistic in the beginning. I started to lose the optimism when I saw the watering down of the concept of comprehensive care for all citizens, the amount of money being spent on daily lobbying efforts against meaningful reform.
People are media-driven. If they see it, they believe it. People are speaking out without thinking about what they are seeing and hearing. If somebody says that seniors are going to have to have mandatory end-of-life counseling every five years, they believe it. And that’s nowhere in [the legislation]. The lack of the public thinking through what is being said concerns me.
— INTERVIEWED BY JOEL SMITH