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The Nine Commandments 

by Cara Gardner


The Washington Health Foundation, a non-partisan healthcare reform organization based in Seattle, held roundtable meetings in each of Washington's 44 counties, asking healthcare experts and community leaders to discuss their values about healthcare and their ideas about how to fix the ailing system.


"What if we asked what people think? I know that seems earth-shattering, but we thought that'd be a good idea," James Whitfield, director for transforming health care for WHF, joked last week. "In three months, we visited every county in Washington state. A total of 1,200 people showed up to participate. We received 10,000 individual responses, meaning that's how many times someone stood up to say something in the meetings."


WHF had a UW researcher analyze the data from each of the roundtable meetings and condense people's expectations and ideas -- what they said was important to them regarding the healthcare system -- into nine "Key Values." These nine values were presented to the participants at the first annual Washington Health Summit, held at Seahawks Stadium last week. After extensive discussion, participants ranked the values by using instant electronic voting. In order of importance, the following are the values our state's healthcare leaders established.





1. Reallocating Resources -- The No. 1 value determined at the summit, this will assure appropriate services are provided and appropriate priorities are addressed.


"We waste so much money on administrative costs," said Mike Kreidler, insurance commissioner for Washington state.


"I think we need to face up to the mix of health services we provide and root out the kind that don't give us a bang for our buck," added Don Sloma, executive director for the Washington State Board of Health. "We're at a point where the government has to get real and get serious about the amount of money they're spending on health."





2. Redesign the Health System -- A broad value, but ranked as the second most important one, is redesigning the healthcare system. There are varying suggestions on what parts of the system need redesign; some say all of it needs to be rebuilt. But the consensus is that there are deeply rooted systemic problems that need fixing. A representative from the roundtable meeting in Wahkiakum County said, "We need a basic framework of significant reform. Principles, rather than money, must be the driver."





3. Engage and Educate -- An overwhelming value is the need to educate the public about healthcare. Experts agree that people should be actively engaged with the healthcare system and the policies that are passed. Americans want the best possible healthcare at the cheapest possible cost -- and they want it right now. A delegate from Franklin County said that, "Education to consumers about the cost of healthcare will create more realistic expectations from healthcare consumers."





4. Assure Fairness -- Equity isn't just something we value when it comes to healthcare; it's a cultural belief pervading American life. While we like to think we live in a fair society, our healthcare system tells us that we are sorely mistaken.


"As a society, we need to prioritize," said Deana Knutsen, chair of the board of directors for Washington Citizen Action. "I want to see a change and to make sure everyone has access to care."





5. Personal Responsibility -- We're not exactly doing our bodies -- or our healthcare system -- any favors by smoking, eating fast food and foods full of preservatives, working long hours, sitting in front of the television, engaging in dangerous behaviors and so forth. It costs money -- lots of money -- to take care of people with lifestyle-related health problems. Part of reducing the stress on the system is taking personal responsibility for our habits and utilizing preventative care, such as keeping regular exams and check-ups.


"At the turn of the [last] century, we died at [an average of] age 47. Now it's 77. Then we died of diseases -- now it's [mostly] behavioral," said Mary Selecky, secretary of the Washington State Department of Health.





6. Collaboration and Cooperation -- Though it was the first time many of the state's healthcare experts had met together, many valued collaborative approaches and felt that collaborative resource allocation should take place across sectors, stakeholder groups and industry segments. A representative at the roundtable meeting in Kittitas County said, "Bring all the players into a common place so all can hear who needs what and who has what."





7. Community-Based Solutions -- This shows that leaders do value the public's voice. Healthcare experts agree they want and need community-based solutions.


"The federal government won't do anything unless they can look out and see people doing things. We can't stand back and say, 'You guys take care of it,' because they won't know what to do," said Bob Crittenden, president of the Rainier Institute, a Seattle think tank.





8. Government Accountability -- We expect our elected leaders to stand up for what we value.


"If we're looking for leadership, it'll be a part of politics," said Kreidler, Washington's insurance commissioner. "It can't be rearranging the deck chairs on the Titanic, but it can't be so big that it scares people. It's going to have to happen at the state level, and the state will have to provide leadership."


"We need to have a political will," added Crittenden of the Rainier Institute. "[We need] a Governor that's going to do something; we need to meet the fairness test. It's got to be based on our values."





9. Additional Resources -- Many feel the healthcare system needs more resources, particularly financial ones. The current system is stretched to its limits. Many say this should come in the form of a tax -- always a controversial solution. In a WHF poll, 52 percent of those asked said they probably would be willing to pay higher state taxes to help pay for healthcare coverage for low-income residents.





Publication date: 11/06/03
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