After those debacles, says Karen Merriken, Group Health's public policy director, reform was "off the table" at the state level, and the failure dampened policymakers' enthusiasm to try again. But the rising costs of the intervening years and the acute need for access to health care have put "issues of cost, quality and access back on the table," Merriken says. The renewed interest has everything to do with getting costs under control and addressing soaring rates of un-insurance and under-insurance.
A couple of years ago, says Merriken, Group Health's board of trustees decided the time had come to renew the discussion of health care reform. They looked around and saw a system that was fragmented and focused on responding to acute conditions, such as heart attacks, with expensive doses of technology. The emphasis on fee-for-service rather than preventive care gives doctors an incentive to do tests and procedures, inflating administrative costs, billing and other paperwork and contributing to waste and redundancy. But Merriken acknowledges there were problems with managed care as it was rolled out in the '90s -- too much focus on managing costs, for example. And she says people often felt strong-armed into joining HMOs, which contributed to an overall lack of trust in the system.
Merriken says Group Health was heavily influenced by the 2004 report, Insuring America's Health, published by the independent Institute of Medicine, which discussed why coverage matters and what happens to communities when people don't have it. The report also put forward some bedrock principles: Health care coverage should be universal, continuous and affordable for families; it should be sustainable for society; and it should work to enhance health overall. Adopting these principles, Group Health began advocating for change and educating the community.
The first community discussions took place last year in Seattle, Olympia, Mount Vernon and Spokane; this summer, they return to boost Spokane's "health policy literacy." For example, says Merriken, the state Office of Financial Management counts more than 600,000 people in Washington who are uninsured -- more than 10 percent of the population. That's doing better than the national rate, she points out: Of nearly 300 million U.S. citizens, 43 million are uninsured -- roughly the populations of California, Oregon and Washington combined. Spokane County is right on track with the state, with one of every 10 citizens uninsured. That's nearly 44,000 people.
Of course, some groups are more likely to fall outside the health care safety net than others. Young men younger than 25 make up nearly a quarter of the uninsured, and more than 16 percent of the unemployed lack health insurance, compared to less than half that (7.4 percent) for jobholders. Low-income families are particularly hard-hit: Two-thirds of them are uninsured.
Part of building literacy about health policy is getting across why coverage matters, Merriken says. For example, family health crises are a leading cause of bankruptcy, and babies born to uninsured families are often less healthy at birth. People and families without health care are far less likely to get preventive care or deal with chronic conditions and are more likely to die. In fact, a 2004 IOM report cites the lack of health insurance as a cause of the deaths of some 18,000 people in the United States every year. Those are some of the reasons, Merriken says, that Group Health believes "universal health care should be a goal for this country, and we ought to work for that." The American public is being squeezed on one side by soaring costs and on the other by declining access.
"We will have to confront those issues," Merriken says. "Health care is at a tipping point."
The forum will begin on Wednesday, July 26, at 6:30 pm at Group Health Cooperative's administrative building, 5615 W. Sunset Hwy. A light summer buffet will be served. Call 241-7130.