Careful Surgery Will Save Reforms

Washington state’s health care reform law is going to be changed. It should be changed. But it shouldn’t simply be repealed.

Repeal would mean a return to the, uh, good old days: Doubledigit inflation in health care costs. Dwindling availability of health care coverage. A system focused on treatment of the sick rather than on the promotion of wellness.

In the two years since its adoption, the Health Services Act of 1993 has had beneficial effects that residents of the state may already take for granted. The state now prevents insurance companies from denying coverage to people who change jobs, have pre-existing conditions or become expensive to insure. The inflation of health care costs in Washington has fallen from the double digits to 5 percent a year - half the national average. Large insurance companies and care providers have begun to manage care in costefficient ways.

If the Legislature removed the pressure for reform, the health system would be tempted to drift back toward its old comfort zones - and to slam the public with rate increases and benefit cuts to make up for the self-restraint of the last two years.

The public wouldn’t take that lying down.

Nevertheless, the reforms of 1993 do require major surgery. The mandate for employers to insure their workers cannot be enforced without congressional permission and there is no chance that the new, conservative Congress would grant permission.

So, policy makers must turn from mandates to incentives, a method more attractive to majority Republicans and more respectful toward the business community.

Here’s the issue: How can you make it attractive, and affordable, for the uninsured and their employers to buy health insurance?

Two knowledgeable legislators, Spokane’s John Moyer in the Senate and Phil Dyer of Issaquah in the House, have one set of answers to the question. The state’s health care reform commission has another. The commission’s detailed report, prepared at public expense and shaped by extensive public input, deserves the Legislature’s attention as the Moyer-Dyer bill is refined.

The commission proposes intriguing amendments: Make basic coverage more affordable by offering large deductibles, plus limited price breaks for the young and those with healthful lifestyles. Look at tax breaks to reward small businesses for beginning to insure their employees. There’s more.

Health care and its costs affect everybody. The Legislature needs to take some time with the issue. Reform shouldn’t be viewed as one take-it-or-leave-it law. It’s a process of learning and revision. We have to keep at it.

The following fields overflowed: CREDIT = John Webster/For the editorial board