Ah, Relief That Acts Eventually, Maybe

The last time Washington’s Legislature tried to fix what ailed the health insurance market, it tried the power of regulatory force. A year later, voters booted Democrats out of office and most of 1993’s reforms, but not all, were repealed.

Now, the health care issue is back, along with a different set of headaches. And the Legislature, politically divided, is looking for a cure. Again. However, the odds are poor that it will find some miracle-working policy in the high-pressure environment of the special session that began on Monday.

Whatever the Legislature proposes to do, someone can be counted on to fight it. Insurance companies, big businesses, small businesses, hospitals, doctors and ideologues with political ambitions all are working hard to defend their own interests.

One group has not been so successful: Consumers. Working stiffs don’t have lobbyists. They just have legislators. And legislators have difficulty sorting out the conflicting claims.

Meanwhile, out in the real world, people continue to struggle. In the early 1990s, the problem was double-digit inflation in medical costs. Since then, managed care and technological advances such as outpatient surgery have clamped down on costs - though inflation is rearing its head again. Today’s problem is a lack of clarity on what the problem is.

Managed care annoys consumers and physicians, who object when insurance companies interfere with medical treatment options.

Insurance carriers aren’t happy, either. The state regulates them aggressively. They’re losing money on their core business and making up for the losses by investing cash flow in the stock market. Most have stopped issuing individual health insurance policies, essential to small business and the self-employed.

It should be obvious that the system needs willing insurance carriers and that profits are what make insurance carriers willing. However, the annoyances of managed care make public opinion reluctant to trust the insurance industry with greater freedom.

Given more time and a bigger crisis, the Legislature may be forced to admit that the state is part of the problem. When it partially repealed the 1993 reforms, it left in place some mandatory-coverage entitlements that give consumers the impression they can buy insurance only when they need care, then cancel it. Insurance can’t work that way. It’s affordable only when the customers buy insurance and keep it, through good health and bad.

While a majority of state residents do have coverage through their employers, they’re getting this essential product from an ailing system. The vanishing individual market, thin profits and coverage hassles between carriers and sick people are a sign of trouble. Even if legislators do nothing this spring, by next year the problems may be so serious that they will be impossible to avoid.