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Sue Lani Madsen: Vermont couldn’t do it, why Washington

Washington state’s majority party has been pursuing universal single-payer health care as the generic cure for America’s health woes for years. Unfortunately, when government-controlled systems are the only treatments you’re willing to consider, it’s easy to rationalize the diagnosis to match the prescription.

The Universal Health Care Commission report to the Legislature builds on the work of the Universal Health Care Work Group report. This statement from the commission’s 2022 report is indisputable: “The United States pays more on health care a per capita basis compared to countries with universal health coverage models.” Yes, we spend a lot on health care but it doesn’t necessarily follow that a single-payer system in the United States would change that.

The same report also points out differences in population, lifestyle, governance and taxation make it hard to tell if single payer would be feasible in the U.S. Overall, outcomes for the money spent are mixed. The report says the U.S. does better compared to its peers on some measures of preventative care but deaths due to manageable chronic diseases are higher.

Rep. Joe Schmick, R-Colfax, has often been a lonely dissenting voice on the work group and the commission, asking questions about the consultants’ optimistic assumptions. In an interview last week, Schmick pointed to his comments in the 2022 report noting universal health care would double the state budget. He says he can’t support dismantling the current system for an estimated savings of, at best, 4.1%.

“In Vermont, they discovered they couldn’t control the cost and they abandoned it” before it even got started, Schmick said.

In spite of caveats within its own reports, the state of Washington is plowing relentlessly forward because the controlling party is convinced it just has to work because they want it to work.

Vermont has one major insurer and a smaller, healthier and more homogeneous population. Politically, they’ve supported Bernie “Medicare for All” Sanders in Congress for over 30 years. And Democrats in Washington don’t seem to be learning their lessons.

As long as costs continue growing faster than the economy and medical inflation exceeds the new normal, health care is less affordable no matter who is paying for it.

The current situation has problems, “but we have to deal with what we have,” Schmick said. In his opinion, the five big health care systems in Washington seem more content with divvying up the state than competing. “We need to look at certificate of need and remove as many barriers as possible to have more providers coming in.”

The certificate of need process limits the construction of new hospital facilities even in areas of rapid growth. Schmick pointed to the years of delay and millions of dollars spent by Kennewick General to get permission to build a new hospital. “I’m not sure that policy is productive,” Schmick said.

According to Schmick, another promise coming from members of the commission for improved quality is provider control over care, but there’s no universal health care system that doesn’t have a board reviewing and limiting access to some treatments and procedures. “I believe they’re putting forth false hope … that hasn’t been the case anywhere else in the world that has embraced a single-payer system.”

Schmick illustrated the math behind the problem. If cost is the 100% baseline, Medicare rates pay about 60-65%, Medicaid currently about 30%. “Every single time the state pays a Medicaid claim, we’re counting on private pay to make up the difference.”

The commission proposes raising Medicaid rates on par with Medicare. Doctors came to the Legislature last year and said they needed about $125 million to make the move to the higher rates, but “in the budget they got a $9 million increase,” Schmick said. “That’s why we continue to have high private sector rates.”

The focus under single payer has been arbitrary caps on payments from the state. Labor is a major component of health care, so “who doesn’t get paid?” Schmick said. He wants well-paid nurses and “I’m worried about the critical access hospitals in my district, worried about the future and how they’re going to be sustainable.”

Remove all the critical access hospitals and everyone loses access while enjoying Washington outdoor recreation or simply traveling between urban centers on Interstate 90.

Another report to the Legislature is due by the first of December with financing proposals, starting with a new payroll tax estimated at about 10%. Vermont couldn’t do it, and they already had an income tax.

Accessible, affordable, good quality health care for all is desirable, but it’s not clear how the Democrats’ preferred models can accomplish this. We need a health care commission ready to look beyond a single failed prescription.

Contact Sue Lani Madsen at

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