— from Dale Heisinger for Coalition for Orcas Healthcare —
When Island Hospital departed Orcas Island, a coalition of citizen volunteers organized an election to allow voters to establish a Public Hospital District (PHD). The goal of the PHD is to ensure access to primary/urgent care for all the members of our community in a financially sustainable and dependable manner now and in the future.
The coalition has provided information and answered questions for the past six months. The coalition, however, is not the Board of Commissioners of the PHD. The coalition does not endorse any candidates and cannot answer on their behalf.
Once elected, the Commissioner candidates now identified are the ones who will decide on issues important to voters. Therefore, if voters are concerned that the UW or any other clinic will not respond to the needs of Orcas Island residents, they must elect commissioners who will exert their authority and responsibility to require responsiveness and accountability from the practices they fund.
To learn where candidates stand on the issues, it is incumbent on all of us to attend Town Hall and neighborhood meetings and to go to any candidate Facebook or web pages. Your involvement now is the best way to make sure your voice is heard, your needs are understood, and your priorities are met.
Additionally, candidate e-mail addresses are posted at: https://weiapplets.sos.wa.gov/elections/Candidates/WhoFiled?countyCode=sj
I’d love to read the candidates’ positions on funding health care for low income islanders — while it may seem to others incumbent upon we citizens to show up & talk to & hear positions in person, this citizen would much appreciate a web presence wherein each candidate would state their positions which would be available to All & provide information upon which to base our votes. Many of us are not retired &/or available at the times chosen, so may I suggest that it’s incumbent upon those running to state in writing what their positions are? I don’t mean to be unreasonable, but am struck that No One in this forum has answered my specific questions about guarantees that this large ongoing tax would provide health care to the uninsured and underinsured in our community. If the candidates’ commitments in this regard are available somewhere already, great, point me there would you? If not, please provide.
I don’t know that anyone is really confused about this issue of Coalition v. Commission.
I do know that there are many people concerned that the individuals that are up for election (if you want to call multiple unopposed candidates an “election”) were/are also part of the group that campaigned heavily to put UW medicine in the Medical Center building, obligating our community to hundreds of thousands of dollars in payments. A large segment of those voices make up the Coalition as well. I pass no judgment on the work of UW medicine, but the potential conflict of interest raises many concerns about future decisions that will be made with public tax dollars.
The creation of a consistent level of quality service 24/7 on Orcas Island I believe is a monmental task given the Island’s minimal tax base and I believe (hope) that’s the primary goal of this initiative.
Unless UW will provide those services for free I’m not sure how you guarantee the provision of any service that doesn’t have sufficient funding sources from the vast majority of the program’s users and potential users both. A lopsided subsidy system is not financially feasible wherein a few pay for the many. Until and unless the national
Government steps in and completely socializes the delivery of medical care nationwide with its much more sizeable scale, a premium based system wherein services are paid for for the vast majority of recipients is necessary as a fact, regardless of politics. We all have an example to share but one who lives part-time in a State with the nation’s largest subsidized pool of those needing care (and who are perhaps the least healthy among us), to boot, a sole proprietor like myself must shell out close to $2000 per month for a plan most good doctors won’t take and tht carries with it a $9,000 annual deductible. That means even the occasional flu isn’t covered. This is what a lopsided subsidy strategy has created in New York state.
As a result, gainfully employed sole proprietors or owners of small family owned businesses simply cannot afford Obamacare (or TrumpCare) as they now exist. Many of these full time working families simply go uninsured until a need arises and then pay the penalty (soon to be going away) as the rule regarding pre-existing condition coverage incentivizes this strategy.
The quickest practical solution is for the pool of payers to increase.
The ugly truth is that systems based on lopsided contributions snare mostly the vast hard working middle class, never the rich and never the poor.
I would hope this initiative would be a reality based concept to provide real medical services on Orcas island around the clock at an affordable price and on a consistent basis.
If so, this requires the greatest number of people paying into the program.
The Coalition has an excellent web site with a wealth of information along with backgrounds and statements by the candidates. You can find that at http://www.coalitionfororcashealthcare.com
You can also find questions of the candidates and their answers at http://www.MadronaVoices.com. You can also find the results and analysis of the recent survey on the proposed hospital district.
Yes thanks Steve
I’ve seen no information about UW’s obligation to provide care to the uninsured or underinsured.
Neither have I, Peg. I wonder if any of the candidates will choose to address this?
Both medical practices on the island have policies or protocols regarding “charity care” or providing services to uninsured or uninsured patients. Anyone may ask them for their written or informal policies. Contact information for the UW clinic manager is published in this week’s Sounder. Both clinic websites have “contact us” buttons.
The PHD on San Juan Island directs its funding to it’s hospital’s mandatory “community benefit” effort. Community benefit usually includes charity care. The elected commissioners could designate PHD clinic support to include that purpose. That would be a reasonable question to ask candidates.
This is math and basic economic modeling.
Our economic model since the country’s inception (and only somewhat amended by the New Deal) simply does not support a society with a sizable “subsidized” population. Why? Because it’s not compatible with our country’s economic model; changing the model, if that is the intent of some, will take generations and still may not happen due to large swathes of the population being more in favor than not of no caps on one’s abilities to fly solo and as high as he/she desires.
At the end of the day, UW is part of the US’s economic system. They simply can’t afford free medical service past a certain (population) point and remain viable, not just financially viable, but move forward on all of their other fronts, namely, quality medical education, innovation and medical advancements, generally.
Time and time again we clamor for more protection and free and/or subsidized services irrespective of the above hard-wall macro facts and conditions; and when the response by those to whom we clamor is muted or less than satisfying we make the problem worse by blaming the wrong people for a macro-condition neither of their making, nor within their power to alter.
The bottom line is there isn’t yet a viable model to provide anything free in this country past a certain population point/number. Ours is and will likely remain, given global trends and the comparative purchasing power of nation states, a pay-in-to-receive economic system.
In other words, the overwhelming vast majority of our working age population must pay into the system with real dollars in order to receive services like health care, roads, schools, etc. If not, the system fails and the result is what we are beginning to see now: more stark partitioning and divisions between those who can afford quality services (not just limited to healthcare) and those who cannot for any variety of reasons.
In the end, compassion and charity are built into our systems but both rely on one fundamental assumption above all else: that the overwhelming vast majority of working-age adults are paying into our system and paying taxes. Hence: the importance of jobs that pay.
Chris, I agree with most of what you have to say. In addition, the healthcare environment is a moving target. (It may even happen that by the time the revenue for the district actually begins rolling in, our leaders in Washington and Olympia may have accomplished something to rationalize our disconnected and expensive system.)
My FIRST concern about the initiative as proposed — apart from the concerns expressed by Leif, which I echo–is that the initiative petition seemed to wildly overpromise and, if it becomes law, those promises could easily come home to roost with no revenue to cover them. Assuring high-quality primary care to all comers into the future is a big undertaking.
On Lopez, the Commissioners added “island-appropriate” care to their mission statement so that people would not expect specialty and tertiary care there.
The second is that there is a breathtaking lack of data available to the voters and the Coalition. How many people live here and how many get their health care here? How many more would if they could? What are the demographics? How many are insured and by whom? How many residents visited each practice in 2016 or 2017? How many tourists? Certainly the two practices have much of this data; they collect it in their records and must present it to various payers to get paid. How much of the uncompensated care burden did each practice carry? Why was OIMF so expensive to run? What ratios will the Commissioners use to divide the subsidy it plans to distribute?
And why do we need to personally contact UW for its uncompensated care information? Isn’t that public? I know Dr. Shinstrom has his posted.
*lack of data AVAILABLE to the public
Peg, all very reasonable questions and the type of vetting that should precede voting.
Not having access to Orcas Island’s data, I would imagine many have insurance already and/or have medicare with a policy for the coverage gaps. I would also imagine that care for many property owners is obtained off island when needed or certainly when the need isn’t acute but perhaps even more serious and debilitating over time.
That leaves me wondering who will be receiving the bulk of care and how will it be paid for and by whom? I’m still not clear on how the funding is to be raised but I’m fairly certain most homeowners already pay exhorbitantly for their medical insurance as do I. Are we to pay even more now than we already pay? Would everyone who would receive care be required to purchase an insurance policy? Are the homeowners on Orcas Island meant to step in and take the place of State and Federal government in providing a private form of medicaid? Is UW expected to play that role with its own budget? Lots of questions.
What I have read leads me to believe that property owners are to be taxed and that this will be the primary source of funding. Am I wrong about this?
If i’m right, does this thinking take into account that these very same people to be taxed already pay high premiums for medical insurance?
I doubt that many can drop what they have and so they’ll pay for their own, which they can hardly afford, and then have to pay for others?…and end playing the role of federal and state government as insurers of last resort? Am I missing something?
If this is the proposal, it’s not viable or sustainable and smacks of being draconian in the assumptions it implies and thereby would be making; further, it would represent a form of involuntary usurpation of power (and is very un-American).
I can envision a program so thinly financed as ending in a bust with lots of lingering liabilities, obligations and law suits; and either UW throwing in the towel or quality care as assumed simply not provided. Yet the taxes and money would then go where?
There must be accountability or it will be imposed legally and painfully the hard way.
These issues and questions you raise should be sorted out before, not after, the fact.
Looking forward to having any of my working assumptions corrected and any helpful links provided.
I received a survey from Madrona Voices and went to their website for more info. I for one would truly like to see the delivery of reliable quality medical services on Orcas Island based on access to UW’s resources. I’ll use it myself and gladly pay what I hope would be a reasonable monthly premium.
What I’m not understanding is what would the funds raised by taxes be earmarked for? Establishing and running the facilities? To subsidize people who arent paying into the system? I’m also concerned with the realities on the ground with these tax and spend initiatives that often underestimate true costs especially for medical servies and drugs which have no cost caps (and when they do its actually your service and care that end being capped).
I havent seen a system yet that has figured this out: good timely service with choices at an affordable rate.
Orcas Island is a small base from which to launch this enormous project with little or no controls on potential use; the mounting costs and inflation combined with no controls on usage will quickly overwhelm the project precisely because no proscribed limits or conditions will likely be placed on access. The nature of this undertaking is by definition highly personal and emotional; once begun the project can’t be easily tailored, if at all. The result is failure at a high cost on many fronts.
The end result may be that the project fails to provide any material benefit to those paying for it and what services are provided slowly erode as costs rise.
So one natural questions is what limits if any would be placed on the use of and access to services?
My experience living some of the year in a system overwhelmed with subsidies is that based on all metrics the entire medical eco-system substantially declines in the quality care provided leaving those who contribute via taxation and premium payments, both big and small, very dissatisfied and finally underinsured or uninsured; and quality medical care unavailable except for those willing to pay exorbitantly high monthly premiums with high deductibles, and where no primary care or special routine office visits are exempt from the high annual deductible—this means the flu isn’t covered despite the high monthly premuim paid. The only freebie in these heavily subsidized systems is your annual physical and there, too, not all is covered.
The ensuing mess, if this becomes an endless pit of earnarking more and more money in return for less and less quality medical service, raises unpleasant realities seen in many places throughout the country.
Do we want to import such a model to orcas island by attempting a project too large for the island’s financial capacity?
We certainly need more clarity and perhaps some definitions limiting the parameters/actions of commissioners elected to run the project so that we can prevent even bigger problems from developing and have some built-in breakers, especially as this project seems to be financed on the backs of so few people.
For now, it seems a real mismatch of need and capacity without the inclusion of very defined parameters and controls.
Chris, part of the reason you are not finding answers to your questions is that the people who will make the decisions are not elected yet. Until they are, the decision makers don’t exist.
We may not like how we have to vote on whether to have a hospital district before we know who the decision makers are or what they will do but in this case we actually do know who at least 3 of the 5 will be and they have told us what they plan on doing. Unlike many places throughout the state that have already gone through this process, we have the advantage of knowing who most of the commissioners will be and what they are likely to do. Read their statements on MadronaVoices.com. Their phone numbers and email addresses are posted online on the county web site and they have been attending numerous meetings explaining their positions.
In reality, we are choosing commissioners that have a lot of latitude in what they will fund and what metrics they choose to use when deciding how much to subsidize a service. The only limitation they have is a total amount that they can tax. At most, they can tax about 1.7 million a year. The amount this can increase by each year is limited by state law.
How the process of the election works is also governed by state law.
Commissioner candidate information, contact info and position statements are online at:
https://www.coalitionfororcashealthcare.com/canitate
A transcript of candidate responses to questions asked at the 3/24/18 Candidates Forum are online at:
https://www.coalitionfororcashealthcare.com/town-hall-meeting-2-23-2018
Responses to candidate questions asked by Madrona Voices are online at:
https://www.madronavoices.com/phd-interviews/
Thank you, Steve. Good advice.
As I was reviewing madronavoices.com I noted statements from the candidates and am now becoming more informed.