by Bill Bangs, Orcas PHD Commissioner Candidate
A number of people have, quite properly, raised the question of what an Orcas Public Hospital District (PHD) would do to ensure care for all islanders, including the uninsured and underinsured. My position is that any practice or provider would need to satisfy certain conditions before they were eligible to receive public funds. Here are two such conditions that I would like to see imposed.
- A provider must accept, as payment for primary and urgent care, all government-sponsored insurance plans (including Medicare and Medicaid) and all private insurance plans approved by the State Department of Insurance.
- A provider must have a financial assistance policy that is at least as generous as the Washington State charity care law (RCW 70.170.060) where “hospital” is extended to apply to primary and urgent care clinics receiving support from this district. I believe that this says, among other things, that access to medically necessary care shall not be based on ability to pay (although the final cost to the patient, if any, will be based on that ability).
I cannot speak for the two existing practices, OFHC and UW Medicine. However, it appears that both assert that they currently satisfy these conditions. See https://www.orcasfamilyhealthcenter.org/pages/care-for-all/ for OFHC and https://www.uwmedicine.org/patient-care/billing/financial-assistance/policy for UW Medicine which explicitly states that you are eligible for financial assistance if you are at or below 300% of the federal poverty standards. For a family of four, this means you are eligible if your annual income is $75,300 or less (see: https://www.payingforseniorcare.com/longtermcare/federal-poverty-level.html).
Of course, policies are one thing and actual practices are another. The PHD should monitor the providers to verify that they are living up to the spirit as well as the letter of these conditions. Should the PHD operate a “complaint management system” (as I’ve previously recommended – https://www.madronavoices.com/wp-content/uploads/2018/02/Bill_Bangs.pdf ) then issues arising from real or perceived policy deviations can be addressed.
Thank you, Mr Bangs.
What’s new or novel here? The same same same
is a failure!
I’m all for being practical and realistic. But this means recognizing what Washington State, any other State in the Union, the Federal Government, any other University Hosptal medical
Center (Cornell, Columbia Presbyterian, Harvard) and yes Washington State Medical, too, have all failed to provide consistent care at affordable rates but instead have offered: paraboloc rising costs, a withdrawal of services, declining metrics, fewer choices, longer wait periods, financial punishment for second opinions, denial of coverage for necessary medical procedures that work but cost more, and on and on and on, etc.
In short, the standards and models you suggest don’t work now, have not worked before and are heading no where short of decline in all respects that matter to human beings.
The vast majority of Americans can relate to this especially if they aren’t cogs in the wheel of a large “corporate” universe.
So, while I agree that we don’t toss out what isn’t perfect but try to improve and in the meantime live with a declining scale of service and quality of life for those not flush with money, why do we need to import an HPD onto Orcas Island with all of its concomitant risks in exchange for the less than ideal system we already have in place?
There’s seems to be no rational basis for this effort and expense to property owners and/or residents alike who will end not receiving the care needed.
The obligations the island assumes for taking on this project with little or no prospect of improving healthcare for the island’s residents over the medium to long term, given the lack of anything novel in approach (which has already proven to be unsatisfactory), seems to call into question this entire effort as perhaps misguided (feel good stuff, for sure…but at the end of the day still ineffective).
I see nothing novel here to suggest that this approach will usher in a healthcare solution…only a tax without a net benefit to anyone.
Well said Chris Graham
We need a better plan before we buy
The Pie in the Sky
Thank you Bill, and others running for PHD commissioners, for being willing to grapple with healthcare that is badly broken in America. We don’t have the option of “just say no” unless we are also willing to embrace no pie, no sky and no medical practice on the island that is financially viable and sustainable. If we refuse to move forward AND try to fix OUR problem well then we can travel off Island to gain access to the same broken system over which we would have zero control.
Lief,
I understand your points but what is proposed does not work. It’s nothing new.
Travel the country, tens of thousands of large and small communities alike will show you your proposed sysytem upfront and personal like. It doesnt work.
Our healthcare system is a functioning system in decline that once it reaches its extreme dysfunctional state causes an uproar in the public and a call to action a la what we now see happening on Orcas. And what’s the soultion? Repeat and fail again—but with new money from the private citizens of Orcas Island.
The difference here is you are asking property owners to pay for this failed repeat, digging deeper into private coffers for money better spent on other needs in each person’s struggling household.
It’s not right; it’s clearly not fair.
This kind of policy and mindset is exactly why we we’re where we are today as a nation…
Do we really need to prove the same system being discussed here is a failed system the only difference here being the island wants to now take on the burden and role of being a Sfate or Federal government, an entity-insurer of last resort? It will not deliver because there are too many moving parts (like parabolic costs), which Orcas Island cannot control.
But we already know this, right? Yet we proceed with the same mindset, the same broken system. You need proof, still?
I think not.
Ours is a system of representative democracy, not mob rule.
You have to travel back to 5th century Athens to see it, contextually, that is, if you want to retain some semblance of intellectual honestly (use only primary sources? How’s your Greek?).
Once there you’d see the first iteration of “representative” democracy in that only those with skin in the game could vote because, the rationale was (and arguably still is today), that only with the invested stake of your drachma (Drachma of Aegina) (i.e., dollars) on the table, being the truest most visceral cleanser of faulty thinking there has ever been, do people eschew irrationally based proposals and thought.
Clearly, we need an expansive definition of “representation” today (as we have) but the animus and cold rational thought undergirding this invention of the Golden Age of Athens is based on logic and a rational clear-eyed observation of the human codition and how humans behave, i.e. human nature.
I must report that logic and empiricism demonstrate clearly that human nature DOES NOT evolve.
With the help of scientific instuments we see the physical world around us including our own physical bodies “physically” evolve (if you lived long enough you’d need nothing but your unaided vision) and yet we then assume the same evolution applies to our natures, our human condition, our primordial instincts of fear and flight, survival, the need to covet, jealously, envy and yes helping another as this often further guarantees your own survival (an enlightened version of self-centered behavior or selfishness).
About 2.5 million years ago at the dawn of the paleolithic age up until about 9600 bce, at the end of our last ice age, our human nature used clubs, spears, arrowhead tips made from stone and all assortment of lesser “evolved” crude instruments to express human nature in vivid and often violent fashion; fast forward this so called evolution of human nature and we find gun-powder, cannon balls and muskets….fast forward yet again in this so called jouney of the evolving human nature and we have automatic weapons, grenade launchers, IED’s, thermonuclear and nuclear weapons (which we have used).
Our physical world has evolved based both on empirical and a priori evidence, including our toys of weapons. But our nature? The human nature of the man or woman who invented and now hold and use these evolved toys?
Proof? Really? Well, we have 2.5 million years of empirical evidence.
Believe it or not, this ties back to healthcare choices being made now by us on Orcas Island.
We eshew rational behavior and delude ourselves daily. If we look at the preponderance of available working trials of this un-novel proposal which alleges to be tailored made for Orcas Island (as if we live In a bubble unaffected and beyond the micro and macro forces and trends that have placed our healthcare system on its own version of life support), we behave now quite predictably, quite human but not nearly our peak performance or capabilities.
If we want to try to at least fashion together a new interrupting tool, if this is currently possible in today’s marketplace, then at least we will have used an evolved tool to better our chances of success.
What we have in the present PHD proposal is not that evolved tool. Only the weakness in our natures prevents us from seeing this clearly. That’s why those with skin in the game are pushed to be more rational. But this does not say that I dont want an improved new and improved system; I don’t mind paying my part for it either if it were presented. It’s that there’s nothing novel or new here.
Instead, this reeks of desperation, not the product of a cool, calm and deliberative set of minds.
We are capable of being rational despite our natures; it’s just not one of humanity’s instinctual habits. We must work at it and eschew the lazy mind and the poor thinking it produces.
Honestly, lets be clear.
We are assuming that every mechanism repeated above and elsewhere regarding the pooling of resources, accessing the scales of larger networks off island for cost control strategies when this suits the island’s needs, and remaining local to chart our own course for more locally-based needs when this is the better strategy—-we assume naively that any of this is novel. None of it is new. It has failed for economic reason! But now you ask that we pay for this failed idea and assume the concomitant risks it will bring to the island.
Getting into detail to avoid the over-arching ineffectual reality of a PHD system is disingenuous; it’s a diversionary tactic to turn common sense on its head; what’s shameful is how such little common sense is permitted these days in the village square.
Well, I applaud you and your work…a critically important contribution to society. Thank you.
Know that my heart is in the right place and that i want the best outcome for the Island.
(As i’m sure does everyone else)