Fed up with what it calls health insurers' "stranglehold" on Washington state, a grass-roots coalition of doctors and consumer groups is promoting a November ballot initiative that would create a single-payer healthcare system to cover all state residents.
The group, called Health Care 2000, filed an initiative with state regulators earlier this month that would guarantee coverage for Washington's poor, unemployed and chronically ill. The system would pay for all necessary care, including prescription drugs, glasses and hearing aids, mental healthcare, substance-abuse treatment, alternative medicine and long-term care.
Health Care 2000 will begin collecting signatures for the initiative in March.
"The idea is simple," Health Care 2000 President Stuart Bramhall said. "Ensuring primary care is cheaper than paying for hospitalizations. And that lowers the cost for everyone."
The proposed system differs drastically from the current one. It would be run by a board of trustees appointed by the governor and confirmed by the state Senate-rendering health insurers superfluous. The state would file to be exempted from Medicare and Medicaid.
The system would differ from the best-known type of single-payer healthcare financing, the Canadian system, because it would keep a tighter grip on costs, Bramhall said.
"Canada is like the Model T," she said. "When their system was implemented, no one was concerned about cost control. Fortunately, we've been able to learn from their mistakes."
A single-payer plan for Washington would cost roughly $17.5 billion per year. But it would save $2.3 billion annually by streamlining claims processing and eliminating administrative waste related to advertising, lobbying, eligibility reviews, and exorbitant salaries for chief executive officers, according to Health Care 2000 Executive Director Cindy Laws. Costs would be controlled partly by capping administrative expenses at 8% (vs. 20% to 25% in the current system), charging copayments, using physician report cards and creating incentives for preventive care.
If approved in November, the new system would require all employers to pay a 10% payroll tax. Individuals would pay monthly premiums of $75 to $150. Small businesses that don't offer insurance would be subsidized.
But getting the initiative passed could be an uphill battle. The insurance industry is a powerful lobbying force, and the November ballot will include several alternative initiatives to modify the state's healthcare system.
State legislative proposals this year focus on allowing consumers to sue their insurers and amending 1993 healthcare reforms that led to the collapse of the state's individual insurance market. The amendments are designed to help the many self-insured individuals who can't buy coverage.
But proponents of Health Care 2000 believe the system is beyond repair and should be dismantled and rebuilt.
"Our system has been plagued with problems since the early 1990s," Laws said. "Now those problems have festered. The number of uninsured has grown from 400,000 to 700,000, and even those citizens who can afford individual health insurance can't buy it at any cost. Premiums are soaring . . . and doctors are opting out of their contracts because their reimbursement rates have fallen."
Representatives of the insurance industry, however, said a single-payer plan would limit consumer choice.
"A single-sponsor system offers only one supplier to meet demand. We believe the best solution is to have multiple suppliers competing for that demand," said Trent House, executive director of the Association of Washington Healthcare Plans.
"Our consumers want the choice of multiple plans and options, and you can only have that choice in a dynamic market," he said.
For now, the Washington State Medical Association, which represents 8,000 physicians and surgeons, hasn't taken an official stand. It's conducting a study on universal coverage and expects results this summer.
"Our membership is very split on the issue," said WSMA spokeswoman Jennifer Lawrence Hanscom. "Some are for a single-payer system, while others support medical savings accounts. Still others are undecided."
Health Care 2000 isn't alone in its effort. Coalitions in California, Illinois, Maryland, Massachusetts and Oregon are drafting similar initiatives.