A review of the events in health care reform in Washington State over the last decade is in order. In some respects, the health care reform debate in Washington State has mirrored that in the rest of the nation and in some respects the experience in Washington State has been quite unique and instructive.
Health care financing reform began to be seriously discussed by politicians and public opinion leaders in Washington State in the middle 1980s. Health care financing reform became a focus of Governor Booth Gardner’s administration. Legislative Resolution #4443 established a blue ribbon commission to study various possibilities of health care reform in Washington State, and the Redmond-Gardner Commission, as it came to be known, eventually recommended a single payer, Canadian type health care reform for Washington State, modeled to some degree on that in British Columbia. It should be noted this recommendation from the commission was voted on by its members and passed by only a one-vote margin with at least one member of the commission refusing to participate in the vote because of his distaste for what he deemed the preordained conclusions of the report. The commission’s report was finalized in 1992.
Meanwhile, Governor Gardner had decided to move ahead with legislative initiatives for health care reform accompanied by allies in our legislature. He introduced a “pay or play” proposal modeled to some degree on that which had been passed under Michael Dukakis in Massachusetts. However, vigorous debate in the legislature — punctuated by the AAPS disclosure the Massachusetts law had never been implemented because of predictions of massive loss of employment — defeated the “pay or play” proposal. One of the supporters of system-wide health care financing reform, Dennis Braddock from Bellingham, Washington, subsequently introduced an initiative to the legislature for a single-payer type health care reform package but this did not succeed in collecting adequate signatures to be referred to the legislature.
The elections of 1992 substantially changed the makeup of the government in Olympia, Washington. An admittedly very liberal governor was elected as were large Democrat pluralities in both houses of the legislature. These entities announced early on there would be system-wide health care reform passed in 1993 and, in fact, in the 1993 legislative session, a bill appearing in all significant ways identical to the Clinton Health Security Act (HSA) was introduced and passed. This legislation was then presented to the Governor for his signature, and a signing ceremony — with Hillary Clinton beamed in via satellite link — occurred at one of the local managed care facilities in April 1993.
AAPS had become extremely active during this debate and, in fact, as the legislative session was analyzed, it was discovered the bill had come within a hair’s breadth of defeat at several junctures during the process. AAPS members sensed there was a chance for significant modification or repeal and went to work.
The Clintons’ plan was announced later that year. The six months left for AAPS members to act, between the passage of the Washington State act and the introduction of the national HSA, allowed the AAPS time to refine and hone its message. The AAPS lawsuit against the Clintons for the secrecy in which their plan was developed, continued to bring forth damaging revelations, and helped crystallize opposition to the HSA.
Meanwhile in Washington State, it became quite clear that the Health Services Commission was going to promulgate regulations extremely unfavorable to private practice, and AAPS members stepped up their activity accordingly. The author of this article became active in a weekly radio show which became so popular that in mid-summer of 1994, with only 10 days notice, the radio talk show host and the author were able to gather some 3,000 people to protest a visit by Hillary Clinton to inaugurate her Health Security bus tour. Unfriendly receptions across the country dogged the Health Security bus tour such that it became a public relations fiasco and, helped seal the fate of the HSA. It also made clear who had supported and who had opposed the HSA nationally and the Health Services Act at the state level. I am also convinced AAPS activity during this crucial time contributed very significantly to the outcome of the 1994 election.
As you know, an almost exact reversal of the 1992 Democratic gains in the legislature occurred in November 1994. The House of Representatives in Washington State went from two-thirds Democrat and one-third Republican to two-thirds Republican and one-third Democrat. A large Democrat plurality in the Senate was negated with an essentially equal representation of Democrats and Republicans. AAPS members and policy leaders felt, therefore, the likelihood for significant “reform-the-reform” legislation existed.
In concert with a malpractice- insurance-specialist turned legislator, Phil Dyer, AAPS strongly promoted repeal of the majority of the Health Services Act. Because of some extremely elegant negotiations by Republican leadership with Democratic Governor Mike Lowry, the Health Bill #1046 was passed and approximately 75% of the Health Services Act was repealed.
Yet, not all is rosy in Washington State. As in much of the rest of the country, what managed care failed to accomplish legislatively has been accomplished through market penetration into employer-based health care plans. Plans are getting progressively restrictive with providers, and in what they will pay. However, AAPS is proposing legislation to introduce stronger potential for medical savings accounts in our state as well as a managed care disclosure package, not unlike that passed last year in Arizona. These are thought to have a reasonable chance of advancing through the state legislature.
The health care financing reform battle in Washington State has been illustrative in the effects a small but principled organization can have. AAPS in Washington State has found that the keys are good press relations, a formal organization of the state chapter, and a set of physician-spokesmen who are willing to take time from their practices to educate legislators and the public at large. It has been an honor to work with AAPS members during this time, and I think, it bodes well for the preservation of private practice medicine.
Michael Schlitt, MD is a neurosurgeon in Seattle, Washington and a member of the Editorial Board of The Medical Sentinel. He is currently serving as President, Washington State Chapter of the AAPS. His address is 4011 Talbot Road South, Suite 460, Renton, WA 98055.
Originally published in the Medical Sentinel 1996;1(1):33-34. Copyright©1996 Association of American Physicians and Surgeons (AAPS)