Sue Lani Madsen: Security and freedom

“Those who desire to give up freedom in order to gain security will not have, nor do they deserve, either one.” – Thomas Jefferson

There is common ground on health care – the system isn’t working. Everyone has favorite anecdotes about what’s working the worst, either before or after the Affordable Care Act or both. Lots of both.

On Saturday, a group called “Healthcare For All – Washington” is hosting meetings in nine locations around the state. The Eastern Washington meeting is at 2 p.m. in the downtown branch of the Spokane Public Library.

If you are a conservative and choose to attend, expect to hear many progressive voices. Somebody might chant “Medicare for all” as the magic solution. Remember, they mean well. They want everyone to be able to go to the doctor when sick, even if they’re broke. Nobody should be left out, and nobody should suffer financial catastrophe. Those are shared goals, even as you question the government’s ability to meet those goals without making things worse.

If you are a progressive, be aware there are conservatives sharing the room. They may not speak up, fearing false accusations of “You don’t care if people die.” Remember, they mean well. They don’t want to spend money wastefully. Everyone should have choice and control over their health care. Health insurance coverage should be disconnected from employment, freeing both employers and employees. Those are shared goals, even as you question the private market’s ability to meet those goals without making things worse.

It really can’t get any worse. Unless we all stop listening to each other.

Healthcare For All wants a hearing on House Bill 1026, introduced into the Washington state Legislature at the beginning of the 2017 regular session after a similar bill died in 2016. It would create the Washington Health Security Trust.

Dan Schaffer, a retired primary care physician volunteering with Health Care For All – Washington, said the advantage would be having everyone covered, with no deductibles and small co-pays. Businesses would no longer be burdened with choosing their employees’ insurance. He admitted the disadvantage of public funding means “the terrible ‘T word’: Tax,” but the tax is intended to be offset by savings in not paying health insurance premiums.

HB 1026 would create a new state bureaucracy operating a single-payer insurance system, displacing private insurance. Everyone complains about care decisions made behind closed doors by insurance companies, and “at least a public entity is open and accountable to review – that’s the intent,” said Schaffer.

Good intentions, but currently the only single-payer government insurance systems are the Indian Health Service and Veterans Affairs. Nobody is chanting “VA For All” and extolling the virtues of their transparent administrative processes.

The attraction of Medicare For All is its seeming simplicity compared with the confusion created by the Affordable Care Act. No one can easily navigate the bronze/silver/gold/platinum maze of co-payments, deductibles and networks. Medicare is not single-payer health insurance, has its own inefficiencies and relies on private market supplements to its basic hospitalization coverage. But it has an existing administrative structure, even if it needs renovation.

And that could help solve the challenge of choice. Even the choice to make poor choices.

The most hated feature of Obamacare was being forced to purchase insurance under threat of fine. The fine has been removed but leaves the question of what to do about the invincible risk taker who has a catastrophic illness, half a million in medical bills and never bought insurance.

Instead of creating a new bureaucracy, two former candidates for Insurance Commissioner, Curt Fackler and Brian McCulloch, suggest thinking more creatively.

Use the existing Medicare infrastructure to administer $50,000 stop-loss coverage for everyone, a common practice for self-insured groups. Medicare and Medicaid still provide a safety net. Insurance rates are managed in the marketplace with maximum choice. Everyone benefits from a large catastrophic pool with maximum security. No fines for being uninsured, but treat uninsured medical debt similarly to student loan debt in a bankruptcy – difficult to discharge.

Cautionary tales from the basket of invincibles who learned hard financial lessons, plus actual affordable insurance, would drive cultural change toward full coverage more effectively than threat of an IRS fine.

Think creatively, discuss civilly. Solutions that will last longer than a single presidential administration must respect both security and freedom.