Process questions dominated Washingon state's Universal Health Care Commission meeting again this month. There were phases of work being outlined, charts to see and a chicken-egg discussion about where operational and governance roles bounce off one another. 

The commission will be advising the Legislature on steps to take now to pave the way for a universal system in our state. At the last meeting, they talked about the need to get more people under the government’s health-care tent to help convince Washingtonians that this is manageable. Energy for that continued this month and was helped along by the Inflation Reduction Act.

Billions of dollars will be going to extend the COVID-related Affordable Care Act subsidies that were set to expire this year. Read more about the federal Act here, but on a state level, know it’s going to cost us mightily, as the Medicaid safety net is funded by the state and federal governments. As Roger Stark writes for Washington Policy Center, “These subsidies have mostly benefited wealthier families, who already have the financial capability to pursue other health insurance options.”

At the Aug. 16 meeting, the Universal Health Care Commission also discussed increases to Medicaid reimbursement rates that it will be advising, established a technical finance committee to guide its work, and talked about initiating conversations with the federal government about needed waivers and alignments. Coordination between the two governments would be no small task. 

A final package is being formed, and the state’s Health Care Authority should have a final report for commissioners to vote on when they gather on Oct. 13. 

I worry the commission continues to ignore experiences with implementing or running universal, single-payer systems in other jurisdictions. It is ignoring the reality that lower costs, higher-quality care and better access have not gone together. I offered the following comments:

 “The intentions of this board and of people across the state who want universal healthcare and a single-payer system are good. But that doesn't mean overhauling the system we have for universal, single-payer health care will be good for our state or for individuals' health. We're seeing the handwriting on the wall right now with full hospitals, a stressed workforce, lower-quality care, less access and more limitations on health care services. 

When fewer people pay for healthcare — as is happening under federal and state legislation, and matching the goals being discussed by this commission — and when fewer third-party payers compete for people's health care dollars, we will likely see lower quality and access and more stressed-out medical workers.

This commission needs to be sure to look at failures in universal, single-payer health care and be realistic about the inability to realize the fantasy trifecta in a government-run system of lower costs, increased quality and better access. 

We need to strengthen government safety nets, not widen them. We need to emphasize personal responsibility and priorities. We need to educate and put people in charge of their health care dollars. And we need to encourage more competition and a free-market system for health care, which has a real shot at tackling increased, unsustainable health care costs. 

Please let me know if Washington Policy Center can help you with more research or information about a better roadmap for our state.”

The commission and the finance committee it is creating are going to try hard to show a cost-benefit to a new, universal system and dazzle state residents. I hope they don’t ignore other parts of the equation, such as quality of care and access that Washingtonians enjoy and expect.

Materials provided for the Aug. 16 Zoom meeting are here. A recording of the meeting can be found here. Information about the next Zoom meeting from 2 p.m. to 4 p.m. on Oct. 13, open to the public, is available here. 

During these meetings, there is time for public comment that you need to sign up for by 5 p.m. the day before a meeting. Write HCAUniversalHCC@hca.wa.gov to do so.