A cure is coming for health-care ills

Estimates of the amount of money to be saved by overhauling the nation's health-care system are starting to trip over one another. The numbers range from gigantic to ginormous.

Disputes and differences are over the scale of savings — big and bigger — not the fundamental truth that a failing health-insurance regime needs reform.

The public is way ahead of politicians on the need for change. Polls consistently show Americans favor expanded health-insurance coverage for all — by huge margins. The punch line has always been that their genuine enthusiasm for change is diminished by expectations of higher costs and reduced benefits for themselves.

Turns out higher costs and degraded benefits are precisely what they are getting now. Coverage is eroding for the insured, and young adults can no longer assume health insurance comes with their jobs. They most certainly cannot afford the exorbitant rates and skimpy coverage of the individual market.

"The U.S. employer-based health-insurance system is failing," according to the Committee for Economic Development. The usual suspects of lefty rabble-rousers and fanatics for socialized medicine? Actually, no. CED is a respected think tank.

Along with erosion of coverage for workers, the CED sees the competitiveness of American firms is threatened by the cost of health insurance.

U.S. companies are in global markets where competitors are not burdened by employee health care in the price of their products. Detroit automakers famously lament that the cost of health insurance exceeds the expense of steel in cars. They know manufacturing overhead is lower next door in Canada.

Both political conventions were a disappointment on the topic of our health-care crisis. The Democrats were caught up in burnishing foreign-policy credentials, and the don't-call-us Republicans were busy not mentioning President Bush.

Broad exploration of the options beyond employer-based health-insurance coverage are coming from the same source as most of the original thinking and leadership on global warming: the states.

On both the environment and health-insurance reform, making a virtue out of saving money and doing good makes the business community a natural, powerful ally.

Maine, Massachusetts and Vermont are works in progress with variations on the themes of health-care reform and universal health-insurance coverage. Illinois insures all children. States in the double digits are exploring options.

Washington is among the most expansive, creative and careful. Last legislative session, lawmakers established a citizens' work group on health care. Five proposals are under initial review by a consultant, Mathematica Policy Research, whose analysis is due in December. Next, the citizens' panel — to be appointed by whomever is governor in January — would take the findings around the state for public comment.

The plans vary in breadth of coverage and intent. One looks specifically at how to improve rates of coverage among young adults and small employers. Another seeks to provide comprehensive coverage for all residents. There is a Washington version of a single-payer plan gaining traction in Congress. Plus, there is also cost-benefit analysis of a guaranteed health-benefit plan from Insurance Commissioner Mike Kreidler.

State Sen. Karen Keiser, D-Kent, is an energetic proponent of the Washington Health Partnership, which would have employees, employers and the state pay into a pool. Health insurance might come from private insurance companies or via self-insurance. Coverage would be comprehensive, not a "skinny or catastrophic plan," and not contingent upon where a person worked.

With Keiser, chair of the Senate Health & Long-Term Care Committee, coverage would be universal. Everyone not on a federal program is in and pays, and the system is designed to eliminate people timing entries and exits to game the system.

The savings to be found in Keiser's vision and other approaches are in keeping people healthy, treating sick people sooner and standardizing paperwork and billing systems.

Change is coming. Bill payers and the insured agree, they are not receiving their money's worth.

Lance Dickie's column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com; for a podcast Q&A with the author, go to www.seattletimes.com/edcetera