Comments for the

Blue Ribbon Commission on Health Care Costs & Access

Bob Crittenden, MD, MPH

Chair of Working for Health Coalition

June 16, 2006

The Working for Health Coalition is a group of thirty organizations that are focused on assuring that a strong health safety net is available for the people of the state of Washington.  As we all know, only by working together for the improvement of the whole health system can we improve the care for the working, sick, and vulnerable people who lose their insurance and access to care.

There are a number of principles that are needed to improve the system and improve the health status of all Washingtonians.

1. We need to think beyond simple coverage, which is absolutely needed, to include and make progress in improved systems of care and the public health infrastructure.    

2. We have a shared responsibility to improve the system and to finance those improvements – government, employers and individuals – all of us - must change what we do, how and how much we pay for care and public health, and work to improve the systems delivering care and services.

3. Financing needs to be equitable and not skewed as it is now with lower income people carrying the heaviest relative burden through out of pocket payments, premium and taxes.

4. We can change the health system through tough purchasing strategies and regulatory changes, and we need to be sensitive to the relative impact of changes on people with little of no access to care.

Steps to take in 2007: 

1. All kids should be covered for physical, oral, and mental health – there is no reason to leave any child without care, good health and ready to learn and prosper.    

2. Use the existing pharmaceutical law to negotiate better prices and make those prices available to consumers without good coverage.

3. Fund public health so we are ready for both the disasters and the common health problems that greatly affect our health.

4. Assist small businesses by subsidizing the coverage of workers who would otherwise be without coverage and at high risk of financial loss.

5. Take first steps through purchasing or regulation that ensures low-income employees have affordable care available to them in large and small businesses.

6. Strengthen the work of the private and public consortiums using their combined purchasing power to improve quality and restrain costs through evidence and smart buying.

Five-Year Vision: 

1. All people in the state should have access to an affordable and guaranteed choice in health coverage – either through private or public sources.

2. Strengthen the primary care system through incentive payments, a larger well-trained workforce, and technical support to enable effective and efficient care for chronic diseases, prenatal care, urgent care, and children in all parts of the state.  These are the problems of our future.

3. Take steps to decrease the greatest cause of poor health – poverty, by spreading the tax burden more equitable across all people in the state.

4. Understand that only by improving the health of all of us can we improve our own health.