Dr. Paula Lantsberger and Dr. Reena Koshy: The storm of our lifetime has cost our livelihoods — it should not cost our lives

“We’re all in this together,” said Gov. Jay Inslee, as he issued the “Stay Home, Stay Healthy” order in response to COVID-19. More than 1,800 Washingtonians have died from the virus, including essential workers. But while we may be in the same storm, we are not in the same boat, especially when it comes to our health.

The need for universal health care is urgent. We are navigating the storm of our lifetime: a pandemic highlighting racial inequities, and economic chaos tossing folks overboard. Numerous reports confirm people of color are infected and dying from COVID-19 at significantly higher rates than the general population. Worse, evidence shows that Black, Indigenous and people of color, as well as those employed in essential service and agricultural industries are the most exposed to the coronavirus and are less likely to have health insurance.

Prior to the pandemic, 52% of Washingtonians were covered by employer-sponsored health insurance. Our Employment Security Department recently reported nearly 400,000 individuals – one in eight workers – are collecting unemployment benefits. Washington’s Health Care Authority reported on August 13 that 100,000 people have been added to Medicaid in the past four months. 1.9 million residents, 25% of our state population, are now enrolled in the lifeboat of Medicaid. Hundreds of thousands more remain uninsured and underinsured, left in the stormy waters without a life ring. When your health insurance, your rope line, is connected to an employer, your health care goes down with your ship.

In 2019, the Washington State Legislature could not have foreseen the coming storm, but they set out a course with budget language that begins the process of ensuring health care for all in Washington. “The health care authority is directed to convene a work group on establishing a universal health care system in Washington.… The work group must study and make recommendations to the legislature on how to create, implement, maintain, and fund a universal health care system that may include publicly funded, publicly administered, and publicly and privately delivered health care that is sustainable and affordable to all Washington residents.”

An impressive, 33-member Universal Health Care Work Group (UHCWG) was convened. The UHCWG meets Tuesday, August 25, via Zoom. The agenda and materials are available at the Health Care Authority’s Universal Work Group page (https://bit.ly/UHCWorkGroupPage).

This meeting is particularly important; participants will discuss three draft models of universal health care:

Model 1: Universal Health Care (UHC) system with coverage managed by the state, but health care provided by private and by public providers, clinics, and hospitals as it is now. It is “Everybody In, Nobody Out” coverage.

Model 2: UHC system designed by the state but outsourced to private insurance companies to manage, much as Medicaid is run now. It keeps the insurance middleman in the equation.

Model 3: The current system that strives incrementally to fill in the gaps and increases affordability for the underinsured, the uninsured and the undocumented. It leaves us to continually scramble for ways to patch the system, offer equitable coverage, make it affordable.

We believe only one model meets the criteria. As primary care doctors, we know that any obstruction to patients seeking care can, and will, cause health conditions that increase long term costs and risk patient health. “Cost sharing,” which requires co-pays and deductibles, requires enormous paperwork – which often costs us more in payroll than if we had just provided the care.

We are all paying far too much for far too little to cover far too few, due to extreme administrative and billing costs, profits, advertising, and 7-8 figure CEO salaries. With few government price controls, patients pay more for drugs, tests and procedures. We know that the time it takes to get pre-approval from insurance company’s non-medical staff for patients’ medical tests and procedures not only delays treatment but drives up the cost of care.

We cannot retreat from the storm. Washington voices are essential to rescue health care for ALL Washington. When we accomplish THAT, we will all be in this together.

Dr. Paula Lantsberger, MD, MPH, FACOEM is an occupational medicine and preventive medicine specialist in Spokane. She has worked for 35 years to help workers stay healthy and safe at their work.

Dr. Reena Koshy, MD is a Family Medicine Specialist in Seattle and has over 27 years of experience in the medical field.