EDITOR'S NOTE: The Sequim Gazette has taken no position in the debate over health care/health insurance reform, nor is it likely to.

However, when the state's elected insurance commissioner - and a doctor of optometry with service in the Army Medical Corps and former regional director of the U.S. Department of Health and Human Services - speaks, his views are worth considering.



As Washington debates different options for health insurance reform, it's becoming increasingly clear that there's one option we can't afford:

Keeping the status quo.

I'm the insurance commissioner for Washington state. Virtually every day, desperate people contact my office seeking help. And very often, they are calling about health care.

One retired couple has been trying to help their son, a heart transplant recipient, pay $2,000 a month for medication. Another couple, both 62, struggle to pay $1,400 a month for health insurance coverage.

And one woman lost her job and her coverage, only to discover too late that her husband needed a critical operation.

Some argue that we cannot afford to make major changes during tough economic times. I think they're wrong. We can't afford not to fix a system that, for a large and growing number of people, is tragically broken.



Last among 19 nations

As things stand now, the United States is outspending other developed nations 2-to-1 for health outcomes that rank well below many other countries'. The nonpartisan Commonwealth Fund recently ranked 19 comparable countries in terms of premature deaths caused by preventable illnesses such as diabetes, pneumonia and influenza.

We came in last.

Yes, we have some great medical care in America. Absolutely. But fewer of us have access to it.

If things continue as they are now, Washington state will soon be home to more than 1 million people with no health insurance. For many of them, crushing debt or bankruptcy may be only one accident or serious illness away.

And even those with health insurance coverage can't necessarily breathe easy. In many cases, deductibles and co-pays are on the rise, as are premiums.

Businesses struggling to emerge from the recession are watching the rising cost of health insurance become an ever-larger part of their bottom line. Many are paring back benefits, passing higher costs on to workers or simply opting not to offer coverage to their employees anymore. Across the country, this uncertainty hangs over the heads of both workers and their families.



Another defeat unacceptable

I had a front-row seat during our nation's last major attempt at reform. Sixteen years ago, I was a congressman on a key House health subcommittee.

We failed then. We cannot afford to fail again.

The current system is not sustainable. We cannot support costs that are rising three times the rate of inflation without losing coverage, care and quality.

And don't think you're immune from those pressures because you get your coverage at work or through a government-run plan like Medicare. Taxpayers and those with insurance already are helping foot the bill for the uninsured, who turn up as critical cases in hospital emergency rooms, at a far greater expense than preventive care would have cost.

If we stay the course, we'll end up spending $33 trillion over the next decade for the same results. You and I will pay for that. So will our kids and so will our grandkids.

Some critics suggest that our costly system is due to mandates imposed on health insurers. I disagree. If we were to eliminate all insurance mandates - things like coverage for cancer screenings and diabetes - the best estimates are that insurance costs would decrease about 3 percent. That's playing around the edges rather than providing the substantive reform that our country desperately needs.



Desperate need for change

What Congress is considering now should have been done years ago. We need universal coverage, insurance that's not necessarily tied to your employer and an end to allowing pre-existing conditions to wall people off from coverage.

It should be affordable to all, with financial help for those who truly need it. A substantive, public-plan competitor to private insurance would help keep insurers honest and be another choice in the marketplace.

We also need to get away from a system that pays doctors more for ordering a flurry of tests and procedures and instead go back to encouraging common-sense best practices. Technology can boost the efficiency of a health care system awash in paper files and arcane billing codes. By giving more people access to routine care from the same doctor, we can nip problems before they become crises.

(Editor's note: Uncompensated care cost Olympic Medical Center nearly $7 million in 2008 and continues to rise. Much of it occurs because people cannot afford to see a primary care physician and thus put off treatment until it is many times more expensive than the initial cost would have been.)

Yes, change can be scary, but this is change we desperately need. I see and hear it every day: the status quo is bad and getting worse. We can do better. We must.

Mike Kreidler is the elected Washington State Insurance Commissioner, a former member of the U.S. House of Representatives and a former health care provider.