Think About It: Dear Representative Kilmer …

Representative, I like it that you make yourself readily available to your constituents and that you are open with your answers. I came from the metropolis of Seattle to Sequim to work in healthcare and soon realized that, here, I would actually meet senators and representatives, both state and federal, face to face.

I have seen you at a few events, one being the town hall meeting held earlier this year. You set the stage with a great presentation on issues as you saw them. I learned from you that evening.

As a consequence, I expect a lot from you, especially in the area that has consumed all of my professional life; that would be access to healthcare. I wish I could report success, but I can’t. Failure wasn’t for lack of trying. I made it a professional mission to work within the system to bring down the barriers that prevented patient-centered care.

You know, patient-centered care meaning that every effort is made to provide each patient the security of certain access to necessary and uninterrupted health services required for recovery, restoration and comfort.

Nowadays, one needs a “patient advocate” just to get through the system even if you still have presence of mind. Seems that some in healthcare feel responsibility only for informing but not for making sure the patient understands.

The problem of access is compounded over years of fiddling with the system and reimbursement. Medicare has steadily increased regulation and decreased reimbursement to those essential to providing care — hospitals, physicians, skilled nursing facilities and home health agencies.

Private insurance companies resorted to ever-increasing denials of coverage or care to save their companies from bankruptcy and make money. High deductibles, co-payments and premiums have become popular means by which to reduce risk.

What a mess.

Alas, I will take my mission to my grave, although I would like to believe that a miracle will occur and our elected leaders will manage to clear their heads and ideologies and really work together on solving the problems of the existing system and reinvent the delivery and economics of health care

Be one of the creative problem solvers

Representative Kilmer, you were on my short list of young bright voices that was a big picture thinker who would be a leader in big picture solutions.

That is, until I read your views on healthcare problem solving in the recent interview you held with our local papers.

You responded to a reader asking about your views on a single payer system for healthcare: “Single payer has zero chance in this Congress.”

I’m not sure anything healthcare has a greater than zero chance in this Congress, but I digress.

You continued. “Eric Lewis (OMC CEO) will tell you he loses money on Medicare patients. If you put everybody on Medicare, he loses money on every patient.”

Indeed, Representative, cross subsidization of Medicare by private insurances has been true for decades. Acceptance and apathy as a member of one of the bodies of Government who can do something about it, is an attitude that fails any test of even a small wallet picture solution.

You continued. “There are millions of people who get insurance through other means, such as workplace, and they like their healthcare.”

Perhaps, Representative, you have noted the increasing erosion of the health benefit since employers are paying less and employees are paying more.

The report goes on to say that you are focusing on improving the Affordable Care Act. Just what makes you think this has more than a zero chance in this Congress?

Time to think outside the box!

There was a time not that long ago when I thought that America could come up with something uniquely American that could fit into our capitalistic and entrepreneurial leanings. What I learned through the Affordable Care Act was that it was not possible because of a strong force of will that refuses to make healthcare reasonably and with certainty available to all.

The mantel of obstruction that surrounded the successfully passed ACA continues to this day to suck the life out of it. Insurance companies are fleeing the uncertainty of its survival. They want no part of an ACA stripped of its promises to assure protection from risk.

Time to think outside the box, in this case the box being insurance. Even Medicare is an insurance. I love Medicare because I have certainty of access to the right healthcare at the right time but it won’t last.

I get why some members of Congress want to treat it like an insurance — reduce risk by turning all the risk over to the individual. Won’t we find that all vouchers aren’t equal? Just like we now find all insurance access is not easy. It depends on how much healthcare you need.

The plan seems to include high risk pools which will handle the really needy. Do we start piling all the Medicare patients with pre-existing conditions, which is just about all of them, into state high risk pools? Not sure the state can afford that deal since it is an insurance that must worry about bankruptcy. Medicare patients probably can’t afford it either unless they are getting a $20,000 voucher.

But, Representative, you know all of this. That and that you do understand how the suffocation of the ACA is going to hurt many people is why I don’t understand why you’re not thinking outside the box.

I believe there is a way to make this work for all — companies, businesses, providers, people; a way that will provide certain access to necessary and uninterrupted health services required for recovery, restoration and comfort.

We don’t want young families making decisions about their future work based on access to healthcare insurance. Responsible life management is important but healthcare insurance should not be the beacon to which we all reach.

Representative, don’t you agree?

Warm Regards, Bertha

Bertha D. Cooper is retired from a 40-plus year career as a health care administrator focusing on the delivery system as a whole. She still does occasional consulting. She is a featured columnist at the Sequim Gazette. Reach her at

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