Washington State Health

The Washington Post did an analysis on the state of Washington that had a law guaranteeing all residents have access to private health-care insurance, regardless of their health, and requiring them to purchase coverage.  That was  in1993.  Two years later, the state legislature repealed just the mandate part.  So, in essence, this example would be a good study case of what would happen if the Supreme Court does the same to the Affordable Healthcare Act ‘s mandate.  So what happened almost 20 years ago?   Well, the guaranteed-access provisions still stood but the state saw premiums rose and enrollment dropped.   Health insurers fled the state and, by 1999, it was impossible to buy an individual plan in Washington as no company was selling.  Ouch.  “There are seven states that tried this in the mid-1990s and, in every case, it was a disaster,” said MIT health-care economist Jonathan Gruber, who worked on Massachusetts’ health-insurance law and the Affordable Care Act.   To summarize, if the mandate fails, this whole law may be a really, really bad thing.  Don’t get me wrong.  There actually are some parts of it that I like.  My 20 year old son gets to be on my insurance.  Hooray.   But it looks like it is back to the drawing board.   If they have to redo it, they may want to think about paying primary care doctors more (to get medical students interested), NOT increasing the Medicaid roles (a smoke and mirror trick of this law) and putting in some tort reform.  Just sayin’.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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4 Responses

  1. Bill Newton MD says:

    This whole argument boils down to one question. Is healthcare a right or a privilege? Until we satisfy that dilemma, we’ll continue to pull back and forth, and never get anything accomplished really, other than making one group or another rich..

    And just for the record, we specialist and subspecialists have been getting hammered for reimbursment too, it’s not just primary care. I make 50% less than I did in 1998, for more than twice as much work. So, let’s not get too wound up about paying more and more for primary care, at the expense of the speciality MDs.. Supposedly, we are all in this together, and a turf war will only make it easy for others to divide and conquer, all of us.

  2. Pat says:

    Soooo Pat N. … do you mean to say that universal coverage will save lives? If so, do you mean to equate “coverage” with “access”? I work in a poor rural county where there is plenty of coverage, but precious little access, considering the poor economic prospects o anyone willing to work for Medicaid rates.

    Do you mean to suggest that as a general concept, universal access saves lives? How? In every universal health state, choices are restricted, resources are rationed, and those that get the very best, cutting edge care are those with significant private means and/or pull with someone on the inside. So while some lives may be “saved” – however you may define that – others will be “lost” through the bypasses, expensive scans, and wonder drugs all withheld due to cost constraints.

    Or do you simply mean that universal coverage and access is the correct moral choice? If so, do you then mean to state that it is moral for a majority with need to impose their will on a minority with the ability? Is this your concept of popular morality?

    If there are some dying “unnecessarily” then who is doing the killing, and according to what evidence?

    If you believe that there is a “right” to health care, do you likewise believe that physicians should have the property and association rights of other citizens? Aren’t these contradictory positions?

  3. Pat Nagle says:

    This would all be a nonissue if the whole Congress had a commitment to universal health care. Instead, we have vested interests hiring Congresspeople to fight for the horrible system we already have. So we’ll flounder and posture for another few years. Too bad about the folks who die unnecessarily in the process, but business is business.

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