The challenge of offering health care and containing costs

January 18, 2013 

Washington’s new governor has an important appointment to make that will affect all that state government does in the next four years. He must select the new head of the state Health Care Authority.

Undoubt-edly, he will be advised to find an “expert.” I want to caution him that this may not be the best path to go down.

Health care spending is dwarfing all governmental spending. It is crowding out spending that we desperately need to invest in education and our crumbling infrastructure. Much of the conversation on health care reform has been centered on how to open the door to care to the many uninsured. Thus far our laudable efforts to expand access often leave out a critical piece: How do we afford the care that we all so value?

This comes back to the notion of an expert. Gov. Jay Inslee needs a truth-teller in the position. Someone who will tell him on a regular basis that we cannot afford all of the care that people want.

As a society we want the best care possible. We want the most modern and effective care, but do not want to be responsible for paying for it. This “how do we pay for it?” is the part that is not talked about so much.

The truth starts with the fact that rising enrollments and health care inflation always lead to out-of-control spending.

Unlike the federal government, state government cannot print money. It has to craft a balanced budget each year. This means making tough decisions about how much can we spend. Unfortunately, the experts on the federal level have had little success controlling health care inflation.

Washington state has progressively worked to expand access. This has led us to embrace the new federal law and its promise of more care to the needy. However, significant health care inflation always follows any expansion of care.

This will severely limit spending on all of those other critical issues that state government must address. Think education, think roads, think climate change.

The new Health Care Authority leader must have answers to how we can expand access and at the same time live within our means. The new leader’s mantra ought to be that expanding health care access must be coupled with avoiding new health care spending.

This is a commitment to going back to basics. As more patients enter into state-sponsored care, we have to decide what we are willing and able to pay for.

This is a very doable and a healthy process. It means engaging the public to create a priority list of health services that government should pay for. The road map would be a list of services ranked by both priority and effectiveness. As money gets tight, those services at the bottom of the list are no longer paid for.

Here in Nicaragua we have learned much about going back to basics in order to be more effective. We quickly learned that access to a doctor and to medications was not enough for our diabetic patients to succeed. Once we enrolled them in a group that met regularly for training and support, we saw real success in getting in front of their disease. We saved resources by only providing services to patients who go through our groups.

I do not want to sound like a contrarian as I look at the crucial appointment to the Health Care Authority. But without someone who will truth-tell over the realities of health care inflation and the need to say “no” to expanded health care spending, the future for the new governor will be frustrating.

Endless wrangling over the budget for health care is not the best focus for our state leaders. The new governor must do it right and cap health care spending each budget year. Any expert who tells you differently is one who should not be hired.

Federico Cruz-Uribe, former director of the Tacoma-Pierce County Health Department, leads the Centro de Nutricion Comunitario in Nicaragua, a diabetes clinic he founded in 2008.

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