Health summit stimulates action
Grass roots effort emphasized

by Christopher Key

Since it has become increasingly apparent that government either can’t or won’t solve the health care crisis, Whatcom County citizens are exploring what can be done on a local level. Indeed, the keynote speakers at the Health Care Access Summit hosted by St. Luke’s Foundation said that grass roots action is the only viable option for changing the system. The emphatic message from more than 200 participants: don’t let it die here.

The summit was sponsored by Group Health Cooperative of Puget Sound, Olympic Health Management, St. Joseph Hospital, Whatcom Community Foundation and the Eleanor and Henry Jansen Foundation. Other support came from Brown & Cole, the City of Bellingham, Horizon Bank, Intalco, Western Washington University, Whatcom County and the county Health Department.

St. Luke’s Foundation has been approached for funding to help retain physicians. The Foundation couldn’t do that, but hosted the summit in order to address that and other issues. They decided that input was needed from more than just health care professionals and invited a broad range of community leaders to participate in the November 22 event. Kathleen O’Conner, author of The Buck Stops Nowhere, told the gathering that those whose purpose is economic survival have no motivation to change the system. Health care, she pointed out, now represents 14 percent of the national economy, some $1.2 trillion. Forty one million Americans lack health coverage, 800,000 of whom are in Washington. Employers are facing increases in health insurance premiums of up to 50 percent.

“There is no goal or vision of the system as a whole,” O’Conner said. “Cutting the rates that Medicare and Medicaid pays to doctors and hospitals is self-destructive. Health care issues have become ideological; a zero-sum game when one group’s gain leads to another’s loss.”

O’Conner cited unnecessary competition and lack of cooperation among the health care players.

“There is virtually no trust at this point,” O’Conner said, “and patients are the pawns in the game. Until now, no one has thought to engage the community.”

Rebecca Bryson has become an expert on health care through her experiences as a consumer. She suffers from type II diabetes, iron deficiency anemia, gastrointestinal bleeding, and class IV congestive heart failure, among other maladies. She has had three cardiac arrests, takes 27-31 pills a day and has 13 health care providers treating 10 diagnoses. She is grateful to the system that has kept her alive, but sees a lot of room for improvement.

“Health care is system centered rather than patient centered,” Bryson said. “The record keeping is totally uncoordinated. If one of my doctors changes a prescription, it’s up to me to get the records changed at my other 12 providers.”

This lack of coordination in record keeping resulted in Bryson experiencing six medication errors in three days.

“There’s got to be a way to minimize this,” Bryson said, “It’s a huge burden on the patient.”

The current system also creates too many barriers, according to Bryson.

“The drawbridge is usually in the up position,” Bryson said. “First you have to talk to a receptionist who leaves a note for the nurse. When the nurse calls back, you have to convince him or her of your need before having to do the same thing all over again for the doctor. Both the receptionist and the nurse can prevent access to care. HMOs and insurers also act as gatekeepers. General practitioners control access to specialists. It should be easier. Being sick is hard work.”

Bryson emphasized that the problems she faced were with the system and not the people, who, she said, obviously cared about her.

After the first two speakers, the summit attendees could choose to attend any of five different workshops addressing different facets of health care. Since one reporter couldn’t be in five places at once, I chose to attend the workshop dealing with rising health care costs for businesses and the impact of health care on the local economy.

The importance of health insurance was illustrated by Pat Rowe of the Bellingham/Whatcom Chamber of Commerce. He pointed out that the chamber suffered a significant drop in membership when it was no longer able to offer members an insurance program.

“Business owners are caught between a rock and a hard place,” Rowe said. “They either have to pay higher premiums or cut benefits. This creates an adversarial relationship both with insurers and employees.”

The cost of providing benefits threatens the ability of some businesses to compete.

“The big box stores offer their employees inferior wages and benefits,” said Craig Cole of Brown and Cole. “They profit by treating their employees poorly. I’ve had to ask for concessions from my employees in order to stay competitive. Companies that offer health care coverage end up paying for those who don’t.”

Part of the solution, according to Cole, is values-based consumerism wherein the social costs of shopping decisions are taken into account.

“Reward employers who provide the basic needs,” Cole said, “by patronizing their businesses.”

Cole suggested some other ways to help level the playing field.

“There should be incentives for employers to provide health care coverage,” Cole said. “Health care costs should be more broadly distributed. Maybe there could be a higher tax deduction for employers who provide the basics or an income tax on those who don’t provide them.”

Some of the huge variety retailers are not out to compete, Cole claimed, but to wipe out the competition.

“Basic health care is a societal obligation,” Cole said, “and the government is shirking its responsibilities. How many street people did you see before and after the Reagan administration reduced mental health benefits? One way or another, we end up paying the social costs.”

Renowned cultural anthropologist Jennifer James addressed the gathering following a lunch break.

“We’re embarked on the steepest learning curve in history,” James said. “Health care can work, but we have to overcome our fear of change.”

She emphasized the need for grass roots action.

“Washington, DC, doesn’t care about health care,” James said. “Local politics is much more effective.”

The changes have already begun.

“No group in history has lost power as quickly as MDs,” said James. “The hierarchy is flattening out quickly.”

James pointed out that good change may not always look good while it’s in progress.

“We have to decide what story we want to tell,” James said. “The story of the mandala, one of reconciliation, or the Middle Eastern story of revenge.”

It’s not just carcinogens that are making us ill.

“Belief systems make you sick,” James said “It wasn’t 9/11 that ran Boeing into the ground, it was a 1950s command and control hierarchy. The media create anxiety, fear, paranoia. That affects your health, as well.”

Business, according to James, is a story. If you can’t tell a new story, you’re out of business.

“In order to tell a compelling story,” James said, “you need three things: a set of ideas that fit reality; a set of values connected to those ideas; and a personal ability to model those ideas.”

She doesn’t feel that those charged with leadership are telling a compelling story.

“Our leaders are not believable or authentic,” James said. “Those who can’t model the new story will be dismissed.”

We need to take stock of how we create that new story, according to James.

“How do we talk?” James asked. “Is the emphasis on conflict or extremes? Do we label people or seek commonality? How do we inform people? Do the media resort to hype and ignore complexity? How do we involve people so that they don’t feel impotent? We need to seek a deeper view. We need knowledge and accountability. Our aspirations should be based on optimism rather than fear and hate.”

Even those who can make the smallest of changes help tell the new story, James said.

“We have to become increasingly inclusive and look for alternatives to violence,” James said. “Civilization is the long process of learning to be kind.”

At this point in the summit, there seemed to be little disagreement that change is needed. Kathleen O’Conner facilitated a discussion of how to begin the change. The group identified a number of characteristics for an improved health care system. It must be safe, effective, patient-centered, timely, efficient and equitable

The public should be engaged in the process as much as possible through reading groups, churches, civic clubs and senior centers.

“People have to be engaged in the changes,” O’Conner said, “or they won’t buy into the new system. That’s why government imposed solutions won’t work. Pick your fight, start it, and always keep your goal in mind.”

There was no doubt that the people at the summit were engaged. Not only did very few of them leave early, but many remained in animated discussion after the summit ended. Sue Sharpe of the Health Care Access Planning Committee said the summit far exceeded her expectations.

“I met people I know who have the same problems with the system,” Sharpe said. “It made me realize that we’re all in this together. Government can’t solve it, business can’t solve it; it has to be a grassroots effort.”

It became clear at the summit that there is no “silver bullet.” Change will have to come from enthusiastic people who are willing to work and won’t let the issue die.

“One of the things the summit accomplished,” said Sharpe, “was to share information with a lot of people, many of whom are not intimately involved with health care.”

Summit attendees achieved consensus on the fact that the system is broken and needs to be fixed.

“The difficult task,” said Sharpe, “is to identify and get consensus on the subsidiary issues. We can do it if we focus on community and don’t play the blame game. Our goal is not to create a new structure, but to build on what we have. Having this event and seeing the enthusiasm it generated was a great start. We’re building partnerships that haven’t been there before. Providers were talking to providers, insurers were talking to insurers, businesses were talking to businesses. The summit helped get these groups talking to each other.”

One of the things the Foundation learned is that everybody is dealing with the issue in some way and that people have a lot to say about it.

“We are committed to getting a report out as soon as possible,” said Chuck Beard of St. Luke’s Foundation. “We want to keep this issue in front of people. There were some great ideas that came out of the workshops that are quite achievable.”

Sharpe said that the planning committee is looking for ways to sustain the effort.

“Do we need more conversation?” Sharpe asked. “Do we need to get the whole group back together or do we need smaller sessions and individual projects? How do we involve more people?”

Evaluation forms filled out by summit participants indicated strong agreement that the speakers and workshops were effective in creating awareness and understanding. Well over 90 percent of those attending said it was time well spent. The evaluations produced dozens of suggestions as to how to proceed. The planning committee will include those in its report.

The Health Care Access Summit was, by all accounts, a good beginning. Where do we go from here? Stay tuned.