Community comes together to take back health care

The national Committee on the Cost of Medical Care said our costs were so high because we had too many medical specialists; too many infectious diseases; a disease-based system versus a preventative one; and lack of community-focused health-care delivery. Regrettably, this is all still too true — except this report was not written in this century.

It was written in 1932, when 45 percent of our doctors were specialists (versus 80 percent now); and when we had no antibiotics or "wonder drugs" that could actually cure those infectious diseases.

We still have a disease-based system of care, but put a managed-care mask on it and say "prevention."

Finally, we still lack community-focused health-care delivery — except for a first start in Whatcom County, where they recently held a real community summit.

The county is one of six national sites, funded by the Robert Wood Johnson Foundation, focusing on community-based and patient-centered care.

Whatcom shares the same health-care problems as the rest of the state.

In the past three years, it has lost 17 physicians and recruited 18. Yet, it is still short doctors. Its largest clinics, just like clinics in Seattle, Bellevue, Yakima and Spokane, are not taking new Medicare or Medicaid patients. Because of the shortage of doctors, priority goes for urgent care. Routine office visits take the back seat. Waits to see a doctor can rival those in Canada.

What makes Whatcom County different is people there are trying to create a health-action plan that is "of the community, by the community and for the community."

Health summits and town-hall meetings are a dime a dozen. I know, I go to many.

The standard formula is: lamentation, bring in outside experts, showcase patient problems, wring hands, hand the problem back to the experts, and end with malpractice and a litigious society. Hands are thrown up.

I can count on one hand the summits that don't default to this formula.

Everyone says we need to "engage the public," when in fact they would not know "the public" if it walked in the door.

Most summits are organized by external groups with templates and agendas: Like traveling salesmen, they come in and go out, selling viewpoints instead of goods, leaving nothing lasting behind except frustration.

Which is why Whatcom matters.

Their forum was actually planned by the people who live and work in the community — business owners, seniors, clergy, educators, consumers and some providers. Health policy has always been in the stranglehold of special interests — whether it is the American Medical Association, the Jackson Hole Group that crafted the Clinton health plan, or various business groups on health.

What Whatcom is trying is a first.

We have never before asked the community what it wants in a system of health care that will meet the needs of businesses, individuals and families, and sustain our health and the economic health of the community.

More than 200 people spent a full day discussing just that. Their community also funded the program — St. Luke's Foundation and local businesses and nonprofit organizations, not outsiders, associations, advocates or drug companies.

While special interests were there, they were outnumbered by contractors, pastors, seniors, engineers, car dealers, food-packing and storage-plant operators, Rotarians, unions, retail-store owners and the Boys and Girls Clubs.

People came because they were not where they wanted to be. Doctors can't afford to see patients they want to see. Patients can't see doctors. Employers can't afford premium increases, nor can individuals and families. The health-care safety net is stretched to snapping just when it will face crippling cuts from both the state and the feds.

By the end of the day these citizens came up with some fresh ideas: Create a local nonhospital tax district to finance services; create a 1 percent tax on income or sales just for health care; create a community vision and goal for health care; let the community help in recruiting doctors, not just the clinics; make health care patient-centered and let patients control their records; create a standard billing/claims form; get rid of individual payment systems for specific programs. Tell stories to create a common vision.

Can they pull it off? Who knows? They are, however, trying and have a national sponsor in the Robert Wood Johnson Foundation.

Whatcom is doing what we have never done — truly engaging the public about what a system of health care should do.

In the '60s, women banded together to "take back the night" to assure their health and safety. The time is now for the public to take back health care, for the health and safety of our communities.

Whatcom took step one. Who will take step two?

Kathleen O'Connor writes regularly on health-care issues for The Times. She publishes "The O'Connor Report" and hosts seminars on the health-care marketplace.

Her Web site is: www.oconnorhealthanalyst.com.