This Washington

McKenna, Inslee Spar on Health Care Reform

By Erica C. Barnett January 5, 2012



Gubernatorial rivals Jay Inslee and Rob McKenna squared off---sort of---at a conference on health-care reform in SeaTac yesterday afternoon, making the case for their competing visions of health care reform. ("Sort of" because McKenna and Inslee spoke several hours apart, and because McKenna appeared via a shaky Skype connection from Spokane, where he was appearing at a number of campaign events.)

Both men offered "three-pronged" solutions to the current health care crisis, and many of their points and proposals overlapped. For example, both Inslee and McKenna said the main challenge facing states when it comes to health care is the fact that medical costs are rising faster than inflation. The cost of health care, Inslee predicted, "will bankrupt us all. ... I believe that the status quo path is one destined for economic disaster and literal bankruptcy for our state."

Echoing Inslee, McKenna said, "The path we are on is not sustainable; it's certainly not sustainable for state government, which saw its health care costs increase ten percent in the last year."

Similarly, both candidates highlighted the need for innovation in health care, citing several of the same specific hospitals---Virginia Mason, Children's, and Swedish---that have cut costs through innovative use of technology and by applying manufacturing principles to health care coverage.

And both sang the praises of preventative care---Inslee citing King County's Healthy Incentives program, which lowers health care costs for employees who monitor their diet and exercise and maintain a healthy lifestyle ("we really don't have a health care system; we have a sick care system"), and McKenna citing "managed care" programs that give "consumers"---his word for patients---an incentive to maintain good health and "stop behaving as though health care is a free good."

Where McKenna and Inslee parted most dramatically was on what a reformed health care system would look like. For Inslee, a staunch defender of President Obama's health-care law, the solution is mandatory health insurance, combined with expanded Medicaid and state health-care exchanges (the Obama plan). Implementing the full plan, including mandates, Inslee argued, is the only way Washington State will be able to preserve its social safety net and fulfill the constitutional mandate that 'education is the paramount duty of the state."

"We have to make a decision, and that is whether or not we're going to give up on the paramount duty of the State of Washington, which is the education of our children, or give up on the safety net," Inslee said. "We should do neither of those."

McKenna, on the other hand, argued against the federal mandate (the subject of the federal lawsuit McKenna joined as attorney general last year) and suggested that states needed to "realign incentives" for doctors and patients---making patients less inclined to seek out costly health care services while encouraging doctors to cut costs---instead of imposing "price controls."

Casting doctors as salesmen and patients as consumers, McKenna cited states like Indiana that have switched their workers to high-deductible insurance policies coupled with health savings plans---accounts that give residents a few thousand dollars a year to pay for all their health care costs at market rate. "Consumers have to have a financial incentive to become more cost-conscious," McKenna said. "They have to have a reason to be more conservative in their health care. They need to shop around, think more carefully about having that MRI for their achy knee. ... That's a direction I intend to take as governor."

McKenna also questioned the notion that lack of access to health care is epidemic in America. In coming up with estimates that 47 million people are uninsured, McKenna said, "They counted people who are in the country illegally, people who are eligible for Medicaid but are choosing not to be in Medicaid," and currently uninsured people who would simply pay a fine rather than pay for mandatory health care under Obama's plan, McKenna said. "They overstated it."

McKenna also decried what he called consumers' "lack of information" about the cost of medical care and the quality of various providers. "In a truly competitive marketplace, you have access to information," he said, citing the example of an unemployed friend whose pregnant wife needed an amniocentisis, a medical procedure to diagnose fetal abnormalities. After trying for weeks to find out what the procedure would cost, McKenna said, his friend finally found out it was $13,000.[pullquote]Is the lesson that uninsured people should forgo expensive tests? Or is the lesson that the market price of health care can be really high, and that universal health care is the best solution? McKenna didn't say.[/pullquote]

(It was an odd anecdote with an unclear lesson. Is the lesson that uninsured people should forgo expensive tests, even if they could diagnose major fetal problems like Down Syndrome? Or is the lesson that the market price of health care can be really high, and that universal health care is the best solution? McKenna didn't say.)

Finally, McKenna and Inslee disagreed sharply over whether overturning the federal health care mandate would have the effect of killing the entire federal health care law; something McKenna, defending his claim that the national lawsuit he's part of would not toss the whole law if the mandate was found unconstitutional, has denied repeatedly. Inslee---in perhaps the strongest moment in an otherwise somewhat lackluster speech--argued vehemently that without a mandate, national health care would be meaningless.

"There are people, some of whom are running for elected office---I'm not naming any names here---who will say that we can preserve the [health care law] without the mechanism of everyone paying into the pool of health care insurance," Inslee said. "Do not let anyone hornswoggle you into that falsehood.

"There's no free lunch in this life. We all have to show some responsibility for our own health care, if in fact we're going to keep having health care. Frankly, I think this is a conservative position."

McKenna, as he has since filing the lawsuit against the health care law in 2009, said" "The Affordable Care Act is not going to be overturned. The individual health insurance mandate will be struck down. It is unconstitutional in my view, and it will be severed from the rest of the law and the rest of the law will remain in place."

"The mandate isn't going to work anyway," McKenna continued. "It's not going to function in the way envisioned. If you're already staying out of the market by choice because it's cheaper to do so, you're going to choose to pay the fine under the mandate rather than pay ten times as much for health insurance. We need a mechanism other than the mandate to make sure that people don't game the system."
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