Washington Universal Health Commission on Thursday discussed the readiness of the state to create a single payer system.

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The commission was created after Senate Bill 5399 passed during the 2021 legislative session to make healthcare more accessible and accessible to residents. Health Management Associates (HMA) employees help Commission, providing recommendations on the development of a baseline report for legislators on the possibility of creating a state universal health care system.

To assist in this process, HMA has created report this indicates Washington’s willingness to implement the key design components needed to create a universal healthcare system, which HMA director Gary Cohen presented to the panel. The report discussed the feasibility of several key components of the design, including eligibility and registration, benefits and services, funding, cost recovery and supplier participation, elements of cost containment, infrastructure and governance.

Discussing the benefits and services component, Cohen asked whether the panel members thought a universal health care system should provide one set of benefits for all, and if so, what benefits should be offered. Commission chair Vicki Lowe said the results of recent meetings indicated that several medical services should join medical in the plan’s proposals.

“It’s hearing, vision and behavioral health,” Lowe said. “And I heard that public health should be part of universal health care. Dentistry is part of healthcare. [It’s] everything is connected.”

Cohen also asked about the possibility of offering additional options with any proposed universal health plan, which panelist Dave Iseminger—Director, Employee and Retiree Benefits, Washington State Health Department—said could create equity issues.

“You can have people who want [an] increased benefit, and some can afford it and some can’t,” Iseminger said. “There are a lot of people who would love that, but it raises a very clear question about fairness.”

Lowe said any cost-sharing option would also raise questions of fairness.

“Cost sharing is a matter of fairness,” Lowe said. “I have never seen a report that it helped save needed services. This makes it difficult for people with lower incomes to see a doctor. I am strongly against cost sharing. I think we should look at benefits as benefits.”

However, commissioner Jane Beyer said she was concerned about the financial implications of the additional benefits for small healthcare facilities.

“I understand all the shortcomings of the paid system,” Beyer said. “That’s what worries me… We are seeing significant consolidation. Now we are starting to see more private investment coming into healthcare. From the point of view of this small practitioner, this in itself will encourage this service provider to sell his practice to a large hospital system or private equity firm. I don’t think we want to create practices that encourage people to sell. I think the commission should be directly involved in these discussions.”

No final decisions have been made, and the members of the commission will again discuss their options at a meeting on July 13.

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