UHCWG Final Draft Report (12/18/20)
Comments

By Sarah K. Weinberg, MD, Work Group member

Overall Comment

The Report is still lacking in conveying a sense of urgency. Our state (and the nation, for that matter) needs to step up to the urgent need the political will to move to a universal health care system, as exemplified by our poor response to the COVID-19 pandemic. We need our report to convey that need for ACTION, not just another massaging of the problem. A large majority (72.7%) of those making some kind of choice among the 3 models chose Model A. While not a formal recommendation by the entire Work Group (ten of whom are state officials and unlikely to see their role as making a choice), there is a clear majority of the rest who would likely support a formal recommendation for Model A had the opportunity been presented to us.

Detailed Comments

Executive Summary
Page iii: “Although the Work Group did not recommend a particular model….” This is disingenuous. 16 of 22 WG members who participated in the poll were in favor of Model A, and an overwhelming majority of the public comments submitted were also in favor of Model A. How about: “Although the Work Group did not formally recommend a particular model, a large majority (72.7%) of the members who participated in the poll would have favored such a recommendation, along with an overwhelming majority of the public commenters.”

Background

Page 2: Work Group Discussions: “…or create a single recommendation from the group.” Actually, this is not true. The WG was established precisely to make one or more recommendations to the Legislature, not to just massage the problem. The end of this paragraph would be a good spot for the 16/22 (72.7%) preference for Model A.
Defining Universal Health Care in Washington

Page 12: Affordability: Need to add a criterion of transparency, especially of prices and costs.

Page 13: Feasibility: There really are two parts to this issue: 1) the technical feasibility of setting up administrative systems, corralling needed funding, and ensuring adequate provider supply; 2) political feasibility, which involves heavy lobbying and campaign contributions by those profiteering from the current non-system to ensure opposition by politicians. “Transparency” related to special interests should be added to the list of criteria.

Page 40: Inclusion of Federally Funded Program Populations: This is one of the main administrative hurdles faced by any state wanting to set up a universal health care system. However, “…the Washington Health Security Trust model excluded participants in seven types of federally funded programs.” is over-simplified. In fact, the WHST states the intention to include these federally “protected” populations once waivers can be obtained from the federal agencies involved.

Achieving A Vision for Universal Coverage

Page 47: The statement: “However, the Work Group members disagreed on a preferred model.” This is not reflective of a 72.7%  preference for Model A and the total lack of preference for Model B. How many people need to disagree to warrant that statement? How about: “The Work Group did not make a formal recommendation of Model A, but a clear majority (72.7%) of those stating a preference would recommend Model A. None chose Model B, and three individuals chose Model C.”

Appendix D: Engaging Stakeholders and the Public

Page 63: Public Engagement Tactics: “Summarize key themes from public comment” and “Post summary on website”. I’m not seeing anything about summaries of public comments on the website, although a one-sentence summary of overwhelming support for Model A is in

Appendix F.
Appendix F: Public Comments
Page 65: Should state “Model A” as used throughout the Report, not “Option A”.
Appendix G
Page 74: Cascade Care subsidies report: Where is their report, due to the Legislature on 11/15/20? Have they found any magic pot of money that can be used for subsidies? (What I’ve heard about a proposed tax on insurers indicates two serious problems: 1) I think it will be earmarked for other more general health system issues like shoring up public health departments, and 2) Will enrollees be protected from insurers passing on the tax to them as higher premiums or larger cost-sharing.)

Finally, the typos and the like that I found

First, I was very pleased that report writers corrected all the typos I mentioned in my previous comments!
Page 10: In footnote 13: In the first line, “care the improves” should be “care that improves”
Page 36: Affordability, first paragraph, next to last sentence: “…eliminating cost-sharing such as premiums and co-pays.” Premiums aren’t really considered part of cost-sharing, and deductibles, which definitely are, should be in this sentence instead.
Page 43-44: Survey of Work Group Perspectives: The numbers don’t add up. 22 in Table 16 + 6 in Table 17 does not equal 29. Not only that, but the roster in Appendix C (pages 60-61) lists 36 members, and there are inconsistencies between the roster in the report and the roster on the website. Mary Beth Brown, who was one of the 6 who abstained, is not listed on either roster. Zach Snyder is listed on the website roster, but not on the one in Appendix C. On the other hand Sybil Hyppolite is on the list in Appendix C, but not on the website. (I can accept that Jason Brown and Robyn Williams, both from the Office of Financial Management may have shared one spot on the roster. Overall, needs fixing!
Page 85: Methodology: First paragraph, last sentence: “Please refer the discussion….” Need to insert “to” between “refer” and “the”.

That’s all, folks!