Thursday, October 1, 2009

Proposition 4 - Right To Affordable Preventive Healthcare


Residents have the right to affordable preventive healthcare. For residents otherwise unable to access such care, the City shall guarantee such access by coordinating with area healthcare providers to create affordable fee-for-service programs within eighteen (18) months following adoption of this Charter provision.

From the Envision Spokane FAQ on this right:


Isn’t this just Socialized, Government-Run Healthcare?

No. This Right only applies to those residents currently unable to obtain healthcare from any other source, and only applies to preventive healthcare. Under the Right, the City would be tasked with working with area healthcare providers to create a program that would provide affordable fee-for-service preventive healthcare to all residents of the City. How the City creates that program in cooperation with area healthcare providers would be left up to the City Council, but it would be area healthcare providers providing that healthcare, and not the City – with the requirement that such care be affordable.

Wouldn’t this Bankrupt the City?

No. The fee-for-service provisions would enable the City to capture all of the administrative costs associated with the program.

Isn’t this Unenforceable Because “Preventive” is Not Defined?

No. The Right was drafted to give maximum flexibility to those designing the program, and thus, if the City engages in a good faith effort with area healthcare providers to define “preventive care,” then the standard within the Right will have been satisfied. In addition, the City Council would have the option to adopt implementing ordinances, which would further define the program and the standards used within that program.


I think another key issue here is the definition of "affordable". What is that based on? Also, there is nothing in the text that states "This Right only applies to those residents currently unable to obtain healthcare from any other source..." It specifically states "affordable preventive healthcare."

What determines a good faith effort on the part of the city? While establishing ordinances to define the program and standards used may be an option, the text states "the City shall guarantee such access by coordinating with area healthcare providers". Coordinating doesn't necessarily mean legislating. The city is not only being told what it must do but is also given the specific method for doing it. Coordinating with area health care providers satisfies the requirement of the law as to what the city must do even though such action may not guarantee access to affordable preventive health care. It's possible that the city and the health care providers may not be able to come up with an affordable fee-for-service program even if they act entirely in good faith. What happens if this is not economically feasible?

What will be the basis for determining the fee for the "affordable fee-for-service programs"? If we're talking about people who can't afford it in the first place, how do we make it affordable without the city or the health care provider(s) taking a loss?


Sherry said...

Recent issue of The Atlantic Monthly has a really interesting in-depth article about health care reform. Author's nutshell is that trying to tweak the current system will not produce meaningful, necessary changes, and we need a complete start from scratch.

Barb Chamberlain said...

Another point where I think this one misses the mark--fee-for-service is a broken model. There was an article in the Spokesman about the struggling hospital in Garfield County trying to make it, and thinking about whether it would make more sense to be paid to keep people healthy, instead of paid for over-treatment (which is incentivized under fee-for-service models).

This really isn't the most progressive healthcare reform that could be considered--it's practically conservative :D.

What I could really get excited about is more effort by the city--working on its core services such as street design/engineering--to create an infrastructure more oriented toward overall HEALTH (to which medical services contribute only a small portion of your outcomes).

If more streets had bike lanes, or enough shoulder/lane width for cyclists to share the road--if all our sidewalks were actually complete so people could walk to a transit stop (which would also make sidewalks more accessible for people in wheelchairs)--if we emphasized design standards that draw people into walking rather than driving--we'd be healthier. We'd lower the cost to the system of preventable diseases like obesity, diabetes and cardiovascular disease that are expensive epidemics.

That's the kind of thing you could actually call on the city to do while staying within the appropriate scope of authority and responsibility for city government. Put a Complete Streets amendment up--as a single-subject measure, not weighed down with other unrelated issues--and let's see what happens.

Not that I feel strongly about this or anything.