Q&A: Rep. John Driscoll

John Driscoll has spent his entire career in health care administration (lately as director of Project Access, a local volunteer network of hospitals and providers to serve the uninsured) but he got a fresh new look at health issues last year as a freshman legislator — a Democrat representing the 6th District — who had to help trim $1 billion from the Washington health care budget. The experience reaffirmed his observation that one of the critical factors in reform is flexibility in coverage.

INLANDER: What reforms are needed?
DRISCOLL: We [at Project Access] have been noticing an increase in uninsured people in the last six months. We are getting more referrals from low-income clinics, but we are also seeing that family practitioners are sending us patients who have suddenly become uninsured because of the economy.

You can leave a job for a multitude of reasons, and when you have employer-based medical insurance, people tend to drop their coverage when they leave a job. You can buy a COBRA, but those are expensive. One of the most important reform aspects is portability of insurance. It gets really complicated, but to make sure people have continued medical coverage, you have to figure out how to maintain continuity of medical insurance to make it affordable.

What makes this complicated?
We can standardize business practices, [but] it gets really complicated because states regulate insurance practices. It’s not federally controlled. Over the years in Washington state, for example, we have required insurance companies to include certain things in their policies — screening for cancer, prenatal care, there are about 50 of them.

The insurance companies say to us that requiring these coverages adds a lot to the cost of the premiums. I know without a doubt that if you get examined and find a cancer earlier rather than otherwise, the cost of care is so much less.

People say get rid of all this regulation and insurance will become cheaper. I personally am not convinced.

Do you see cooperation or obstruction to reform?
Predictably, any industry wants to hold onto what you have and for the future to be the same as the past. But I also see pharmaceutical and medical insurance companies in particular becoming really activated. They are stepping up federally to participate in a constructive way, whereas in years past they would hang back.

I think the difference is they think President Obama is serious, and change is going to occur, and they are better off at the table.

How do we move away from employer-based health care?
I think every community needs to have a very comprehensive community clinic system like CHAS. I think that’s fundamental. We need to put more resources into those safety-net clinics, so they get enough doctors to run a 24/7 operation. This will directly result in fewer people going to the emergency room for minor care or primary care health issues.

I’ll tell you a story: I have a daughter in college and she cut her finger after midnight. She was unable to reach me or [other family]. She was scared. She was bleeding. So she went to the emergency room and she walked out with four stitches and a $1,500 bill.

I told her if she just held her finger over her head and waited until morning, she could have gotten those four stitches for $100.

What about complaints of government control?
Medicare is a government-run program and they have an exhaustive list of what they will pay for and what they won’t pay for. So we already have government deciding your health care.

Plus you have restrictions on what is covered in your own medical insurance policy. Do you have a $1 million policy but need $2 million in treatment? You are uninsured.

I could easily imagine taking the whole Medicare system and making it from birth to death. The infrastructure is in place. It would be a single-payer, universal coverage and … Well, that’s the political firestorm.