by Kathleen O'Connor

Say it! We don't have a health-care system. We have a business-to-business enterprise that is unsustainable. We have no goals, no outcomes, no objectives other than controlling costs and preventing or containing epidemics. Neither accountability nor responsibility exist. Instead, everyone is pitted against each other for their own economic survival.

And, it is going to get much worse. Hospitals and clinics are competing against each other for employees and are giving salary increases and signing bonuses just to get them. Check the want ads. All this does is increase their overhead.

But, while these costs are going up, the economy is tanking. We are in a recession. This means more layoffs, more uninsured. If the number of uninsured increased by 10 million people in the middle of our greatest economic growth, what in the world is going to happen in the midst of this recession? Safety net? Hardly.

Hospital and physician clinics have been bleeding for years. Clinics are closing or merging. People are losing jobs in droves. Some think the number of uninsured in Spokane alone will be as high as 25 percent.

Over $1.8 billion is now coming out of the state budget. Where is that coming from? Off the backs of the weakest and most vulnerable: children, the poor, the elderly and chronically mentally ill. What will happen to them? Where will they go? What care will they not get?

We can no longer keep whacking each other in the health-care blame-and-game battlefield. Insanity is doing the same thing over and over again, expecting a different result. It is time to stop re-arranging deck chairs on the Titanic.

We are at the tipping point. Health-care costs are going up too much to be sustainable for businesses or individuals or the government. More people will be uninsured, as much as from the economy as from Sept. 11. We have never before acted as a community when it comes to our health care. We have only come at it from cost, as an employee benefit, not for the health of the nation.

This must change. We must look at the health of our communities together. But, before we do so, we need some guiding principles. So, I offer a "Health Care Magna Carta" to hold us all accountable for the decisions that will be made.

We need a national dialogue, state by state, on what a system of health care should do. We have never asked this question as a society, a state or a nation. Oregon tried in Oregon Health Choices with its community dialogues. But, they asked the wrong questions.

We need to ask what a system of care should do, how each of us can participate in it, and outline our respective roles and responsibilities. Then, and only then, can we create a system of care with rights, responsibilities and accountabilities rather than point fingers of blame as we all game to our economic self-interest.

To that end, I offer here excerpts from that Magna Carta:

• We believe we must all participate in health-care decisions and that health care is too important to be left to someone else;

• We believe everyone who participates in the health-care system should pay for it — individuals, businesses and government;

• We believe all people should have access to a common set of health-care services that promote the health and well-being of our nation;

• We believe no person should face bankruptcy because of catastrophic health-care costs;

• We believe in the freedom of employers to offer more than a common set of health-care services;

• We believe we should all be in the same risk pool rather than separate our society into smaller and smaller segments;

• We believe we all need clear and succinct information about health-care services and benefits;

• We believe we need central standards and management of health-care financing and services, just as we have central standards and management for the banking industry, but we also need local flexibility to meet the specific health-care needs of our communities;

• We believe funds for health-care services should not be dictated by the specific health-care categories;

• We believe we must hold a structured national dialogue so we can define the goals of a health-care system that can sustain the health and well-being of our nation and of our people.

To that end, I have created a contest and pledge my own funds to start it. I invite corporations to compete with a $1,000 entry fee, which will be used in part to manage the contest and to fund a scholarship for the colleges and universities that will participate.

Kathleen O'Connor, author of "The Buck Stops Nowhere: Why America's Health Care is All Dollars and No Sense," writes regularly on heath-care issues for The Seattle Times. www.oconnorhealthanalyst.com

Copyright © 2001 The Seattle Times Company

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