Letter to Editor | Drastic Situation May Result Should We Fail

— from Steven Jung —

I write in support of the forthcoming ballot initiative to create a Public Hospital District. Also on the ballot will be the election of five commissioners to implement a sustainable program of primary, after hours, and urgent medical care on Orcas Island. I believe the many points in favor of the district have been well articulated and are probably understood by most islanders. They include:

  • Providing broad access to fundamental medical services for all residents of or visitors to Orcas Island, regardless of their age, economic status, or residence.
  • Offering the option of support for all medical practices currently operating on Orcas, with the possibility of including new practices that might evolve in the future.
  • Safeguarding the quality of Orcas medical care services and facilities, both those available on the island and those available off island through information technology.
  • Creating a reliable partner for our Island’s existing, and wonderful, Emergency Medical Services (EMS), offered through the Orcas Island Fire Department.
  • Coming into step with similar public healthcare districts now operating on Lopez and San Juan Islands.

The point I wish to emphasize in this letter is the drastic situation that may result should we fail to pass the ballot initiative. Without a stable source of adequate funding, it is likely that none of the Island’s current medical practices will long survive. We could very well find ourselves without any primary, after hours, or urgent care options short of calling 911. Furthermore, with yet another failure of our community to step to the plate to provide sustainable financial support, it seems inconceivable that any qualified service providers will opt to move to Orcas in the future.

Notwithstanding the increase we will incur in our future property taxes, I believe that over time the healthcare district will save us all money, compared with the costs of leaving the island to find routine medical care or being flown off island for urgent or after hours care.

Please join me in supporting the initiative.

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Comments

Letter to Editor | Drastic Situation May Result Should We Fail — 15 Comments

  1. Increasingly, the pro-Hospital District voices cry “the sky is falling”, i.e. that there will be no medical care left on the island should the Hospital District not be approved by the voters. Somehow medical care has existed here for many years without a Hospital District and I suspect it will still be here in some form or fashion if the measure is not approved.

    If you are trying to sell the Hospital District to us, tell us how we will receive care that is better than the existing care in return for our tax dollars. Speculative fearmongering is usually used when the benefits don’t justify the support required, instead scare tactics are employed.

  2. I fear this is not speculation. Dr. Shinstrom’s board members have stated clearly in several meetings that, without substantial support from a Hospital District, their office will close by the end of this year. The UW Clinic has said the same. The major donors who kept things going for a couple of decades, donating hundreds of thousands of dollars, have either moved or passed away. I don’t see any more white knights on the horizon.

  3. The question appears to be will the islanders decide to subsidize UW forever. And if so, what is the limit of their appetite for more funding over time? Medical care is unlikely to go down in cost…Or, will those who can afford care continue to get it while those who can’t are forced to travel off island?

  4. Mr. Webster, ARE YOU WILLING TO DONATE significant thousands of philanthropic dollars, year after year, to provide on-going primary and urgent care for Orcas residents? Or is Mr. Webster willing to do the fundraising necessary, year after year, to provide that degree of financial support?

    WHAT DO YOU PLAN TO DO should YOU, or your family, need local primary and urgent healthcare if our existing two clinics are no longer here?

  5. I would like to hear from those who do NOT support the Hospital District – what are the alternatives? I would love to hear of some – or even one – so that I can make a choice instead of voting for what seems to be the only option to keep healthcare available to everyone on the Island.

    Keeping things as they are is NOT an option as I understand it.

    Both clinics have stated that they will not stay if there is no stable source of funding. How will that void be filled?

    I am genuinely hoping someone – or lots of folks – has given this thought and can offer up the missing solutions. I suspect at least one of the clinics has spent a fair amount of time investigating the options. Have you? Speak up!

  6. Steve, I don’t know if you chose the headline for your Letter,
    but “Drastic Situation May Result Should We Fail”
    is not really what your opinion is about.. something more..

    A non-Apocalyptic vision of our shared future coupled with some realistic safeguards for the pitfalls we have actually discovered along the way would be ..

    Refreshing!

    It’s really not about the money.
    Stop talking about the money, already!
    And stop talking about your property values too.
    There is no Cosmic rule that anything but deer and rabbits need to live on Orcas. We have the *option* to make this thing livable and inclusive for the short while we have.

    a no brainer

    as one of the Saints of my generation Carlos Castaneda might say it: Before you embark on any path ask the question: Does this path have a heart?

    What IS our path.

  7. As I understand it, neither the UW Clinic nor Dr. Shinstrom’s clinic would be “subsidized” by the Public Hospital District property tax revenues. The demographic reality is that people using Medicare and Medicaid make up a large proportion of those who use the medical clinics on Orcas Island. Medicare and Medicaid reimburse at only about 50% of the actual cost of the services. The basic costs of running a clinic are not lower on Orcas Island than in more urban mainland communities. In fact, housing costs for staff are likely higher here on our island. If staff cannot afford to live here, they will be forced to find work elsewhere. This brings up another significant problem – the lack of affordable housing.

  8. There is so many questions about what will happen if the hospital tax is approved ? Where will the funding go that will be approved by a new board of commissioners ? How many facilities will the new tax be able to fund so that we have improved medical care and after hours care ? So there is so many uncertainty for the future. The Fire Department who does a fabulous job in responding to emergency calls will also need more funding in the future. Orcas needs one medical center with some after hours care. How much money would the new tax raised every year and would that be enough
    to fund all our needs. I would like to see a plan that show us a lot more information.

  9. In my estimate this island needs at least 2 or 3 primary care practices to support our population. No, Dorothy, the government does not pay full costs for caring for Medicare or Medicaid patients – another fraud brought to you by Washington DC.

    The choice is straightforward, medical care here, or suck it up and head off on the ferry.

  10. For those who have questions about the proposed Hospital District, PLEASE go to the Coalition’s website: CoalitionForOrcasHealthCare.com
    We’ve been trying very hard to include the whole island in this conversation. For those who don’t read the paper, posters or signs, or who don’t attend Town Hall and/or neighborhood meetings, all of the Q&As that have resulted from those meetings are published on the website. If you can read this comment, you’re on the internet and you can look at the Coalition’s website. The presentation from the last Town Hall meeting, which was about costs, is also there.

  11. Why don’t the Medicare and Medicaid programs pay all of our medical expenses here on Orcas? There may be three things to think about here.

    First, how efficient is it to have three separate practices (until UW Medicine eliminated one) serving our small population? Actually, I think we had a situation at one time in the past where all the doctors were at the Medical Center. The good folks that sponsored and funded the Medical Center must have had this in mind. That did not seem to work out for a number of rumored reasons. So now a lot of duplication of administrative and insurance occurs. Also, for practices outside of the Medical Center, there is rent to pay. Can we get to a structure here that is more efficient? Do all four physicians on San Juan work out of their medical center? Would the Hospital District promote more of the same or a much more efficient Orcas medical system?

    Don’t many people seek their primary care off island? What would be the impact of getting even half of those folks back to on island care? Would more paying customers make things more economic? Could we operate a more efficient medical care system? My criteria in selecting my primary care physician, is my view of their diagnostic expertise. I want my problems found before they become serious (preventive medicine?). I am not interested in a practice that says show up when you have something wrong. I also want to be dealing with the same person (or mostly the same person) when I go in for a problem. This is not happening for me on Orcas these days. I was a patient of Dr. Geffer then Dr. Valesquez. Where did they go? How do we get people to view Orcas as the place to get their primary care? Can the Hospital District somehow encourage folks back to Orcas for primary care?

    Second, both Medicare and Medicaid are funded by the Federal Government at levels that do not cover all costs (including the deductibles that we pay). Why hasn’t some solutions been reached to this problem? Well, it must be the Republicans because they have a majority in both houses of Congress and also the Presidency. But, remember, not so may years ago, the Democrats were in the same position and the problem was not solved. Perhaps it is both partied. Do we have the wrong people representing us in Congress? How about selecting some folks that would work for solutions rather than play party politics? Is the Hospital District the best way to fund the Federal Governments obligations?

    Third, even if the politicians could find solutions, does this country have the financial resources to spend more money on these programs? Remember, we are borrowing tons of money to keep this ship afloat. How long will that last? We could reprioritize our spending and say cut out military spending. How safe would we be then? Maybe cut our Social Security. Wait, I paid into that my whole life and I want to get something out of it. I guess the best solution is to severely cut the pay of our fine elected officials, aren’t most of them already millionaires? We all will have a chance to vote in future elections! Let’s try some new people!

  12. Some interesting realities about US healthcare:

    +The cost of fraud and abuse estimated by CMS* is ten percent: approximately [at last check] equal to our national defense spending. This is an archaic moral equivalency that dates back to the Vietnam era and no longer valid due to the next reality check:

    +the rate of inflation is 2.2% but the price of medical care has grown at the rate of 3.6%; about 70% faster. Although inflation dips during recessions, medical care inflation stays steady and so steadily erodes our place in the global economy and punishes market segments with less earning power [US!];

    +Furthermore the number of medical providers per capita varies widely from area to area as do costs of medical care. CMS has reams and reams of data to validate this central fact of healthcare: it violates the generally accepted truisms of market economics. As I have pointed out in the past, the healthcare sector is characterized by something economists call “externalities” that make a joke of normal business assumptions about how to run healthcare.

    This has been unfortunately demonstrated in spades by Island Hospital in our little rural microcosm. Interestingly we spent the better part of a $million to transfer our electronic records to UW who then discarded the man who created those records, just as OIMCA has been allowing to happen for many many years. So let us please mute the applause button here.
    ..Back to externalities and Quality. Healthcare is about the details, it is about the human ability to understand complex relationships between those details even though we must rely on technology to keep track of all those details; humans are the key to value and one might say, values .. which is to say ‘externalities.’

    But in healthcare where this is MOST true, this relationship is severed repeatedly and quality suffers with the most vulnerable and complex patients suffering the most .. that would be US ALL, as we age. Again in spades Orcas has discovered how this works through the continuous hemorrhaging of the most vulnerable here who can only survive by extensive professional collaboration and the submersion of competing personal agendas throughout the community. THIS community! And yet we’re snarkily addicted to vicious competition, and wasteful arrogant monopolistic patterns of bullying and exclusion and malfeasance.

    We need different practices, varied practitioners, and varied complimentary patterns of care and a new vision. Without which a PHD is a Pipe Heck! Dream. **[read it!]

    _____
    *Centers for Medicare and Medicaid Services
    ** QUALITY THROUGH COLLABORATION: The Future Of Rural Health
    https://www.nap.edu/catalog/11140/quality-through-collaboration-the-future-of-rural-health
    Board on Health Care Services,
    IOM [Institute Of Medicine (now The Health And Medicine Division, HMD)]

  13. Janet–I don’t understand your first comment. As I understand it, both the UW Clinic and Dr. Shinstrom’s clinic would indeed be “subsidized” by the Public Hospital District property tax revenues–to the tune of $800,000. The OI Medical Foundation has committed to pay UW at least $500,000 toward any operating loss posted by UW, and this appears to be the model contemplated by the proponents for the Hospital District. Other published materials suggest that Dr. Shinstrom’s practice will receive approximately $300,000 in subsidies, thought the details of that calculation have not, to my knowledge, been made available.

  14. Hi Peg,
    The situation does make my head spin, but I do not think that we are subsidizing the offices offering medical services. We would be helping to pay for their actual costs. Maybe the people with higher property taxes are “subsidizing” the medical care for those with lower property taxes. I am likely in the higher tax group, but do not mind helping to subsidize others.

    pay part of the cost of producing (something) to reduce prices for the buyer.
    “the government subsidizes basic goods including sugar, petroleum, and wheat”

  15. Janet–I think it depends on how we mean “subsidize.” As I read the UW contract with the Medical Foundation, if the District assumes the responsibilities under the UW contract, the District will be on the hook for the difference between UW operating costs minus UW revenue, capped at about $500,000. There is a lot of wiggle room in the definitions of “costs” and “revenues,” so much so that I’ve spent a goodly part of my career devoted to those issues.

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