We Could Have Had Universal Healthcare

Last Wednesday was the final day for bills to make it out of their house of origin in the Washington State legislature. While many bills still in play are worth paying attention to, I want to focus on a pair that didn’t make the cut: Senate Bill 5233 and House Bill 1445. by Tobias Coughlin-Bogue

Last Wednesday was the final day for bills to make it out of their house of origin in the Washington State legislature. While many bills still in play are worth paying attention to, I want to focus on a pair that didn’t make the cut: Senate Bill 5233 and House Bill 1445. 

Both bills would have created the Washington Health Trust (WHT), a system of universal healthcare for the residents of our state. Introducing universal healthcare bills to both houses in the same session is a first, and these bills enjoyed unprecedented support. Efforts to enact universal healthcare at a state level have been underway in some form since 2016, but this year the bills received a record number of cosponsors in each chamber—11 in the Senate and 17 in the House—plus the endorsement of the Washington State Democratic Party.

Our state has a Democratic trifecta, meaning that the committees that both bills needed to pass through—Health & Long-Term Care in the Senate and Health Care & Wellness in the House—are chaired by Democrats. In this case, Sen. Annette Cleveland (D-Vancouver) and Rep. Dan Bronoske (D-Lakewood). Universal healthcare has been a part of the Washington State Democratic Party’s platform for almost a decade.

The bills also arrived at a time when our country’s system of private insurance is at an all-time low in popularity. Conversely, the concept of universal healthcare is polling better than ever. Our state’s bills would do exactly what has made universal healthcare such a popular idea: provide comprehensive coverage to all residents of Washington State at low or no cost.

So, if everyone loves universal healthcare and all the politicians involved say they do too, why the hell didn’t it get a hearing?

“That's a question I've been asking since 2016,” said Andre Stackhouse, the executive director of Whole Washington, one of the groups behind the WHT bills. 

“I wish I could say that I was surprised that the bills didn't get a hearing this year,” he said. “We have worked very hard to establish something of a dialogue and a working relationship with Chair Cleveland, but this is something she's held firm on ever since she was elected chair.”

This year, at least, she offered some explanation as to why. In response to a letter from Healthcare is a Human Right Washington (HCHR-WA) that went to her and Rep. Bronoske, she wrote:

“Regarding your request for a hearing, I have been clear in all discussions that Senator Hasegawa’s Washington Health Trust bill, SB 5233, would not be heard this year because I am not willing to disingenuously give advocates hope by hearing a bill that will not be moved out of committee. We are facing very dire budget shortfalls as a state this year that prevents bills with large fiscal notes from moving forward.  In addition, it is premature to consider SB 5233 when we still face the roadblock of the federal government in preventing implementation. Finally, the work of the Universal Health Care Commission must be more fully completed before any policy is considered.”

Earlier in her response, she told advocates copied on the email, “Be assured that I am a continued strong advocate of our shared goal.” 

While one might expect a strong advocate of state-level universal healthcare to advance a bill that would create such a system out of the committee she controls, she went on to list several things she is doing instead of that.

One was to join Sen. Bob Hasegawa (D-Seattle), one of SB 5233’s cosponsors, in writing a letter to the Universal Health Care Commission asking them to study SB 5233 and develop recommendations for future legislation. Never mind that the bill is pretty finely tuned already. The other was to wait on passage of Rep. Hasegawa’s Senate Joint Memorial 8004, a nonbinding resolution that would ask the federal government very nicely to let us do universal healthcare.

Democrats are once again gearing up to tell us that better things are not possible, and they really like sounding like the voice of reason when they do it. “Just wait, we’re working on it, someone else is stopping us, these things take time.” But is this actually reasonable? Let’s take a closer look.

First off, while the Universal Healthcare Commission (UHCC)  is still studying the issue and plans to issue a final report that could potentially inform future legislation, it is by no means opposed to the WHT.

“The UHCC has published their Washington Health Trust Analysis Report and found that it aligns with their universal health care system design,” HCHR-WA wrote in its letter. Saying we need to wait for the UHCC to wrap up is something of a stalling tactic here, it seems.

Second, it is not fiscally irresponsible to enact universal healthcare. Not enacting universal healthcare is, in fact, the fiscally irresponsible choice, according to HCHR-WA’s letter:

“The Washington Health Care Authority’s Work Group Report has also estimated that a system like the WHT would potentially save $800 million to $2.5 billion in an implementation year, and up to $5.6 billion on an annual basis in total health care spending once its transition is complete. The WHT raises all necessary revenue and will result in savings for the state across other sectors like housing and law enforcement. In a year in which the state is experiencing significant budgetary challenges, revenue and savings like these may be necessary to implement the budget.”

It might sound preposterous that making the state responsible for all Washingtonians’ healthcare costs would pencil out, but there would be plenty of money coming in. The WHT’s coverage obligations would be backed by a lot of new revenue, specifically in the form of taxes on business and capital gains.

Employers would pay a new 4.5-10.5 percent tax on wages, while sole proprietors would pay 2 percent of earnings. Investors with capital gains of over $200,000 would pay 5 to 9 percent of their profits. For capital gains exceeding $300,000, they’d pay an extra 2 percent. However, profits from home sales or retirement accounts would be exempt, as would capital gains reinvested in a primary residence.

“[The cost is] very similar to the current system where the employers pay premiums and they usually share those premiums with the employee,” Stackhouse said. “I think for most people [it’s] very competitive compared to what they're paying.”

Several studies have shown that the only people who pay more under a system like the WHT are people in the top 1 percent of earners.

“It's really only incomes above, I think, $500,000 that pay significantly more,” Stackhouse added. “And the biggest, biggest impact is [in favor of] the working and middle class who right now pay the highest percentage of their income on healthcare.”

While there is no federal law explicitly preventing states from setting up universal healthcare systems, to make such a system work, states would need to use the money they get from the federal government for Medicare and Medicaid to cover the cost. To do that, they need a waiver allowing them to apply that money to the WHT. If a state enacts a universal healthcare plan and then approaches the Department of Health and Human Services only to be denied, it could leave you in quite a bind. States are required to balance their budget every year, and if they’ve suddenly taken on the cost of covering all residents while losing a major revenue source earmarked for that purpose, they won’t be able to balance shit. 

“They are in financial peril,” Stackhouse said, referring to programs that cover low-income residents like Medicaid or Cascade Care. “So even just to save existing programs, we need to talk about raising revenue.”

So if it’s not really about cost, because it might actually save us money, and it’s not really about federal barriers, what is it about? You could point to a lot of more, shall we say, transactional reasons why Sen. Cleveland continues to table the bill — her 2024 campaign donor list is chock full of large insurers, pharmaceutical companies, and healthcare industry associations, as is Rep. Bronoske’s — but let’s examine what Sen. Cleveland said about not getting anyone’s hopes up.

Cleveland is not wrong about the barriers something like the WHT faces, whether legislative or logistical. Getting away from the miserable, bloodsucking system of private insurance that we have now takes time. Private insurance won’t go away overnight or perhaps ever (nor is it intended to under the WHT). Funding for universal healthcare might get pulled out from under us like a rug. The deranged fascists in charge of the federal government might come down even harder than that, denying funding for other things until we give up our silly notions of socialized medicine. Right now, we have no way of knowing what would happen if the WHT was enacted into law.

But part of why we don’t is because we haven’t done it. We’ve known it’s the right thing to do for decades and now, when we have a viable plan to do it, the people who are supposed to be fighting for us are stalling.

Full disclosure: If I come off biased in favor of these bills, it’s because I am. I have lived with type 1 diabetes for almost 15 years. I have navigated every nook and cranny of the private insurance landscape. I have paid thousands of dollars, even while insured, for the simple privilege of being alive. And I’m lucky to have been able to stay insured. Without coverage, financial ruin comes to most diabetics in a matter of months. 

Frederick Banting invented insulin in 1921 and sold the U.S. patent for it for $1, with explicit instructions to make it cheap and widely available.

“Insulin does not belong to me, it belongs to the world,” he said.

It now belongs to three massive pharmaceutical companies and costs $300 a vial. It costs them $2 to make that vial. If we lived in a just society, the price-fixing ghouls who have created this reality would face consequences.

When it comes to hope, I would say it’s too late. I already have hope. I hope every day for a system that doesn’t do this to people. But every day I see people in power preserve a system that actively does this to people — that causes medical bankruptcies and denies claims and drives people to ration their insulin until they fucking die — and my hope turns into anger.

In this case, I think anger is very appropriate. I think we should all be very, very angry that anyone allows this insane, criminal system to continue. I think that no matter our political affiliation, we should be asking anyone who wants to represent us what they really mean to do for us. And when. Are they willing to stand up to their donors? Or better yet, are they willing to forego donations from the people they’re charged with regulating? Are they on our side? If not, well, the word primary is also a verb.

So what’s next for Washington’s Universal Healthcare dream? Whole Washington, the group behind the WHT, is not giving up so easily. They’re starting the ballot initiative process as soon as this month. Despite what Brian Heywood thinks, they’re not only for billionaires to buy policy. and if you want to put the ballot initiative back in the hands of the people, Whole Washington would love your help.