On Monday, Jay Inslee addressed the WSMA Legislative Conference attended by about 140 physicians and practice administrators.

Some folks commented at our State of Reform event that Jay appeared to be very strong on federal issues, but less so on state health care issues.  In fact, a number of folks who will be supporting Inslee this fall commented to me that they were concerned that he hadn’t apparently spent enough time on state health care issues, based upon his speech at our event.

I heard the exact opposite at WSMA.  Inslee appeared to have a very detailed and comprehensive level of understanding of what’s happening in the state, as well as federal issues.  The idea that kept running through my head when listening to him was “fine grained” – that he appeared to have a clear sense of the most important values and issues facing physicians today at a very detailed, nuanced level.  It was a strong performance that earned a standing ovation from the group.

Afterwards, the word from the crowd was that they were very impressed with his level of knowledge, his understanding of the physician culture, and his sincere approach to the issues.  This was a crowd willing and ready to throw him under the bus after responding well to McKenna.  Instead, Inslee left the crowd thinking – in the words of one politically “independent” attendee – that “there are two great candidates for physicians and for health care running for governor.”

During his speech, Inslee highlighted three lessons he had learned from listening to physicians and physician groups during his career against which he said he measured policy options.

I was the founding co-chair of this group we called the Quality Care Coalition.  And we did that because we understood that we have to work on these systems to improve quality and reduce the rate of medical inflation.  So those are the three lessons that the rest of my comments will be centered around:  the centrality of that relationship between physician and patient, the need to align incentives with quality outcomes, and the ability to allow physicians to have collaboration amongst themselves.

This piece of the “centrality” of the patient-physician relationship is hugely important to physicians.  After a few decades of what physicians perceive as an undermining of their authority by plans and hospitals, hearing a gubernatorial candidate speak to the importance of physicians and the importance of their relationship with patients

First, I think perhaps the most important element of the Affordable Care Act to control costs is the impelmentation of an effecitve, robust, and transparent excchange .  The current bill… I think is generally going in the right direction.  I think the concerns about what counts as a “qualified health plan” will get worked out, with your help.  But I do share some concerns about empowering an exchange board to make decisions that might more properly be made by the elected legislators.

On the issue of cost, and aligning incentives in the system for outcomes, Inslee showed he was willing to address the most central and ‘fine grained’ payment issues in the market today.  For this quote below, he was interrupted by a round of applause – the only time that happened during the day.

The recent spate of the free standing ERs I think shows the incentives of today’s health care system are a bit misdirected…  I think it’s a valid question as to whether there should be divergent payment rates depending on where the cre is provided.  Perhaps we can keep primary care in a primary care setting, with the patient, the families and a trusted physician.  I haven’t seen any research that facility fees lead to patient outcomes.  I think this is worthy of discussion.

Dr. Peter Dunbar, past president of WSMA, asked Inslee about tort reform saying “you have a consistent history of supporting the trial lawyers side of things.”

I think there are things that we can do to reduce the cost of the tort system… and some of these are in the ACA…  I think about 40% of all of the costs of your insurance premiums do not go to pay claimants or the injured party, they go to finance the cost of this system of litigation.  So trying to reduce the cost of that litigation I think is a winner for both sides of this coin because it doesn’t reduce the justice either party gets but it reduces the cost.  And there is huge waste in the legal system.  I’ve been in the system and I’ve seen it.

He continued on tort reform, with perhaps the most heartfelt comments of the day.

I believe in democracy, and I believe probably the least tainted instrument in democracy that we have today is a place where there are no lobbyists, there are no politicians, there are no lawyers, and there are no doctors – and that’s in a jury room.  They are just 12 randomly selected Americans.  And they can’t be bought, and they can’t be threatened, and they can’t have lobbyist taking them out for dinner.  And they try to do the best they can to try to decide what is right in a case and I believe that is a fundamental bloc of our democracy.


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