When a resolution calling for formation of a task force to study a single-payer health-care system surfaced at the 1998 annual meeting of the Washington State Medical Association, many felt it would be promptly rejected.


Instead, the associations policy-making body, the House of Delegates, referred the resolution to an executive committee for further study. Although in subsequent committee discussions some sponsors of the resolution withdrew their support and the idea now appears to have died, John Arveson, the associations director of professional affairs, thinks the delegates response is revealing.


Its telling that the House of Delegates, a broad spectrum group, felt it was worthy of discussion rather than simply defeating it, he says. There is a sense of frustration and anxiety about how the market system is evolving.


One form of single-payer system, of course, is socialized medicine, with the government holding sway as the single payer. Socialized medicine is seen as an anathema by many, with doctors associations being among the strongest critics.


Arveson had believed the resolution, brought forward at the October meeting by a half-dozen Western Washington doctors, would go down in quick defeat.


The resolution cited as justification for the study of such a system the growing number of uninsured Americans, including an estimated more than 600,000 in Washington state; questions about quality of care being compromised by decisions based on financial rather than medical considerations; and losses blamed on the multiple financing mechanisms used today. It asked for the association to convene a task force of health-care providers, consumers, and other stakeholders to investigate the feasibility of establishing a single health-care fund to guarantee access to health care for all Washington residents.


Physicians are seriously thinking of restructuring, possibly to a single-payer system, Arveson says.


John Gollhofer, a Spokane doctor who is president-elect of the State Medical Association, isnt so convinced. He says health care financing faces significant problems, and access to care is always a priority for doctors and their professional associations. Nonetheless, he calls the resolution regarding a single-payer system just one more theory.


A huge majority (of doctors) do not favor that resolution, Gollhofer says.


He says having a resolution referred for further study is simply part of the parliamentary process, and doesnt necessarily indicate interest or support. The executive committee has met with the authors of the resolution, two of whom said they no longer endorse the idea of studying a single-payer system for Washington, Gollhofer says. Even if the resolution fades away, though, Gollhofer says financing health care is still an issue.


Gollhofer says massive reform for health care, such as President Clintons unsuccessful plan offered earlier this decade, usually isnt effective. He says change happens most effectively in small increments. For example, he says the association is supportive of more funding from this years Legislature for the basic health plan so coverage can be expanded.