This editorial will appear in tomorrow’s print edition.

The Franciscan Health System – an empire of hospitals and medical clinics in Pierce and King counties – is about to take the big step from a no-smoking policy to a no-smoker policy.

To a nicotine addict seeking a job at, say, St. Joseph in Tacoma or St. Clare in Lakewood, it will be brutal. Although the rule won’t be applied retroactively to current employees, Franciscan will effectively be hanging out a “smokers need not apply” sign as of March 1.

Franciscan is far from alone. Some other large companies, such as Alaska Airlines, have had no-smoker policies in place for years. But health care organizations in particular have recently been moving to ban smoking – on or off the job – among their employees.

This is less a cause for celebration or criticism than it is a simple inevitability. Like many smokers themselves, America can no longer afford cigarettes.

The U.S. Centers of Disease Control has estimated that tobacco creates a $193 billion-a-year drag on the U.S. economy. It pegged the cost of treating nicotine-driven diseases at roughly $96 billion. Another $97 million resulted from lost productivity – absenteeism, impaired workplace performance, etc.
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This editorial will appear in tomorrow’s print edition.

It shouldn’t need pointing out, but this is hardly the time for lawmakers to be squeezing another benefit into health plans that hundreds of thousands of Washingtonians already can’t afford.

State Sen. Ed Murray, D-Seattle, has the best of intentions. He proposes to require all state-regulated health policies to cover smoking-cessation treatment, including at least two cessation courses a year and coverage for over-the-counter and prescription drugs.

The idea is to curb the enormous health care costs that tobacco inflicts on society and help the smokers themselves escape an addiction that often leads to horrifying diseases and death.

The problem is doing it in the midst of the worst economic distress in generations.

As mandates go, this is one of the better proposals out there. But it’s part of a much larger context: Washington already mandates more treatments for more classes of people by more kinds of professionals than the vast majority of states.

Mandates always mean that people who would never use particular benefits – the services of naturopaths, midwives or massage therapists, for example – are required to help pay for others’ use of those benefits.
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This editorial will appear in tomorrow’s print edition.

Gov. Chris Gregoire had to perform an agonizing arithmetic to come up with a budget for the next biennium.

After the recession and the voters knocked a $4.6 billion breach between revenues and existing services, there was no way to balance the budget without hurting hundreds of thousands of people.

Cut health insurance for the poor, and people will die. Cut crucial education programs, and some children will forfeit their futures. Cut prison funding too far, and predators will go free. Cut food programs, and kids will go to bed hungry.

Cruel …

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This editorial will appear in tomorrow’s print edition.

Initiative 1098 is the most slickly packaged measure on the November ballot.

It would enact a new income tax on wealthier Washingtonians – 5 percent on individuals earning more than $200,000 a year or couples earning more than $400,000. If the idea of soaking the rich doesn’t quite close the deal, the initiative throws in two other sweeteners: a 20 percent cut in the state property tax and a higher exemption from the state business and occupation tax.

The latter two provisions allow its supporters to tout I-1098 as a tax cut. Which it is – except for the fact that it raises four times as much in taxes as it cuts.

In fact, the “middle class tax relief” it would deliver to homeowners would be barely perceptible: Because the state’s share of property taxes is small, a reduction of 20 percent would translate into savings of about 4 percent.

Clear away the clutter, and I-1098 is an attempt to create a tiered income tax without benefit of an amendment to the Washington Constitution. The state supreme court has forbidden that in the past; the initiative’s sponsors are hoping today’s justices will have different ideas when I-1098 inevitably hits the courts.

The measure has several strikes against it: It may be illegal; it would target wealth-creation in the middle of a recession, and it would enact an income tax with no constitutional limits or corresponding constitutional caps on other state taxes.
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This editorial will appear in tomorrow’s print edition.

It’s fitting that the U.S. Senate is poised to approve historic health care legislation during Christmas week. Like a big present under the tree, the package looks gorgeous, promises to run up the Visa card and conceals things known to only a few.

But shaking the box tells you quite a bit. The immense bill would extend coverage to most Americans now uninsured, require all individuals to carry medical insurance (subsidized as necessary), and prohibit insurance companies from refusing to sell coverage to the sick or dropping them after they get sick.

This is good, as far as it goes. In a humane society, access to health care is a moral imperative. Americans should not die because their wallets can’t get past a biopsy at the front desk.

And the law must demand that individuals carry coverage. The logic follows mandatory auto insurance: If you don’t insure yourself, you are effectively planning to dump your expenses on someone else. Those who think this violates their rights ought to pledge in advance not to accept care from a doctor or hospital unless they pay full freight. Any takers on that bargain?
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This editorial will appear in tomorrow’s print edition.

It took the worst recession since the Great Depression to force the issue, but Pierce County may finally do the unthinkable: require workers to share the cost of their own health insurance.

County Executive Pat McCarthy’s 2010 spending plan is a brutal budget for brutal times. But one of the economies it proposes has long been routine in the rest of the world: splitting the cost of premiums with county employees.

Assuming it’s adopted, this would soften the sweeping budget cuts McCarthy is proposing by a cool $3 million.

It’s amazing that any group of employees is getting free coverage these days. Predictably, this group belongs to the public sector. Private employers, facing market discipline, can’t afford such munificence. The most generous private coverage is generally found within large companies – and they require that employees foot at least a quarter of the bill, on average.

Fully paid premiums break budgets in a couple ways.

Up front, they cost the employer a fortune. According to McCarthy, Pierce County spends an average of $1,000 a month on each worker’s health insurance. Dependents are included regardless of whether they qualify for some other insurance plan. Superior court judges have enjoyed double coverage, from both the county and state.
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This editorial will appear in Friday’s print edition

Health care providers are urging their patients to get flu shots this fall – against the regular seasonal flu and the new swine flu virus.

Uh . . . physicians, heal thyself.

According to the Centers for Disease Control, fewer than half of health care workers got a flu shot last year. That might fly during a normal flu season, but the 2009-2010 season is shaping up to be anything but normal.

The nation’s health care delivery system may be taxed far more than usual due to the new swine flu virus (H1N1). It will need its providers healthy and on the job, not out sick with the flu or, worse, at work with the flu and spreading it to vulnerable patients.

State health officials should give serious consideration to requiring health workers to be immunized against both types of flu – a step New York has already taken. At this point, it’s still voluntary in Washington state.

The swine flu virus is already here – witness the big outbreak at Washington State University. But it will be five or six weeks before immunizations are available for high-risk populations – pregnant women; young people 6 months to 24 years old; caregivers of infants under 6 months; health and emergency medical workers; and adults 25-64 with pre-existing lung or heart problems, or compromised immune conditions. Read more »

This editorial will appear in Monday’s print edition.
Congress returns this week from a summer of discontent to stare down health care legislation – including Medicare reform – once again.

Fresh from their battering back home, Democrats will be trying to figure out how to salvage health care reform without setting themselves up for a fall in next year’s mid-term elections. President Obama is expected to lay out his must-haves in a Wednesday address to Congress that will likely be two parts “go get it done” and one part “I’m in this with you.”

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