SEQUIM ­– Three providers laid out two ways to gain not just a better health insurance system, but also good health, during a lively forum last week.

The proposed reform bills in Congress, designed to heal the country’s health care woes, mean “big changes, but not the level of changes we need,” Eric Lewis, CEO of Olympic Medical Center, began in the discussion at the Sequim Sunrise Rotary Club on Friday morning.

The legislation, which lawmakers and President Barack Obama hope to pass by the end of the year, could improve Americans’ access to care and pay primary care doctors more — something sorely needed on the North Olympic Peninsula, Lewis said.

And the proposed bills in the Senate and House of Representatives, each 1,000 pages long, are designed to ensure that 94 percent of U.S. residents get health insurance; they would expand Medicaid to cover more low-income people and provide a “public option,” a government-funded insurance policy, as an alternative to the private companies.

Out of business

When one Rotarian asked Lewis about whether the public option could drive some private carriers out of business, he gave a reply that sparked applause.

“I’ve been dealing with insurance companies for 25 years,” Lewis said, “and I’d be fine if some of them went out of business. The public option is something we should definitely try” to defy the powerful insurance lobby that has influenced Congress for decades.

To lower health-care costs for ourselves in the meantime, primary care providers are key, added Joe Corn, a Sequim internist.

“If you don’t have a primary care doctor watching everything, things go awry pretty quickly,” he said.

If you end up in the emergency room or if you need expensive tests, your bills may skyrocket far past what you would have paid for visits to a family physician or nurse practitioner, he said.

But the shortage of such providers in Sequim is worsening.

If you have a primary care doctor now, you’re fortunate, Corn said, adding that when Paul Hogue died last October, some 2,700 patients at his Sherwood Medical Clinic had to hunt for a new provider.

“We have no place else we can put people,” Corn said.

Tom Locke, health officer for Clallam and Jefferson counties, stepped forward next, calling himself the “mop-up speaker.”

Our current health insurance system, Locke said, “is utterly unsustainable” and has too long neglected something that could save a lot of pain.

More prevention

“We have a long tradition in this country of giving lip service to prevention,” he said, “but we put about 1 percent of our health care budget into it,” even though preventive care and early detection of disease are much cheaper than trying to treat a full-blown illness.

“We wait until the baby has fallen down the well,” Locke said, and the system tends toward “rescue therapies” and high-cost surgeries.

A system that emphasizes prevention would cover such services as mental health care and early treatment of addictions and obesity, Lewis added.

“It’s easy to get addicted to eating too much” for example, but instead of helping people turn away from harmful habits, the system is inclined more toward treatment of advanced heart disease and diabetes.

In an interview after the forum, Lewis pointed out that the United States is the only industrialized country with an employer- and private insurance-based health care system.

“We almost got single-payer after World War II,” when President Harry S. Truman pushed for it and Congress nearly enacted it, he said.

But in the intervening years, the country has slid into a public-private dilemma: private insurance premiums many people can’t pay, alongside federally funded Medicare.

“Medicare gets us halfway to a single-payer system,” Lewis said.

Medicare crash?

But he predicted that without an overhaul, Medicare is headed for a crash as baby boomers retire by the tens of millions.

In this country, we want everything, he added: “access, low cost, the greatest technology and no wait times. We have to choose two of those,” and so far the choice has been for technology and no wait times instead of access and lower cost.

But Canada, Europe and Australia have single-payer frameworks that “cost half as much and have better outcomes,” he said. “We can look around the world and see successful systems.”

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Sequim-Dungeness Valley reporter Diane Urbani de la Paz can be reached at 360-681-2391 or at diane.urbani@peninsuladaily news.com.