Health Insurance? Forget It.

Seattle, Wa.

Hillary Clinton and Al Gore, survivors of Bill Clinton's failed attempt to socialize medicine six years ago, still haven't given up on the idea of state-backed universal health insurance. Mrs. Clinton promises to make it an issue in her senatorial campaign. In his presidential bid, Gore proposes giving all children a government guarantee of health-care access and argues for a "Patient's Bill of Rights" granting further new rights to adults, including the right to see a shrink at your insurer's expense.

But in this, as in so many other things, denizens of "the other Washington"-as locals here call the nation's capital-live in a kind of vacuum-sealed terrarium separated from the reality of most Americans' lives. In the Washington that sits on the edge of the Pacific Ocean, socialism in the doctor's office has run up against a barrier as formidable as the Pacific itself. Call it "reality." This correspondent happens to have found that out the hard way.

I moved to Seattle recently with a view to making a go of it as a freelance writer. The morning after I pulled into town, I opened the Seattle Post-Intelligencer to discover that I was in deep trouble. I'm someone with an unusually strong interest in staying healthy-okay, okay, I'm a hypochrondriac-so in my mind keeping within easy contact of expert medical attention is second only to easy access to food and water. Medical attention means medical insurance. And as of that very day, in Seattle and most of the rest of Washington State, insurance carriers were no longer going to be writing new policies for self-employed individuals-like me. Employers can still buy group insurance, but if you're, say, an entrepreneur or a writer on your own and without insurance, you're out of luck.

Any number of hypochondriacal symptoms presented themselves to me as I read through the news story. Is that a pain I feel in my back? Head? Arm? Stomach area?

Actually, a self-employed person can buy insurance if he's desperate enough. As an emergency measure, insurance commissioner Deborah Senn has opened the state's so-called high-risk pool to all comers. This means we can buy the kind of insurance that was designed for people so sick they can't get insurance any other way, the kind that's 50 percent costlier than if you got your insurance through an employer. Thanks! So far 18 people have signed up.

What happened to Washington State, where-I thought before leaving Manhattan-the living's supposed to be so easy, not to mention healthy? Ideologically speaking, the place has a split personality. Evangelical Christians are startlingly prominent. At your nearby, heavily trafficked Starbucks, don't be surprised to see a twentysomething white guy in grunge attire sitting next to you and, of all things, intently studying the Bible. Even in suburban, upscale Mercer Island, where I live-the socio-economic equivalent of New York's Westchester County-church parking lots are jammed on Sundays.

Then again, Washington also has a weakness for left-secularism, often in some wacky forms. The lower portion of each afternoon's Seattle Times front page is apparently reserved for covering this other half of the region's culture. The big story in this vein last week was a fire-breathing-literally-post-op transsexual who climbed to the top of a utility tower and snarled traffic for hours by shaking his bared breasts and blowing and igniting geysers of liquid propane from his mouth, till cops coaxed him down. In New York, they would have just shot him. His stated purpose: to protest laws against women showing their naked bosoms in public.

In 1993, at the same time the White House was promoting Hillary's plan, Christian Washington State snoozed as radical Washington State passed the Washington Health Services Act, ClintonCare in miniature. Nine separate health bureaucracies bloomed. An insurance commisionership was inaugurated and Deborah Senn, a regulatory attorney with no health-care experience, elected to the job. The legislation promised reforms in which everybody would be required to buy insurance from one of several government-controlled health plans. Choice in health coverage would be severely limited.

Republicans succeeded in unraveling the Act's most egregious features, but one reform that survived has contributed to the downfall of the individual insurance market here. Under this provision, nobody can be turned away, and no pre-existing condition can be excluded. Let's say that an AIDS-infected resident of another state is looking for a more generous health plan. He moves to Seattle. Any health insurer selling policies in King County is obliged to sell him insurance just as it would to somebody in perfect health. Within 90 days, the insurance carrier must begin covering the AIDS patient for all his medical needs and desires.

Alarming losses began to be reported in the individual insurance market: $15.5 million in one year at Blue Cross, $7 million at Pierce County Medical, and so on. Carriers predictably tried to make up for the losses by raising premiums-in a single year, in the case of Pierce County Medical, by as much as 34 percent.

By 1995, companies had begun reaching a decision that they could no longer do individual-insurance business here. Estimates vary, but between 30 and 40 carriers have ceased writing individual policies in Washington State. In 31 of 39 counties, you couldn't buy such a health-insurance policy if your life depended on it.

Paul Guppy, of the Washington Institute Foundation, a free-market-oriented think tank, takes the commonsensical view that "the more government restricts freedom in the marketplace, the harder it becomes to stay in business and offer your product at competitive prices. . . . Deborah Senn's opinion is that a little bit of socialism doesn't work, but if you put the whole socialist straitjacket on like they've done in Canada, then it will work."

That's pretty much what she does say. Queried as to what lessons insurance chaos in her state may have for would-be reformers like Hillary Clinton, an irritable Commissioner Senn replies, "You'd have to ask her." The commissioner's own appetite for insurance reform remains undiminished. "We didn't have reform, we had half reform. The lesson that everyone should have learned is that you can't take a piecemeal approach." The party to blame is not the reformers, Senn insists: "This is very much a stand-off created by the carriers." She blames, for instance, Blue Cross for spending too much money on administrative costs and other carriers for selling insurance to larger employers for too little.

Cleverly, Senn avoids falling into the liberal trap of calling health care a "right." Instead she says that reform of the kind envisioned in 1993, and presumably still glittering in the mind of Mrs. Clinton, is ultimately about "finding a way to be really smart with our health-care dollars. It's very pragmatic. We're all going to pay for it as a society, one way or another." In the absence of guaranteed access to health care, individuals will wait till they're good and sick before seeking out a doctor, then end up in expensive emergency-room care.

Anyway, she thinks, the real crisis isn't with the individual insurance market at all, but with the group market. Her office recently published a "white paper" asserting that carriers lost $43.8 million on group policies in 1997, but only $11.9 million on individuals. If so, it remains deeply mysterious that insurers continue to sell group policies as they always did, while evacuating the individual market almost en masse.

Clearly, even a little bit of socialism is a very bad thing. What will Al Gore and Hillary Clinton, the latter currently expressing interest in gradual rather than dramatic insurance reform, make of all this should either attain higher office? To paraphrase Deborah Senn, you'd have to ask them.

Meanwhile, about the pain in my stomach area . . .