May 17th marks the 20th anniversary of health care reform in Washington State. On that day in 1993, the Washington State Legislature adopted a comprehensive reform of health insurance markets and health care delivery and finance. Although most of the more “robust” provisions of the state reform law were repealed two years later, Washington retained most of the market reforms and developed many innovative health care programs in the past twenty years.

The reforms retained by the Legislature in 1995 and expanded over the years might explain why Washington residents don’t notice much change in their lives since the federal health care reform law was enacted. Washington the state has long required guaranteed issue of health insurance coverage, limited exclusions, mandated benefits, permitted access to all types of health care providers, created community rating, permitted coverage of dependents to age 25, and regulated managed health care plans. That’s not even an exhaustive list however exhausting.

Washingtonians have deep experience with health care reform gained over the last twenty years that have included these lessons:

  • complex reform leads to complex deformation,
  • big bites lead to choking,
  • community rating creates surly neighbors, and
  • money runs out.

Meanwhile, federal reform has skipped merrily down the same path that Washingtonians followed in 1993. Regulators blithely ignore the State’s history and experience. But let’s be clear that criticism of federal reform or any reform doesn’t mean that reform isn’t needed.

No one in their right mind believes that the existing system for health care delivery and finance works well. Many people in their right minds differ on how much change should happen, when that change should happen and what change will work. Unfortunately, while the political and regulatory war over health care reform reaches its 20th anniversary in Washington, the families and businesses affected rock back and forth in the turbulent waters and some fall overboard.

Federal regulators are just now understanding that just because you can adopt a regulation, it doesn’t automatically follow that those affected will be able to understand and comply. More importantly, regulators are learning that people can lose patience when promises fail to match the reality.

David Brooks, a New York Times columnist I admire and rarely miss, wrote today about the chaos of health care reform. I cannot match his intellect or skill and so instead, I add the following visual observation to mark my 20th year working on health care reform.