The proposed Orcas Public Hospital District presents many issues for consideration, but none as significant as the election of public hospital district commissioners.

Orcas residents already pay taxes for Orcas Island Fire and Rescue, and they have also donated generously to build the Orcas Medical Center facility and to subsidize multiple Orcas physician practices. Yet why have all these past investments achieved neither self-sustaining primary care nor 24/7 urgent care for Orcas? One reason is that Orcas has never put a health care governance system in place. Think about the difference which local health commissioners might make.

First, elected commissioners will work for Orcas residents, not the providers, in assessing Orcas-wide health care needs and planning for services. They should assess provider services and coverage as a condition of public subsidies. Tax funds will flow through one public source rather than multiple private channels, and the Commissioners will be held to standards of transparency and fairness via the elective process.

Second, any licensed physician can legally practice on Orcas, but probably cannot establish a viable practice without subsidies. Even if pre-existing physicians are “grandfathered in,” the commissioners may still choose to tax-subsidize any future new providers only if they avoid redundancy, coordinate their services with OIFR, fill unmet needs and meet other specified criteria.

Third, the commissioners can establish budget priorities. Instead of subsidizing only weekday care, they can target some funds to urgent care outside of office hours. They can even require that any subsidized practice must participate in after-hours care. They can finally think beyond weekday-only clinics and start addressing Orcas urgent care needs on nights, weekends and holidays.

Orcas doesn’t need a hospital yet, but we certainly do need better medical care outside weekday clinic hours. If you believe, as I do, that Orcas deserves to receive sustainable 24/7 medical care in exchange for the next bundle we invest, then let’s elect some wise and brave PHD commissioners. Let’s empower them with dependable tax dollars so that they can leverage future Orcas health investments where Orcas residents and visitors need them to go.

Norm Zimlich

Orcas Island