The community conversation around creating sustainable health care on the island continued last week with the focus on possibilities to fund primary care, ranging from relying on private donations to creating a health care taxing district.

More than 70 people attended the meeting, which was hosted by the all-volunteer Vashon Maury Island Health Collaborative. It was the third in a series of three meetings the collaborative has held in recent months. Collaborative member Tim Johnson, also the business manager at Granny’s Attic, was one of the evening’s moderators.

“The basic problem is in the current world and where we live, a robust primary care system does not pay for itself, does not pencil out,” he said.

This has been part of the message at all three meetings. At the first, held in September, Neighborcare officials addressed the organization’s challenges on Vashon, and several islanders shared some of their concerns about Neighborcare’s service levels, which declined last summer. At the second meeting, also in September, islanders shared what they would like included in island health care, leading up to the discussion last week: how to pay for local medical care to ensure it is sustainable.

As is familiar to many islanders by now, Neighborcare is expecting a $350,000 operating deficit this year at the Vashon clinic. Several months ago, Neighborcare CEO Michael Erikson wrote an op-ed indicating he believes community financial support for health care is essential, although he has repeatedly stated Neighborcare does not intend to leave the island.

At the meeting last week, Johnson indicated the question regarding raising money to support health care is about taking care of ourselves as islanders, not about taking care of Neighborcare. While Neighborcare is the health care organization that is here now, he said, if the island puts together a funding plan, Vashon-Maury might end up with a different provider or multiple providers. Regardless, without an effective community financial support plan in place, financial challenges would remain.

“No matter who the provider is, with our wants and needs, there is a fairly large funding gap,” he said.

Members of the collaborative have looked into grants to support health care on the island, Johnson said, noting members came up short in part because of the island’s small population and because its proximity to Seattle and Tacoma make it ineligible for rural health care grants.

As he did in the previous meeting, collaborative member John Jenkel, who is also on the board of Neighborcare Health, shared how some other communities similar to Vashon have addressed their health care needs. Orcas, Lopez and San Juan islands have all formed taxing districts, with Lopez Island voting to do so last April, and Orcas passing the measure in July, he said. Point Roberts, a small community near the Canadian border, also relies on a hospital district and is currently looking for a new organization to provide services, after its former partner, Island Care out of Skagit County, left for economic reasons. Cle Elum has aligned itself with Kittitas Valley Hospital, after Swedish left the community.

Like Johnson, Jenkel noted that the economics of primary care are “really, really tough.” He noted that the health center has lost money under Highline, CHI-Franciscan and Neighborcare, and that the island will need to be “a good partner” going forward.

“If we are a community that is consistently losing money in the clinic … and we want someone to come here and help us with this problem, we have to be prepared to be part of the solution. And to be part of that solution, I think, you have to be reliable, you have to be predictable, and your funding has to be sustainable,” he said.

Islanders and collaborative members shared their ideas for possible funding, which ranged from a wealthy funding “angel” simply taking care of the problem at one end of the spectrum to forming a health taxing district at the other. In between, there were a handful of other ideas, including financial support from the county and state, grant assistance and community fundraising.

Jenkel provided some approximate figures regarding a local health district, which would provide funds for health care through a levy, such as those for the fire, park and school districts. In Washington State, the combined limit for junior taxing districts is $5.90 per $1,000 of assessed value. Currently on Vashon, there is enough room for $.17 per $1,000 without affecting another district. At that level, the owner of a home assessed at $450,000 would pay about $80 per year for the health district, bringing in, island-wide, approximately $500,000 annually. At $.50 per $1,000, that homeowner would pay about $225 annually, totaling about $1.5 million across the island.

Joe Wubbold, noting the number of island nonprofits that raise money individually, suggested an island-wide foundation to serve health care and other causes. Bernie O’Malley, stating that Neighborcare appointments are so hard to get he knew of three people who went to Seattle for care the previous week, suggested community fundraising for three years, with the clear understanding that Neighborcare would improve services during that time. Others raised out-of-the-box ideas that may be beneficial, such as telemedicine, while others inquired about joining with other systems — which Jenkel indicated might be possible, with different providers offering what they do best.

Islander John Staczek said he thought holding another meeting is important, and Johnson said the next meeting is likely to come after the holidays.

In the meantime, collaborative members say they will be doing more work on the issue, including working with the county officials in Executive Dow Constantine’s office and visiting other communities that have funded medical services with health care districts or foundations to learn what went right — and what went wrong. They also plan to reach out to people on the island who have not attended the meetings, or at least not in large numbers, to learn about their specific needs, including island employers, mothers’ groups and members of Vashon’s Spanish-speaking community. Johnson also said he would like to develop a matrix to evaluate Neighborcare objectively, so community members will know if, for example, phone hold times are growing shorter and if people can make appointments in a timely way. Collaborative members also want islanders to reach out to them if they are interested in working on the health care funding effort; those who do should email the collaborative at vmhealth.org and note their interests and skill sets.