Here we go again.

I have more than a decade invested in trying to help sustain health care on Vashon, and there are many who have labored far longer.

In the Vashon-Maury Healthcare Collaborative, we worked to fill the healthcare gap caused by the sudden departure of CHI Franciscan (who refused an existing subsidy to avoid the suggestion of community ownership). We secured state capital funds (thank you Senator Nelson!), a suitable piece of property for a future clinic, and spawned the campaign that would create the island’s Health Care District.

I’m intimately aware of how far we have progressed in securing our own local access to care, and how difficult it has been. While this may be a period of frustration, it is also another opportunity to grow and improve.

The Health District is doing what it promised: establishing a financial framework to attract and fund care on the island, while working to secure resources for more effective delivery of care in the future.

It has taken its financial and operational obligations seriously, as it should. None of its contractual asks of the current healthcare provider are unusual (having been modeled after other district contracts), unnecessary, or onerous. The District seeks a reasonable and minimal framework for verification and input on the prudent spending of tax dollars.

It is pursuing future-ready facilities with a significant component of community ownership. This community ownership is important in the event one or the other of the contracting parties decides to move in a new direction, a lesson well learned from the Vashon Community Care shutdown.

The District has moved to harness state funds, available property, and prospective federal dollars to lower the property tax revenue necessary to fund these facilities. This process has been openly shared with the current clinic operator. Sea Mar specifically endorsed the District’s request for federal funds. There has been no sudden surprise, but rather a substantive and ongoing dialogue.

Sea Mar was not interested in coming to Vashon without a significant and ongoing subsidy. Only upon disagreements over operational/fiscal oversight and partnership parameters on a new building did the subsidy appear suddenly unnecessary.

The idea that Sea Mar will now bear the full cost of building a new clinic — as well as the substantial current losses in operating costs into the future — sounds tantalizing. However, past experience leads one to question how this self-sufficiency has suddenly become possible and to carefully consider Sea Mar’s ability and willingness to operate sustainably into the future.

We have been in this position before — beholden to the continued willingness and ability of an off-island entity to provide sustainable care on their terms. The results have not been good.

I am quite skeptical of anything that appears suddenly, does not logically comport with experience, and sounds too good to be true.

Sea Mar is not the first provider proclaiming it has never left a community, and that claim does not preclude them from leaving if they choose. We are still going to be here. This is precisely why we have a District: to have the funding and the ability to negotiate a beneficial relationship with a service provider and to confirm the provider’s ongoing obligation and accountability to this community.

Vashon can be different and difficult.

I’m sure working in a new environment with a new District finding its way has not been perfect or easy. Staffing and delivering care have been tough tasks, admirably carried out by Sea Mar and by a group of predominantly local people who work heroically, are short-staffed, and underappreciated. But that care has not been delivered without nearly $3 million in island subsidy.

Despite a rather curt and puzzling series of decisions by Sea Mar, I would ask the District to continue to operate in good faith and to offer formal mediation of what should not be insurmountable operating disagreements.

If the disagreements are ultimately structural, then so be it. In any case, the District should continue to ensure that it seeks the most effective and locally accountable delivery of health care on the island, with or without Sea Mar here.

We cannot go back to where we began, expecting something great and sustainable simply dictated to us without either our funds or our active participation.

Tim Johnson, manager of Granny’s Attic, has long been active in health care efforts for Vashon including Vashon-Maury Healthcare Collaborative and the campaign to establish Vashon’s Health Care District (VHCD). He recently served on a task force established to help advise VHCD on matters related to its efforts to build a community-owned health care clinic on Vashon.