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A prescription for better health-care coverage in WisconsinBy Bobby Peterson
Can't we do better? Of course! Wisconsin can and should lead the nation toward an equitable, efficient and quality health-care system. Gov. Jim Doyle's recent proposals to extend coverage to children, the disabled and those with illnesses is a step in the right direction, but we can do more to help expand affordable coverage and save precious public money. Wisconsin already spends more than $2 billion a year of public money on health coverage and much more when you include long-term care costs. Wisconsin hospitals provide nearly $500 million in uncompensated care annually, and 20 percent of every medical bill subsidizes unpaid bills. What's the problem? The path toward true health-care reform is clouded by the politics of distraction and barricaded by the scare and stall tactics of the health-care profiteers who prosper from others' confusion. And we tolerate a woefully inefficient system that spends up to 30 cents on the dollar nationally to shuffle papers. For meaningful health-care reform, we must focus and amplify the voices of concerned people to counteract the bountiful campaign contributions to eager politicians willing to obfuscate the real issues of skyrocketing costs and decreased access to care with simplistic and narrow solutions. Yes, some will clamor for private sector "ownership" solutions like medical savings accounts. But proposals that concentrate risk, deter primary care (with possible flu pandemics around the corner) and disregard the needs of the disabled and chronically ill do not help the people of Wisconsin. Haven't we learned that privatizing health care, as with Medicare Part D, will only result in more headaches and heartache? ABC for Health's prescription for health-care reform is based on our real world experience helping clients obtain or maintain coverage and is premised on five principles: Spread out the risk. The state must facilitate the creation of large risk pools. The current siloization of risk in tens of thousands of employer pools increases administrative costs. The expense is magnified for small employers. By working together, we can combine the purchasing power of many Wisconsinites into efficient, large-risk pools that will save consumer and taxpayer money. Group purchasing power allows the state to streamline and unify systems of administration and negotiate favorable rates. For example, in 2005, in the large pool of more than 500,000 people covered by BadgerCare/Family Medicaid, which provides affordable health care for low- to moderate-income families with children, premiums averaged about $159 a month per person. That's much lower than the state average for individual, private comprehensive coverage. Based on industry averages, family coverage should cost 2.5 times individual coverage, so family coverage is calculated at about $397 a month. At those rates, low Medicaid reimbursement for essential providers could be increased and we would still save money. Combining BadgerCare to a pool of state and county workers would create a growing pool of more than 1 million enrollees and save state and local taxpayers a bundle. Promote a private-public partnership. The solution to our health-care crisis must involve all the key stakeholders and should neither be a government takeover nor a privatized system. There is a third way. BadgerCare already models this type of partnership. The private-public partnership permits health insurance companies to bid for business with the state; however, the state retains the contract and, thus, ultimate bargaining leverage. By permitting a voluntary employer "buy-in" component to BadgerCare, the political resistance of some employers could be eliminated and reversed. Wisconsin could gradually extend the buy-in to all private employers or self-employed people and allow everyone to join over a three- to five-year period. Use the coverage benefits available under BadgerCare. BadgerCare provides some of the most comprehensive coverage available. Dental care, mental health and chiropractic services are all covered and under this plan would be available. The program would have financial leverage to increase the participation of other key providers. We can also be smart and eliminate the enormous front-end costs and political battles associated with the creation of new administrative and billing structures. We don't have to reinvent the wheel; the system is largely in place and can be modified to accommodate more people. Adverse selection issues (where cost could rise) are mitigated by the colossal size of the initial pool and a staggered three- to five-year enrollment. Promote consumer confidence by insisting on quality, fairness and accountability. A new system must include strong quality assurance, comprehensive advocacy, health benefits counseling and an enforcement component to ensure people get the services they need and deserve. We must guarantee independent outreach and enrollment brokers. Locally based community HealthWatch coalitions (see www.healthwatchwisconsin.org) would provide monitoring and community-based feedback. Promote strong policies of prevention and wellness. People with special health-care needs rely on help to get the most effective and efficient care and appropriate medication. Proactive policies of prevention and wellness will reduce cost over the long haul and in the short term also reduce high-cost emergency room visits and other high-cost procedures. Our prescription offers a vision to link all people in Wisconsin to the coverage and care they need and deserve. We propose a comprehensive system of family support and advocacy that breaks down barriers of complexity and bureaucratic inflexibility and prevents those most in need from being marginalized and isolated. ABC for Health and HealthWatch Wisconsin intend to engage and empower the people of Wisconsin through debate and dialogue about the prescription for universal health care. We expect nothing less than forward momentum and a renewed commitment and action from our political leaders to do the right thing: health care coverage for all. madison.com ©2009 Capital Newspapers. All rights reserved. |
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