Citizen Action's Robert Kraig: Two roads to health care reform

Robert Kraig  —  10/24/2008 5:41 am

Until recently, the major divide on the health care issue was between those who believed the system was in need of fundamental reform and those who maintained that modest fixes would suffice. The ground of the public discussion has shifted decisively this election year. Political candidates of all ideological persuasions are falling all over themselves proclaiming their support for baseball, apple pie, and bold health care reform. Former antagonists seem to agree, at least on the surface, that something dramatic must be done if middle class families are to have reliable access to affordable health care.

This surface agreement is understandable given that health insurance premiums have more than doubled this decade, and are rising almost five times faster than wages in Wisconsin. But does it mean that access to affordable health care coverage is on the way? Not necessarily. Beneath the apparent consensus two very distinct road maps are being proposed: one that promises real relief and another that threatens to undermine the health care access most families in Wisconsin have today.

The first road centers on the concept of guaranteed affordable choice. Proposals that follow this path include Barack Obama's health care plan; the Healthy Wisconsin plan, which passed the state Senate last year; and the health care advisory referendums on the ballot this year in Dane County and 21 other Wisconsin communities, which ask the next Legislature to guarantee affordable health care as good as what state legislators receive.

What unites all of these initiatives is the call for better government oversight of the current health care market -- not to run it, but to reinforce and expand the employer-based health care system that still provides coverage to 3.3 million Wisconsin workers and their families. This approach would outlaw the worst insurance company abuses, create more choice and control than most people have now, and guarantee that everyone has access to a range of high-quality affordable coverage options.

The second road to health care system change is much more radical. Rather than building on the current system, it would put us on a path to a system where millions of Americans who get health care coverage from their jobs today would have to go out and negotiate on their own with insurance companies. This road map, proposed by President Bush last year and now supported by John McCain, would take the unprecedented step of taxing health care benefits from employers as income, and use the revenue generated to provide a tax credit for buying health insurance.

Going down this road risks undermining the primary way Wisconsinites get insurance today (through their jobs), without providing a safe alternative. The leading national business associations have predicted this would discourage employers from offering health insurance to their workers. An Economic Policy Institute report released in Madison earlier this month concludes that McCain's approach would lead to 415,000 Wisconsinites losing their employer-based health insurance. Although some, especially the young and the very healthy, would be able to buy insurance on the market, others would face discrimination based on health status, age or pre-existing conditions. Because McCain's plan further deregulates the health insurance industry, these abuses would increase. This approach is touted as increasing choice, but control would be in the hands of the insurance industry, not patients and their doctors.

The road Bush and McCain propose would also exacerbate the underlying cause of the health care crisis: skyrocketing costs. A Citizen Action of Wisconsin study found that Wisconsin insurance companies take double the overhead and profits out of individual policies that they take from policies they sell to employers. As a result, a shift toward individual insurance in Wisconsin would divert an additional $1.5 billion more into health insurance industry coffers and away from medical care.

Given the stark difference between the two roads to Wisconsin's health care future, we all have a huge stake in demanding not just any change but the right kind of change. Businesses and families in Dane County and throughout Wisconsin would do well to demand that all candidates support reform that truly guarantees health security and real health care choices.

Robert Kraig is the program director for Citizen Action of Wisconsin.

Robert Kraig  —  10/24/2008 5:41 am