How should Congress and the president reform health care?

Primary physicians key to public health

I traveled to Washington, D.C., with 11 Wisconsin physicians to give our perspective to Montana Sen. Max Baucus, chairman of the Finance Committee and the central figure in health care reform.

One of the doctors was nearly late for his flight because he was dealing with a patient. He made a home visit the day we left, and was on the phone several times giving instructions to help keep the patient out of the hospital. Hospital stays cost over $10,000 on average, and his calls cost little except his time.

Our message to our delegation was that primary care physicians who thrive on close ties with their patients are becoming harder to find. Young doctors have too much debt, and know that primary care doctors work long hours for half the income of specialists.

Yet it is primary care doctors and their relationships with patients that will help our health care system survive and avoid bankruptcy. We need more of them. We need Baucus and his committee to structure health care reform with this in mind.

Our delegation understands this issue and is concerned. But they need to hear from doctors, nurses and patients because they hear a lot from insurance and pharmaceutical companies. Primary care is the key -- it offers better care with less cost.

-- Dr. Harrison Robinson, Fitchburg

Public needs to focus on prevention, too

I am a nurse working in a clinic that sees over 70,000 people a year.

One major ingredient in health care reform needs to be prevention. We live in a country where two-thirds of adults and one in five preschoolers are overweight. One third of women in the country live in abusive situations. Smoking and alcohol abuse are prevalent, sexually-transmitted diseases are on the rise. All of the associated health care costs are preventable.
Any government-sponsored health care plan needs to require participants to take a class that includes first aid, signs and symptoms of common diseases, risk and stress reduction and how to make good decisions. Documentation can be required before enrollment is accepted.

The government can't afford to rescue us -- we are too expensive.

-- Susan Salvo, Deerfield

Elitist health care excludes 'We the People'

My health insurance policy, if I ever really need it, probably means a death sentence or financial ruin, thus that policy insures nothing but the salaries of insurance executives.

Until everyone that gets their health insurance subsidized by taxpayers -- whether they be the president, members of Congress or other officials -- We the People will not find affordable health care available in the United States of America.

While growing up in the 1960s I was told that "communism could never work" because it is human nature that eventually an elite group with special privileges will find its way to positions of power along with a larger group of slightly lesser privileged supporters to guard the elites privileges, making the total equality promised by communism impossible.

Perhaps just the suggestion of banning the extension of insurance coverage to a spouse or other family member from any taxpayer-subsidized policy might open some eyes.

-- Daniel T. Miller, Richland Center

Follow lead of World Health Organization

If you want good advice about health care, listen to the experts.

The World Health Organization proposes that countries make health system and development decisions guided by four core health care principles: 1) universal coverage according to need and regardless of ability to pay; 2) people-centered services; 3) healthy public policies, integrating the administration of trade, environment, education and other issues that have an impact on health; and 4) strong leadership.

All components of society -- including civil society, the private sector, communities and the business sector -- need to be woven into a secure health safety net. (For more information about WHO, visit their Web site: www.who.int.)

So our deliberations about universal health care are just the beginning of health care reform, and we are already playing catch-up. We are the only wealthy, industrialized nation without it. Now that we have strong leadership, let's move forward.

-- Julie Fitzpatrick, Madison

Health insurance about profit, not our health

Health care is different than health insurance. Market-driven health insurance by HMOs and drug corporations is for profit, not for public health.

Health care access at reasonable cost is what people need. A universal, single payer health care plan, run by the government, will allow patients to choose the doctors, hospitals and other health care providers they need.

Now HMOs and insurance companies determine what doctors you can see and hospitals to which you may be referred. Health insurance limits health care by exemptions, deductions, exclusions and previous medical conditions. They also determine what drugs doctors can prescribe and how much they'll pay.

Technology can solve some of the record keeping and associated problems, but cannot provide health care to all who need it. A single payer system is patient driven. The government provides the money through lo-cost insurance to pay doctors, hospitals and pharmacies.

The federal budget office should do a cost benefit analysis of a single payer health plan and of the other plans being pushed by the Obama administration.

-- Thomas Kozlovsky, Madison

Employers victims of uncontrolled costs, too

The 200-pound gorilla in the room is the uncontrolled cost of health insurance to employers in the U.S. That is a large part of why so many businesses move overseas where those costs are borne by the government and not by employers.

Having a single payer insurance for all would eliminate that burden here and allow more businesses to operate without these costs and pass the benefits to workers in the form of higher salaries. And jobs would come back home again.

Of course we'd need cost controls, and higher taxes would be offset by the lack of private insurance policy costs to both employers and individuals.

Only in America are people made destitute and lose their homes because of medical catastrophes. No other developed countries have this problem.

-- Kay Ziegahn, Richland Center

Partnerships work best, like BadgerCare Plus

Effective health care reform requires a partnership between public and private interests. Such partnerships are the foundation of the BadgerCare Plus programs, the only meaningful health care reforms in Wisconsin over the last decade.

Some scare mongers will confuse and frighten people, claiming that health reforms are a move toward rationed care. We already have rationed care. Your private insurance or public/governmental programs will never provide a blank check. Contracts are full of exclusions, processes and procedures designed to limit certain health care services.

Special interests cry "socialism." but costs for health services already include "under-the-table" socialism. Providers shift the cost of uncompensated care to insured consumers, which costs the average insured family an extra $1,017 per year.

We must pursue honest shared responsibility to cover everyone as we do for roads, schools, police, etc.

Will the government solve all our health care problems? It never has before. Will rugged individualism and your medical savings account save the day? Not likely. Health reform calls for a "we" approach, not a "me" approach. As part of our effort, we must hold policy makers accountable to the public and patients instead of health care profiteers.

-- Bobby Peterson, ABC for Health Inc.

Bet on single payer, not complex Obama plan

If you are concerned about the common good, if you define health care as a human right, then the only solution to our present health care crisis is a single payer health care program.

In 1999, I was diagnosed with lung cancer. I've received exemplary care through my HMO and now through Medicare. Everyone is entitled to quality health care.

A comprehensive, single payer program to which everyone has equal access and with no out-of-pocket costs would serve us better than the giant thing President Barack Obama wants to push through Congress. Nobody knows what the "choice" of a government-run program will look like when the reform legislation is finalized, or what it might cost.

Physicians for a National Health Program spokespersons argue that if single payer were implemented, the potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying more than we already do.

There is good legislation to consider. House Resolution 676 calls for expanding Medicare to cover everyone. Vermont Sen. Bernie Sanders introduced single payer in the Senate.

-- Judy Leurquin, Madison

Reform must include a public component

Private, employer-based health insurance worked fine for a half century after World War II, but it is now outmoded. Too many people are without health insurance, too many fear losing it and costs are out of control.

Any change should include a public component. I favor single payer, universal health insurance. Private insurers could continue to handle the back office operations -- monitoring claims, disbursing funds -- on competitive bids. But because minimum benefits would be standardized and everyone would be covered regardless of age and health condition, marketing costs would be cut.

Some people are squeamish about going to a single payer system. At the least, reform should include a public health insurance plan that would compete with private plans on a level playing field.

There should be a specified level of coverage, say that which legislators and members of Congress receive. Private insurers could offer broader coverage for an additional premium. The government plan and private insurers would be free to innovate in the hope of cutting costs and attracting customers.

Reforming health insurance won't solve all the problems of galloping health care costs, but it's an essential first step.

-- Bill Spevacek, Mineral Point

Improve medical field with 'socialism'

It's obvious that our health care system is in need of healing. To simply tweak the system and keep the private health insurance system intact is to fail.

The ideal system would be a single payer public plan giving universal coverage. Eliminating the complexities of having multiple insurance companies would streamline things. The huge pool of patients would allow for bargaining and lower drug costs. Providers could be paid relative to outcomes, encouraging quality care. Preventive care would be encouraged. Patients could choose providers.

Socialized medicine? Call it what you want. We have it now in Medicare. We have publicly-funded roads, fire departments, libraries and schools. We even have retirement income called Social Security. Is that all so bad? I don't think so.

There'd be many details to work out. No one expects it to be easy. But to continue in our present path of spiraling costs is unthinkable. To expect insurance companies to voluntarily reduce costs is naive. Wasn't that what HMOs were supposed to do? Obviously it didn't work.

-- Barbara Meyer, Argyle

Insurance, drug lobbies ensure poor system

I work in health care and my experience suggests we will never have any type of health care reform in this country.

The insurance companies and the pharmaceutical manufactures have too many vested interests to allow this to happen. We will continue with our present system of waste, abuse and duplication.

Any new plan will be crushed by the opposition using scare tactics such as threats of substandard care, rationing or not being allowed to pick care providers. The TV spots with the scary background music will air incessantly, and a person wearing either a suit or white lab coat will tell us of the tragic results of government involvement with health care.

Our spineless legislators will cave in to special interests, the huge corporate profits will continue, and once again big business will have triumphed.

-- Greg Zeszotaski, Lone Rock