How can health care be made more cost effective?

Provide incentives for healthy lifestyles

The only way for government to stand tall in the universal health coverage issue is to require a high order of self restraint and self discipline among recipients.
This can be done by making a low body fat index and remaining free of controlled substances and tobacco the criteria for receiving lowest co-pays and premiums. Have proportional premiums and co-pays for recipients who choose to scorn wellness in their lives.
A requirement to remain a member of the health plan for 10 years will offset some costs of care with a stream of premiums and decreased "gaming" of the plan.
These policies are not discriminatory, according to the judgments of many courts, if applied without regard to race, gender and so forth. These common sense ideas will work in private health care plans also.

-- Jon Holtzman, Cambridge

Make risk-sharing pool with all health insurers

Why not take advantage of current health insurance by creating a risk-sharing pool to include all current health insurers? This is commonly done now through pools and reinsurance treaties.
One could be designated as lead underwriter and the rest could be operated by managers rather than CEOs. The administrative and sales costs could be significantly reduced.
All applicants would be accepted with financial participation by standard risk classification based on actuarially determined principles. This would maintain the present expertise of insuring and keep the system in the private sector.

-- Bill Hogoboom, Madison

Health care lobbyists only drive up costs

One of the most significant barriers to affordable universal health care is the way lobbyists crusade on behalf of the portion that's privatized. Equally disturbing is the way elected officials cave in.
President Barack Obama has repeatedly said that single-payer, government sponsored health care coverage should be among the options, but few in Congress are listening.
Consider also that, like Medicare, overhead for a government-sponsored option is likely to be around 2.5 percent, while for major insurance companies in the private sector it's 17 percent to 20 percent, much of it earmarked for outrageous administrative salaries and lobbyists.
It is increasingly apparent that our nation is not run by those whom we have elected, but by highly paid individuals who relentlessly lobby on behalf of special interest groups.
We are losing sight of the premise on which our country was founded -- that we are a "government of the people, by the people and for the people."

-- Richard Marzolf, Hudson

Take 'for-profit' part out of health coverage

The question is not, "Where do we get the money to pay for universal health care?" We are already paying for it, although not very wisely.
Most of us have insurance. The rest are either in the public welfare system. Or they file for bankruptcy, and the medical services charge their loss to those who can pay. We actually pay a larger percentage of our income (11 percent) for health care than any other nation, while our health outcomes (longevity, maternal deaths, etc.) are mediocre at best.
Since the lives of our loved ones are priceless, we are willing to pay almost anything, and consequently there are those who are willing to charge almost anything. One way to change that would be to make all health care nonprofit.
This doesn't mean those who provide health care should not be adequately compensated for their skill and dedication. But it does mean insurance companies, hospitals, clinics and equipment suppliers should not be operated for the profit of investors and excessively-paid CEOs.
Other ways to reduce costs include:
• Emphasizing wellness.
• Utilizing skilled health care providers who are not doctors, such as midwives for childbirth.
• Eliminating health care advertising.

-- Gilbert Splett, Madison

List actual costs of health care components

Health care costs and reform are the elephant sitting in the corner.
I had my first experience with the health care industry last year when I had a chronic back problem. After multiple doctor visits, procedures including X-rays, MRIs, and a spinal injection, there was ultimately no relief through traditional Western medicine. But -- my, oh my -- the time wasted and the bills.
I finally went to the head of billing at my hospital with a thick folder containing all my bills to figure out what was what. I can only surmise that all the smoke and mirrors surrounding the medical profession is to camouflage what real costs are.
The start of the solution should be transparency regarding costs at your local hospital compared to national averages. What does that doctor make per year? What does malpractice insurance cost? What are administrative costs? What percentage covers the billing department? How much is collected through insurance and returned to the hospital, doctors, clinics and administrators?
Is the patient getting his or her money's worth?
It will take some time to sort this all out, and a bunch of overpaid people would like there to be no change to the system.

-- Helene Full, Reedsburg

Blame high costs on malpractice coverage

Contrary to what we are led to believe, everyone has access to health care, even though it might be urgent care or the emergency room.
If doctors had access to everyone's medical history through computer networking, maybe malpractice insurance wouldn't be so high. Isn't that the real reason health care costs have skyrocketed? Isn't that why doctors no longer work for themselves, but have to work for corporations?
Then there are all the fancy "campuses" that the insurance companies build.
Why can't everyone just be honest and be happy with "honest pay for an honest day's work." Honor and integrity seem to be irrelevant today.

-- James L. Rinden, Fort Atkinson

Try electronic records, more consolidation

Ideas to reduce costs include:
• Remove Medicare reimbursement oversight from the legislative process.
• Eliminate advertising for prescription drugs targeted to the general population. Negotiate best prices for prescription drugs and review them yearly. Limit payment for "lifestyle" drugs such as Viagra.
• Consolidate all existing federal medical programs -- Medicare, Medicaid, non- service connected VA enrollees -- into one federally-funded plan available to all.
• Don't require anyone to change primary care providers, but do require care to originate with a primary care provider for full payment.
• Cap payments for specialty care that is not referred by a primary care provider.
• Regulate the net profit of private health insurers, such as regulation of public utilities.
• Use electronic records that will limit duplication of exams. Anecdotally, some Medicare beneficiaries seek multiple opinions because they have the time and coverage from the VA and private insurance. Electronic records will eliminate this kind of "shopping."
• Demand that health care providers document best practices for known treatments, such as lowering cholesterol, controlling hypertension and regulating blood sugar -- not to stifle new treatments, but to document that expensive treatments are better than existing ones.

-- Marcia Morris Dobrick, Madison

Try corporate support of public health docs

First make certain that every member of Congress and the president has to take the same exact plan as everyone else.
Then have a VISTA-type organization for medical doctors. They do this in Costa Rica, where participants' medical school is paid for by corporations. After they graduate, doctors are placed in public health clinics for two to three years before they do their residencies. The problem is distribution, not numbers.
Next be certain that all medical advice is properly translated for the multi-cultural people living in our big cities. This is why our World Health Organization ranking is low on new baby wellness -- not all people understand the directions. Homogeneous countries don't have this problem.
Finally, don't require any doctor who is seeing patients under a government plan to have their own malpractice insurance.

-- Frederick L. Katz, Middleton

Support Kind's plan and limit profits

We need to enact U.S. Rep. Ron Kind's Comparative Effectiveness Research Act. America's health care system is notable for being the most expensive in the world, for not covering all Americans, and for being rated 37th in quality by the World Health Organization.
Check out the The Dartmouth Institute for Health Policy study of health care costs versus quality. They found that cost had no relationship to quality. The Mayo Clinic spends $6,688 per Medicare client, compared to Medicare paying $15,000 per client in McAllen, Texas, which have the highest prices in the country, except for Miami, and below average treatment.
We need Kind's bill to improve quality, plus a government plan open to all and support of nonprofit health care institutions such as the Marshfield Clinic or the Group Health Cooperative of South Central Wisconsin.
Reform should be funded by extracting the excess profits from for-profit health care companies of all types and individual health care personnel making over $350,000 per year. With an efficient system, the $2.2 trillion we now spend is enough to cover all Americans.

-- Bill Dagnon, Baraboo