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1/19/2009
Moving piecemeal to government-run health care

Assembly speaker Mike Sheridan “praise[d] Gov. Jim Doyle’s piecemeal health care approach instead of the Senate Dems’ Healthy Wisconsin plan….” That comes to us via a Wednesday WisPolitics luncheon, and as reported by WisPolitics Friday.

I learned details last week about what might be one of those “pieces-of Doyle.” The Heart of the Valley and Fox Valley Chambers of Commerce teamed up to sponsor an information session on brand spankin’ new BadgerChoice – a Doyle administration brainchild that would, according to administration spokesman Jason Helgerson, lead to a “more efficient health care marketplace.”

The state wants to be the provider of choice in the small business insurers marketplace. And it’s scary. Very scary.

BadgerChoice would supposedly save money by the state directly bidding out a number of health insurance packages, doing the insurance admin. itself, and eliminating insurance agents altogether.

Well, you can imagine that health underwriters and agents are not at all happy about this. The Chambers aren’t happy, and neither are quite a few small business owners that rely on those agents regularly.

Helgerson was quite the cheerleader for BadgerChoice – and as far as I could tell, was the only one so inclined in that room of 300 or so. As of now (interesting turn of phrase - ?), said Helgerson, BadgerChoice would not be mandated, but if a small business owner (2 to 50 employees) wants to supply health insurance for his employees, he would be required to work through BadgerChoice. Again I say scary, very scary.

As I’ve said many times in the past, we will not begin to control the cost of health insurance until we begin to control the cost of health care. Period. In that vein, I was almost encouraged, moving even to the edge of my seat when Helgerson, early in his presentation said “Our fundamental challenge is the raw cost of health care.” Hmm. My kind of words. Well, in the couple thousand words that he shared after that, it was clear that like BadgerCare before it, absolutely not one single element of BadgerChoice would impact the “raw cost of health care.” Unbelievable.

Dan Schwartzer, Executive Vice President of the Wisconsin Association of Health Underwriters (WAHU) reinforced my thoughts in that regard. His presentation shared that their research shows over and over that about 12 cents of every health care dollar goes toward administrative costs, including claims administration, reserves and taxes. So if BadgerChoice is implemented (and it could very well be introduced stealthily as part of the budget bill - scary), the state claims they can reduce costs on that 12% via “competitive bidding” – but they’d be doing not one thing to reduce the 88% of dollars paid today to health care providers.

Schwartzer has well-researched, solid solutions that absolutely don’t involve mandatory (or not) government-provided health insurance.

Here’s an easy one governor. Don’t veto HSA deductibility one more time. It’s an absolute no-brainer. Wisconsin is one of only two states in which dollars paid into a Health Savings Account are not deductible from our state income taxes. (Would have saved me over $400 in state taxes in 2008 alone.) HSAs and high-deductible policies are one way small businesses are fighting back against over utilization of the system and the concomitant rise in costs.

And there are more well-researched solutions where that came from – much the governor and legislature can do without making small business owners purchase health insurance from the state.

Typical insurance policies should provide protection against catastrophic financial loss, with consumers sharing responsibility for more of the basic costs. Toward that end, work toward actions that increase cost sharing for BadgerCare; without it, more and more Wisconsin workers will move to the taxpayer-subsidized program.
Fund HCAs for portions of the Medicaid and BadgerCare populations. “We believe in the goal of helping those who cannot afford coverage with the financial assistance to purchase such coverage. However, we do not believe it is beneficial for these individuals to be shielded from the realities and experiences of our health care and health care coverage marketplace.”
Move more government employees to a high deductible plan, in which utilization (and hence, costs to the system) will become better controlled.
Continue expansion of deductibility for health insurance premiums.
Expand, encourage, incentivize, Wellness Programs. Implement Wellness plans for all state employees and Medicaid recipients.
Continue the expansion of health information technology initiatives.
Support the expansion of health care cost and quality transparency.

Good stuff.

300 small business people in the Fox Valley last week got just a taste of what it might mean for Governor Doyle to take us “piecemeal” into government-run health care. For sure, they didn’t like what they heard – and think they know best how to better control the costs of health care.

Jo Egelhoff, FoxPolitics.net

COMMENTS

Dan Schwartzer is a smart guy. "His" plan is a simple, practical, economical approach. It's change we can believe in - without having to "overhaul" anything!

Unfortunately, the message is, obviously, lost on our legislators...the plan is doomed. It may be time to change tactics.

Stop pushing well-researched, industry solutions on the bureaucrats...no one's listening. Take your battle to the streets: Launch a conversation with people who actually have a "real" health plan. TALK to us, Dan!

Engage policyholders in a groundbreaking dialogue about healthcare in Wisconsin: What are people thinking; what are they doing; what do they like - what do they dislike? Then, share the results with all stakeholders (including all those stubborn, ill-advised legislators). Compared to Dan Schwartzer, Jason Helgerson is a healthcare neophyte, but he certainly understands the political consequences of ignoring the will of the VOTERS on a big issue.

It's one thing to talk to Business Owners or bureaucrats about healthcare...it's an entirely different conversation with people whose only vested interest is being able to get healthcare when their kid is sick.

The results will, no doubt, be very interesting and, ultimately, VERY helpful to EVERYone's Cause. We can't screw up on healthcare...

Michael Bina (Mon Jan 19 10:30:27 2009)

The cabal at the chamber of commerce can wring their sweaty little hands all they like.

The truth is that our newly elected legislature should and perhaps will make the best decision for Wisconsin citizens on this. This hardly could be said of the past.

Also please use specific language on these issues. Government sponsored payments in lieu of "underwriters" is not Government run Healthcare. It is the payment mechanism eliminating the insurance companies. And that doesn't scare me at all.

Lon Ponschock (Mon Jan 19 20:41:59 2009)

So Lon, how would you control those 88% of costs? (Be assured, as seemingly proposed, the state's not going to do it via BadgerChoice.) If you see something I don't in the proposal, how will BadgerChoice control those 88% of costs?

Jo (Mon Jan 19 20:48:23)

The cost of insurance is partly what elevates the cost of health care. When you don't personally pay for a dr visit, how careful are you going to be in terms of getting the best price? In fact, it is impossible even to know what the best price is, as MDs are forbidden to advertise their prices per federal law. This is unlike any other tradesman! (yes, I call drs tradesmen).

And the drs, clinics, hospitals, etc. all artificially inflate their prices to recoup some of what insurance makes them write off. For example, a bill for $271.28 gets paid at the rate of $92.32. (A recent actual EOB from my insurance co.) Thus the provider has to write off 178.96. And if the provider charged less, they'd still be forced to write off a large fraction of it.

So nobody knows how much the service REALLY costs. Maybe it is even less than the $92, maybe more. THERE IS NO WAY TO TELL because a third party (insurance) has muddied the waters.

So insurance, whether private or public, is the main problem in this price confusion. In addition to write-offs, most drs have to have full-time staff just to do the coding so that they can get paid from the insurance co. And these staff cost the dr money, which he recoups, again, by price inflation. After all, if insurance will pay even a fraction, why not?

Imagine if insurance were mandated to be only for catastrophic coverage, and MDs could advertise their fees. Imagine if there were truly a free market; something this country hasn't seen in healthcare since the early 1900s. Imagine if drs were truly accountable for their mistakes, in the form of losing their license (which almost never happens; instead the old-boys-network called the state licensing board usually protects drs.) Imagine if a dr simply charged too much relative to others; he'd lose business.

Oh, well; the tide is going to go towards government-funded healthcare. Perhaps when the nation is completely bankrupt--because you CANNOT print money out of thin air, and expect it to have any value--people will come to their senses, and return to individual responsibilty.

emily matthews (Wed Jan 21 16:29:36 2009)

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