The 1st issue of “The Independent Reviewer” is dedicated to the current members of the Wisconsin Legislature dealing with Wisconsin’s health care crisis.

This effort was encouraged by Senator Bob Jauch and Rep. Mary Hubler who represent the area in which I spent my life practicing medicine.

Fred Bannister, MD.*

*Dr. Bannister is the author of the book Health Security America: Fixing the health care crisis, a citizen’s guide to reforming our health care system

Preface

This booklet is written as a follow-up to the book “Health Security America: Fixing the health care crisis” a citizens’ guide to reforming our health care system by Fred Bannister, M.D. Hereafter this book will be referred to as “HSA”. Initially, the book was written to evaluate our national system of health care and recommend changes. The book was adopted as a citizens’ guide to health care reform by the Wisconsin Democratic Party at its annual convention in June 2006 and is part of its platform on single payer universal health care.

It appears Congress is preoccupied with the Middle East Crisis and other concerns and health care reform has been left to the states to solve. Wisconsin is one of those states that is confronting the health care crisis with at least three bills entered in the last session of the legislature that are expected to be reintroduced in this session. The citizen guidelines in Health Security America advocated for health care reform on a national level works as well on the state level and will be applied to the bills that have been introduced to gauge their effectiveness reforming our errant health care system. Health Security America is not part of any bill entered nationally or statewide and the Coalition for a Health-Secure America feels for at least this place in time it can contribute helping others refine their bills so that finally we all can agree on one approach and solve the health care crisis. “The Independent Reviewer” wants to thank all who are trying to help solve the health care crisis. The “Independent Reviewer” hopes any criticism given will be taken in the light of all of us working together in Wisconsin to resolve Wisconsin’s health care crisis.

Background

In evaluating the bills the question has to be asked: What are we trying to do with the health care system in Wisconsin?

Wisconsin values dictate to us in 2007 that every person has a right to affordable quality health care.. The majority of the people in Wisconsin do not consider this a privilege.

Facts:

1. We are a state of 5 million people with 500,000 without health insurance.

2. Health insurance is twice as expensive as other industrial countries that demonstrate better results by living longer. (Japan, 5 years longer and Sweden, 3.5 years longer)

3. It is estimated 18,000 annual deaths occur nationally for lack of health insurance or under coverage. Wisconsin has its proportion of these. Allowing these deaths is immoral.

4. The health care system over the last 30 years has been directed by professional associations of doctors and hospitals with the insurance industry, drug industry, major large clinics, and the government playing a role.

 

Citizens up to recent years have accepted this but cannot any longer as our health system despite repeated changes has failed to supply available, affordable and quality health insurance to every person. Citizens are asking for change and they want it now with no excuse for delay. Bills have been entered in the legislature to reform the health care system and the debate must move quickly and accomplish the task of health care reform.

I ask you to consider the following concerns when evaluating a bill and add these to your own.

1. It is going to be expensive to add 500,000 people to the health insurance roles of Wisconsin. Will the bill or issue you are considering be the most economical way to accomplish this?

2. To be able to afford giving everyone health insurance and keep our state fiscally responsible we will have to reduce costs 50% and avoid debt. (It can be done) Will the bill or issue you are considering be the most practical and efficient way to accomplish the task?

3. To add 500,000 people to the health care insurance system at an affordable rate and insuring quality is going to be a gargantuan task and will bring every special interest (doctors, hospitals, insurance companies and the drug industry) out with every reason not to affect them. This is expected and normal and has to be dealt with. Will citizens benefit from the issue being debated or will a particular special interest be benefited more?

4. Is the transparency of a commission, new bureaucracy or appointed board likely to succeed in accomplishing the changes necessary to reduce costs 50% and provide health insurance to all Or will 5,000,000 people be required to ask the legislature to give them the power to govern their own health care system and approve coverage and premiums? Giving each citizen a method to contribute and decide on major issues will assure success even if a certain number of citizens disagree. The elective process in this country is accepted as the way to solve disagreements and move on to the next issue. To convince 5,000,000 people to try a single payer universal health plan as an alternative to the crisis we now have will require that citizens take a “hands on” method of implementation.

The “Independent Reviewer” is of the opinion the legislature should distance itself from health care reform and give the citizenry the tools to reform Wisconsin’s health care system. The health care industry is the largest industry in the United States. Special interest leaders which amount to less than several thousand people in Wisconsin and now direct our health care industry should no longer be allowed to do so without the explicit approval of Wisconsin’s citizens. Citizens need to take back their health care system that determines life and death in their families. The legislature should not be involved in these decisions other than in a supportive role. Legislators will have to make the decisions if the bills or parts of bills are good or bad allowing citizens to control their own health care system and move forward from there. The following methodology is meant to help the legislature and others with this task.

Methodology

The Coalition for a Health-Secure America has developed a table summarizing multiple plans and evaluating their effectiveness. The table is called the Health Security America Health Plan Success Predictor. It allows the reader to judge the above concerns and others against other health care plans using a numbered rating from 0 to 10 using eight important measures. 80 points is the highest rating a plan can receive.

The measures are:

1. Acceptance/Transparency of information available to citizens- votes by citizens which ever way the vote goes- more accepted than board or panel edicts.

2. Does the plan easily enroll all people?

3. Popular citizen governance in contrast to governance by indirect elections and appointed governance removing as much special interest influence as possible

4. Hospital cost to be driven by citizens not allowing duplication and wasteful competitive spending

5. Does it have set fees for all procedures to stop cost shifting?

6. All restrictions of trade removed such as non-compete employee contracts to allow cost reductions.

7. Plan in place for patients to participate in lowering costs.

8. All elections publicly financed to remove special interest influence.

A major portion of the evaluation grade point is based on the ability of the plan to implement systemic reform in the health care industry. This systemic reform requires citizens to control the health care industry rather than special interests-professional groups, drug industry, insurance companies, hospital associations and large clinics that have failed to provide affordable, quality health insurance to all people. This is all further described in the HSA book. In the same table in bold format another number will appear and this is the number showing the success probability by adding or changing items in the plan to concur with HSA citizen guidance. Web site references to the examined plans are given so the reader can judge the Success Predictor against the material put out by the sponsoring parties.

Web site references

The Wisconsin Health Care Partnership Plan entered as Senate Bill 698 in the last Wisconsin legislative session, co-sponsored by Sen. Russ Decker (D), and State Representative Terry Musser (R). The bill also addressed as the “Newby Plan” or “AFL-CIO Plan” http://www.wisaflcio.org

The Wisconsin Health Plan entered as Assembly Bill 1140, co-sponsored by State Representative Curt Gielow ( R ), and Jon Richards ( D) . The bill is also addressed as the “Riemer Plan”. http://www.wisconsinhealthplan.org

The Wisconsin Security Act entered as Senate Bill 388, and Assembly Bill 807. The bills are also addressed as the “Farley Plan” http://www.wisconsinhealth.org/wiplan.html

Reading the bill itself in the case of this plan would be helpful to supplement the web site and can be found through the linkhttp://www.wisconsin.gov

The book Health Security America is available for $15.95 allowing for easy reading at www.healthsecurityamerica.com or at www.amazon.com For those finding it hard to obtain the book due to inconvenience or funding a request to fredb@healthsecurityamerica.com will have the text on its way electronically at no cost.

The Health Security America Health Plan Success
Predictor including eight measures


Click for larger view

Summary

If the Wisconsin Health Care Partnership Plan is enacted, it has a 22/80 or a 27.5% chance of succeeding. If significant systemic health care reform is added similar to HSA’s citizen guidance to reforming our health care system outlines, the “Independent Reviewer” feels it could approach the 100% success marker. To include all citizens would not be hard, and the state would pick up the premiums for the identified poor. To use an elected board and citizens determining coverage and premiums would drop cost and make the plan much more transparent. Appointed boards are not very free of special interest influence, nor are they transparent. The plan has to be at least that. The removal of restraint of trade tactics would be simple for the plan to do and would reduce cost very quickly. Regional groups preventing duplication of services would improve the plan immensely, as the cost reductions would be felt quickly. Using set fees for all providers would not be a hard task and would drop costs quickly.

The Wisconsin Health Plan has a 13/80 or a 16.2% chance of succeeding. It is burdened with finding consumer health care markets that really don’t exist. It is burdened with the added profit normally accepted by insurance companies of 8-10%. This is a cost we can’t endure. It is burdened with deductibles that will be hard to meet by moderate income families. The acceptance by citizens will be close to zero due to the transparency that is difficult to find in this plan and in the health care industry at its best. Cost control will be almost impossible to enforce with virtually no consumer health care market. Citizens will want to govern their own health care industry at this time in history. There is no way to accomplish this with this plan.

If the Wisconsin Health Security Act is enacted it has a 35/80 or 43.75% chance of succeeding. If the significant system health care reform to the industry is added similar to HSA’s citizen guidance to reforming our health care system outlines the “Independent Reviewer” feels it could approach the 100% success marker. This act would be easy to make more transparent with elections, citizen-run regional planning agencies to stop duplication of services and lowering costs; removing the restraint of trade clauses in contracts would simply be one sentence and would save money immediately. To transfer the determination of coverage and premiums to citizen groups would not be hard and would put the responsibility on the citizen vote, not a faraway board.

We need to be willing to ruffle the special interests and remember it is the citizens that need the health reform and they are the ones we need to pay close attention to on how decisions affect them. It is imperative the people that have worked so hard on these individual plans come together and compromise and change to give the citizens of Wisconsin freedom from the fear of health care costs.

If there are questions or inquiries on this work please contact fredb@healthsecurityamerica.com

Fred Bannister, M.D.
Director
The Coalition for a Health-Secure America
Chetek, Wisconsin
2/10/2007

1. Appendix A is an in-depth discussion of the 8 measures used to gauge health plans.

An in-depth discussion of the 8 measures used to gauge health plans

Moving Americans to a single payer universal health care distribution system or any overall significant health reform plan will be the biggest move financially citizens will make since the advent of Social Security. It will have to be done effectively and the plans put forth to accomplish this task will need to be judged with the realism that people function with in their daily lives and not by ideas that have never been tried. Appendix A will try and give a more in-depth understanding of the 8 measures the “Independent Interviewer” uses to judge health reform plans as they present themselves.

1. Acceptance/transparency of information available to citizens- votes by citizens which ever way the vote goes- more accepted than board or panel edicts.

Boards formed by appointments or indirect elections (boards electing one of their own to a higher board) do not rise to the transparency HSA feels is necessary to make sure as many citizens as possible are informed prior to making health care decisions that will effect them. Both of these mechanisms are generally used as they are simple to implement. The position HSA holds:

Appointed people to what will be a very powerful commission or board will reflect the ideas and the opinions of the appointer. Example: The FDA denying the right of Americans to buy drugs in Canada. Do you believe this? Do you believe Canadian pharmacies are not safe? They are not unsafe and this FDA decision to prevent buying medicines in Canada reflected the influence of the drug industry on the administration in power who influenced those on the boards of the FDA to inflict this injustice on the American people. The professional groups, hospital associations, insurance companies, drug companies and large clinics all will have this influence and will use it to protect themselves. This is the way it is done in America. It will be much harder to obtain special interest consideration if the citizenry has the right to vote on both the leadership and issues.

Indirectly electing people such as the Wisconsin Health Security Act advocates will be very similar. Example: You will elect a county board who appoints a person to be one of 16 members of a region (In the case of the northern region) who then again appoints or elects one of their members to the policy directing board that will sit in Madison. Minutes of all these sessions will of course be available but probably will not be in your local paper and if they are the decisions are now made. The appeal process, if any is actually available, would be very long and arduous. Would you feel you were informed or feel you have contributed by these written minutes? The health care issue is much too important and big to allow this indirect type of governance. Citizens have to be confident they had the right to influence. This influence is best accomplished by voting. Citizens will accept a vote if in opposition to their opinion and move on. This is how it is done in this country. We must not take an easier approach on such a major issue.

2. Does the plan easily enroll all people?

This must be a simple approach and not involve multiple judgments on risk, location, local population, age or other defining elements that would be required if multiple private insurance companies were to bid on the business.

HSA is firm on this. There are five million people in Wisconsin. The actuarial findings outlining diseases, cost of treatment, coverage on this number of people should be very accurate and will allow us simply to say all our people are equal and all will have access to the very same basic health care as everyone else. HSA does not deal with poverty. It expects the government to pay the premiums of those who cannot afford it.

3. Popular citizen governance in contrast to governance by indirect elections and appointed governance removing as much special interest influence as possible

Popular governance means citizens will have a right to vote and not be dictated to by commissions or boards. This is similar to number one but actually insists that the policy board will present to the citizens their findings on an issue and allows citizens to debate the issue at hearings and on the web, but on a date certain vote. Example: Abortion—will the insurance we create for our selves pay for this? The policy board will present what they know about it such as numbers of procedures done in Wisconsin, fees, and ultimately the actuarial cost and its effect on the premium. The simple issue of whether a significant item will be covered in the insurance may well hinge on whether the majority of people feel they can afford it. This is a budget mechanism we use in our daily lives. It is an excellent cost control mechanism. There are many more issues similar to this and there is a definite clear mechanism to deal with them and bring the debate to an end. HSA starts out with the Medicare rules and regulations and then uses popular governance to move on from there.

The main rebuttal to this: you can’t get people to vote in a primary election—how will you get citizens to vote on health care issues? The answer was very succinctly explained by a married father of two kids who answered this very question given me by the moderator of a pubic radio broadcast I participated in. “If the potential is there to lower premiums from “$1,000 to $500” per month (alluding to correcting our 100% more costly health care than other industrial countries) “I will be paying very close attention.” There are many citizens in Wisconsin who will be participating in this voting process, understanding the details and finally voting. This will certainly be a far more effective determination of issues than from a board of “10” people ultimately appointed. The number of people in Wisconsin who would take an active interest would certainly be no less than 500 and would probably be thousands. Don’t let anyone tell you it is much too complicated for citizens to understand. It is not.

4. Hospital cost to be driven by citizens not allowing duplication and wasteful competitive spending

Is there a regional health board composed of elected citizens to see that hospitals don’t duplicate services unnecessarily, spend money on prime time TV ads, waterfalls in the atrium or attempt competitive expensive moves to be the hospital of choice for the area? Two hospitals with two identical treatment wards (e.g. neurosurgery or orthopedics) half full will not be allowed for the same area. Hospitals will be the regions asset and will not be a competitive profit center.

5. Does it have set fees for all procedures to stop cost shifting?

There can only be one set of fees for a procedure in the state. It can start with the present Medicare fees, procedures and diagnostic codes and use its regulations as HSA suggests. These can be changed as time goes on if it is necessary. Presently, Wisconsin is expanding health insurance via Badger care using Medicaid fees. Under our present system this simply causes our hospital costs and clinic costs for others to rise forcing people with other insurance to cancel and everyone spirals downward. Ex: If one person’s Badger Care charge is $21.70 for a sore throat evaluation then the others with insurance will pay more to see that the bottom line of a clinic stays the same- in this case $85. If more people are added at the $21.70 the $85 charge will have to be raised. This is cost shifting.

6. All restrictions of trade removed such as non-compete employee contracts to allow cost reductions.

The rebuttal to this: Any business has a right to do this between two consenting parties. I don’t argue this in any other business but health care. Simply explained Americans cannot afford this in their health care delivery system and I refer you to chapter 9 in the book “Health Security America” for a complete explanation. The savings for the nation as a whole would approach 145 billion dollars annually. Wisconsin as one of 50 states would have its proportion of these savings

7. Plan in place for patients to participate in lowering costs.

This is not rationing in any sense of the word. Example of only one potential savings: If a person has arthritis of the knee and he is markedly overweight there potentially could be a regulation insisting he undergo weight loss counseling and a time frame imposed before he would be allowed to have knee replacement surgery giving the weight loss time to work. 40% of people with this problem with adequate weight loss will have their pain go away. Millions of dollars can be saved this way and in many other diseases as well.

8. All elections publicly financed to remove special interest influence.

Any elections authorized for the implementation of health reform will be publicly financed. This will remove as much special interest influence as possible. Citizens as a group involving health care are not well organized. History has allowed health care to be a personal decision which now is intolerable to the majority of our citizenry as the tools are not available for all citizens to accomplish this. Special interests such as professional groups, large clinics, insurance companies, hospital associations and the drug companies—the mighty five—are very well funded and organized. This special interest influence has to be neutralized as much as possible or the interests of these special groups will again overwhelm the American citizen, as the last 30 years have demonstrated.

Health Security America is the remedy.

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