Examines the Wisconsin Senate’s Health Care Reform Plan included in Senate Bill 40, passed June 2007

“Healthy Wisconsin: Your Choice, Your Plan”

Wisconsin has been blessed with legislative beginnings of a dialog on meaningful health care reform, encouraging its residents that an end may finally be in sight for the health care crisis they have been enduring for the past three decades. But there is a very significant chance this bill or compromise will not pass this session of the legislature, due to lack of bipartisan support in the Wisconsin House. The strength of this plan is to bring to the forefront some of the issues that have to be confronted to give us credible health care reform in Wisconsin. The weakness of this plan is that it avoids many of the major issues that would guarantee its success. Special interests are given a “pass” where real change has to occur. We have a health care system in Wisconsin that is deeply flawed, but in trying to fix it, we must make sure we don’t make it worse.

A basic problem delaying true health reform needs to be reviewed first:

Wisconsin residents are burdened by special interest influence on our politicians, as is the nation. Campaign finance reform has to be accomplished. People are dying now due to lack of health insurance coverage or under coverage. Wisconsin’s share is 330 deaths per year. We spend almost twice as much for health care as our neighbors to the north, yet they live longer. We cannot wait for campaign finance reform to happen. To get meaningful health reform passed whose beginnings are represented by “Healthy Wisconsin” we will have to ask our politicians to please value the input of its individual citizens over the “Mighty Five” special interests: drug companies, professional groups, large clinics, hospital associations and insurance companies

The Coalition for a Health-Secure America can only make suggestions to our elected politicians. We suggest putting together a local citizen group in each district to review and advise them on the decisions necessary to put together the final plan in the House and Senate rather than listening quite so much to the “Mighty Five." The testimony process used by the state legislature is not strong enough to overcome the “Mighty Five,” as evidenced by the senate bill being reviewed. It will be tough to take special interest money out of the legislative process in health care reform as the health care industry spends millions to see their interests are met. The drug industry alone spent 855 million dollars from 1998 through 2006 to see their interests were assured.

Citizens, you will have to insist our politicians listen only to you on this issue. It is life and death, and it is your life and health future being debated. You will have to take a part and hold your legislators accountable.

Our own Senator Kreitlow has stated publicly that a single payer universal health plan—equal and affordable healthcare for all citizens—will not come from our legislature until we have campaign finance reform. If we are lucky, we might be seeing the beginnings of this reform. We have had politicians take zero contributions, such as our own Senator Kohl. For the first time, we have seen a presidential candidate take no PAC money or money from lobbyists, financing his campaign with small donations from the citizenry—and he has collected more than any other candidate. This process may well help us get meaningful, successful health reform in our state. You will have to insist that the people you back for legislative office accept no PAC or lobbyist money again, at least in health care, pending true campaign finance reform. This will make for tough campaigns but interesting campaign ads, and maybe results.

This issue of the “Independent Reviewer” is meant to review the “Healthy Wisconsin” legislation, and this we will do, but the preceding paragraphs need to be kept in mind when your legislator tells you “this is all we could get." Make sure you ask him—from whom? What group of citizens was opposed to more needed reform? This last sentence is not meant to be arrogant but to clarify for at least this one piece of legislation, only citizens not connected with any special interests must make the decisions and urge them on our legislators. As I speak around the state on health care reform, citizens are very much in agreement with the changes that need to be made for meaningful health care reform. As I listen to our legislators, I find them way behind the citizens’ thinking and conclusions on issues involved in health care reform.

I am using as my references in the review a letter from Senator Kathy Vinehout, dated 6/25/2007, and a brochure sent to me by Senator Bob Jauch: “Your Choice, Healthy Wisconsin, Your Plan.”

We will be taking out most all the adjectives used in the references as these are very subjective in the minds of the author and may or may not turn out as predicted.

Healthy Wisconsin: the Pros
The great beginnings in the Wisconsin Senate outlined in “Healthy Wisconsin"

1. Every resident will now have access to health insurance and this is regardless of current health condition.

2. This plan includes prescription drugs, hospital and physician charges.

3. A method of financing this program through employee and employer contributions allowing no one to escape who is employed—both employer and employee. (10.5% contributions from employers and 4% from employees)

4. There is reasonable consumer financial responsibility with deductibles and co-pays.

5. This plan is governed by a public-private partnership that attempts to create a fair market place for Wisconsin residents. The public part is a group of 16 appointed by the Governor and private part will be insurance companies, large clinics, hospital associations and their hospitals negotiating with the public part.

6. It proposes cutting some health care costs by very reasonable and bi-partisan means. The author would describe this as simple, common-sense problem corrections that no one can reasonably oppose. This plan will attempt to streamline administration with electronic technology, lower drug costs by bulk purchasing, discourage inappropriate use of the emergency room, reward healthy lifestyles and preventative care, closely coordinate care for the chronically ill and finally reward providers who deliver the most efficient and highest quality care.

Healthy Wisconsin: the Cons
The risks involved in not finishing this plan with further common-sense decisions, as every citizen not involved with special interests would agree

The plan will take a two year period to get up and running and then a two year break in period where people see what they really have without all the adjectives. This is major reform-at least we’ve not seen anything like it since the HMO legislation beginnings in 1973. The flaws or the unaddressed conditions of the plan will be discussed and they should be fixed prior to starting this plan. Again, be careful with the response “this is all we could get.” Instead ask why and then reply, “Let's do it right and not take the risk of making our current circumstances worse.” If the “Mighty Five” are not forced to make significant changes—in this bill they are not—the risk of making our health care system worse is very high.

Right now we individually pay for our health care with premiums, and those who do not have the money are able to get Medicaid if they are poor enough. Some would say we have universal health care. No one can be turned away from a hospital if ill because of money. This system is terrible and works immorally. All this plan has done is make more people able to work through a very expensive continually inflating system of health care distribution with no effort at real reform in areas that cannot be excluded. To force this senate bill on Wisconsin citizenry without addressing the cost control issue is very unwise. Currently, 10.4% of wages would be paid for by employers and 4% by employees. This is 14.4% or just about exactly twice what Canadians or Japanese pay for their health care and live up to five years longer besides. If this bill is true reform changing the system could not be warranted without addressing this issue. The system has to be affordable as well as allowing access.

In this bill nothing is done significantly to:

1. Encourage regional health committees to prevent duplication of services and equipment between hospitals and or large clinics. We must put and end to prime time ads or billboards all costing thousands. Hospital associations and lobby groups are very powerful but citizens demand this change. The wasted money here is immense. Billions would be a mild conclusion.

2. Reduce administration more. Offering networks is no different than re-offering the HMOs of our time—call it managed care if you wish. Refer to the definitions in the “Healthy Wisconsin” brochure. What is a network? “A coordinated group of health care providers that charge by the person rather than by the service.” In this senate bill, once the network is chosen and the rules written, the gaming of the system will begin again to assure a profit for the group offering the network. Nothing has changed the corporate system of health distribution to say it will be any different except promises and adjectives describing how well it will work. I refer all of the people working on this reform to please look at the brochures of HMOs and managed care groups that have been with us for 30 years. The American public has told legislators very explicitly "no more of this," and yet here it is. Insurance companies and large clinics have simply managed to change the name. The enormity of administration will still be present as it takes many to game the system and study the well intentioned rules. Huge amounts of wasted money here again.

3. Encourage healthy competition. Restraint of trade clauses in provider contracts (generally called non-compete clauses) keep costs very high and their presence is a major part of driving our health care costs to twice that of other countries. In the 50 states, this amounts to 145 billion dollars per year. Wisconsin’s share of this could well be in the billions. I refer you to the book Health Security America for the research on this issue

4. Halt exorbitant profit-taking. Finally the author asks why would you consider insurance companies taking 10% profits or more from Wisconsin residents when a citizen-run group for the entire state could set the rules and the premiums with considerations of all the above allowing us to approach half of our present health costs. Put very simply, we cannot afford them.

5. Prevent cost shifting. BadgerCare should not be expanded due to its cost shifting (making those who have insurance pay more to subsidize others) until a much better “Healthy Wisconsin” bill is presented in both houses. Citizens deserve at least this much so they can evaluate the vote of their own legislators. The Independent Reviewer would call for a special session of the legislature until a meaningful health care bill comes out that will be voted on. This bill should be of such a nature that BadgerCare would not be needed, since all people would be included.

In summary, our Republican and Democratic legislators have to get together, away from the influence of the insurance companies, professional groups, large clinics, drug companies and hospital associations, and include the reforms listed above in any new bill. The Democrats and the Republicans have to sit down and say that they will do this for our people regardless of special interests. I challenge any one of our legislators to get any group of citizens together and have a discussion of the reforms not included in the bill visited above, and then make a public statement that citizens did not want these reforms. That legislator would be run out of office.

Healthy Wisconsin is a beginning, but it needs the work discussed above to make it worthy of citizens' backing. Without this work, we would be risking another fiasco of the magnitude of our present health distribution system, causing even more harm.

Thank you,

Fred Bannister, M.D.
Chairman
Board of Directors
Coalition for a Health-Secure America
July 12, 2007

Health Security America is the remedy.

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