Milwaukee Biz Blog

We are in the midst of what should be an earnest debate about just what our healthcare system should look like, how it should be funded and how it should be delivered.

Unfortunately, this debate has begun as a political debate and it continues as a political debate. That is ludicrous, since a politician, other than maybe for those few politicians who are health care providers, has never helped a person in need of health care.  Health care is neither Democratic nor Republican.

If and when Healthy Wisconsin is removed from the Democrat budget and re-introduced as a free-standing bill, maybe the debate can continue. As it stands today, there remain many unanswered questions. Whenever a Republican raises a question or makes a critical comment, the too-often-heard response is … "Where is your plan?"

That doesn’t change the fact that the unanswered questions remain unanswered. It simply serves to cause the "debate" to further degenerate.

We are witnesses to the plans espoused by Barack, Mitt, Hillary, Fred, John and the rest. They are not medically nor otherwise qualified to tell us what we should and shouldn’t be doing about reforming our health care system. They are politicians.

Unfortunately, politicians tell us whatever they think we want to hear. They view the polls from yesterday and set course with their talking points for today. They move money from one group to a more favored group.

That is not what we need. We need reasoned discourse. We need solid plans from all quarters that can withstand public debate in the full light of day. The informed public can then tell our politicians what we want and need … not the reverse.

We do need to hear from all sides without the volume turned on high. We are sufficiently knowledgeable so as to make good decisions. We need to study the good, the bad and the ugly … and yes, we can tell the difference. We need not repeat the mistakes made by others. We do need to learn from those mistakes. 

We need to understand while we have the best health care system on earth today, it can be improved. It can be improved without completely destroying what we have today. We are the envy of the world, but you wouldn’t know that if you only listened to the political mutterings.

We need to bring the cost of health care under control. We need to determine if employers will continue to make plans available or if individual plans will take over, or if the combination of those two approaches is the answer.

We need to realistically look at every state-mandated coverage item. Maybe we need to embrace a "menu-driven" premium system that would permit the individual to make his or her buying decision based upon actual or perceived needs. That alone could reduce premium costs by 20 percent or more.

We need to review the tax advantages offered to employers but denied to individuals. Maybe it is time for that playing field to be leveled and for the two approaches to be commingled.

We need to recall what insurance was originally intended to do. That was quite simply to be the safety net for the unfortunate few who suffered major or catastrophic health care costs. It was never intended for first dollar coverage until recently.

There are aspects of most every plan proffered that are good. That is the good news. Not everything that is good for us is incorporated in any one plan. That suggests that a single program will never fit every individual properly. That further suggests that a menu-driven system might well be a solution for many who are unable or unwilling to insure themselves today.

We know that we want everyone to have access to health care, but should they be able to wait until they have cancer to buy insurance and begin paying their share? With "guaranteed issue," we encourage just that. That means that all who are insured too soon have been penalized by those who wait until they’re diagnosed with a major illness. Is that really what we want? Won’t we eventually see almost everyone waiting for the day they’re diagnosed with something beyond the common cold?

We want to be welcoming to the immigrants who are working diligently to earn their position as citizens of our great country, but should the illegals be accorded the same gratuitous health care benefits?

Some 11,000 births per year alone occur in Parkland Hospital in Dallas, Texas, to illegal immigrant mothers. Some have had as many as three children in that same hospital. Is that what we want for our health care system? Who do we think is paying those charges? Isn’t it us?

We want everyone to be able have health care insurance coverage, but should everyone be paying the same price for their coverage? If they are abusing themselves health-wise, are they not also abusing all those who are consciously working to keep themselves as healthy as possible?

The oft-mentioned solution is called "community rating." That smoothes all costs over the entire population in the plan. That also means that virtually everyone is either paying too much or too little. Is that a proper solution if one doesn’t want to see income redistribution, or is it a proper use of income redistribution?

Is it not the responsibility of every citizen and legal immigrant to take charge of his or her own well-being? Is that not the American way?  What about the grasshopper in Aesop’s Fable who fiddles while the ants lay up the store of food for the winter? Should the grasshopper get a free ride?

How is it that we should rely on government to do for us when we can do for ourselves quite nicely? Is there any doubt we individuals can do better for ourselves than the government can do for all of us? Are we not individuals with individual wants and needs? Since when did a "one size fits all" approach to health care make any sense?

Do we want an income redistribution approach to health care, or do we want the profit motive at work to assure that we can find the best caregivers for our needs, given our ability to pay? Do we want a government panel making judgments as to what is covered and what isn’t covered and making decisions about what is rationed because money is in short supply? The marketplace is taking care of that now and has been since the inauguration of our health care system. We call it supply and demand in its most simplistic form. That happens with or without health insurance.

Do we want to interrupt, with price controls, the development of most new medicines and treatment regimens and equipment, or do we want the private sector to continue to risk huge investments in hopes of scoring a big new discovery that repays the risk taken by a thousand-fold or more?

What system of socialized medicine can we find that is better than the system we already have? If the answer is that there is no such system, then might we be further ahead to look at reforming our current system to better suit the needs of the 21st century? Are we smarter to build on the shoulders of those who have gone before, or is it better to scrap everything and begin anew?

Should we approach the changes we believe to be necessary incrementally? That would safeguard our current system while we strive to find improvements. Is that not better than simply closing the doors on the old system one day, and hoping that the next morning will bring those improvements we had hoped to see?

It is time for saner minds to prevail. This is a terribly complex set of issues with unintended consequences running rampant. There seems little, if anything, to be gained by scrapping the present system and embarking on a journey in quest of something better when there is no proof it will be better. To the contrary, there appears to be emerging proof that it would not be better.

There is everything to be gained by improving the present system, thus protecting all that is good, while searching out those improvements that will make the difference … that will give us that which we think we need in our healthcare world…not that which we’re being told we need as is now the case.

Alan Campbell is a licensed insurance intermediary who has been involved in a wide range of health care industry positions in more than 34 years in the industry. He is a former president of the Wisconsin Health Underwriters Association and is president of United Resource Group, a company providing online enrollment services for agents and their employer clients.
 
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Is there an issue that you feel passionate about? Share your thoughts with the readers of Small Business Times by writing an entry in the Milwaukee Biz Blog. Just e-mail your blog entry, and a digital head-and-shoulder photo (if you have one) to SBT executive editor Steve Jagler at steve.jagler@biztimes.com.

Part of virtually every discussion concerning the state of health care in the United States is a reference to the uninsured. Given that, we assume that the group of uninsured must be a very important part of the problem.

We need to better understand just what is meant by the ubiquitous "uninsured." We'll likely all agree that it is a very serious part of the problem confronting us as a nation.

We hear of the ever-increasing number of uninsured. The former top number for the United States was 46 million…until it became 47 million. That seemed to occur overnight. I don't know who is responsible for keeping track of that number, but they sure seem on top of their game!

Let's take a look at what comprises the "uninsured." First, this is not a static group of people. Instead, the number of "uninsured" is an estimate…a snapshot…of the number of folks thought to be without health insurance on any given day of the year.

Please also note that I used the phrase, "without health insurance." That is a much different phrase than had I said "without access to health care." Every person in the United States has access to health care…by virtue of federal law.

It is true, however, that much of that health care is received in emergency rooms, and that is a significant part of our nation's problem.

The care is received too late in the wrong setting to be of lasting value to the individual.  The care is also delivered in the most expensive possible setting, and much of that cost is unreimbursed and therefore is ultimately "shifted" to the insurance premiums paid by individuals and employers.

The current estimate for the number of uninsured in Wisconsin is 546,870. That number has increased each year but has remained fairly constant so far, as it's comparison to the total population of the state; about 9.9 percent. Using the most recent Census numbers for Wisconsin, coupled with an analysis by the Blue Cross Blue Shield Association and the Congressional Budget Office estimates of the make-up of the group called "uninsured," we see an emerging picture made up of these parts:

• People who are eligible for existing government programs but who have failed to enroll.
• Middle-class people who earn more than $50,000 per year and who cannot afford or choose not to buy insurance.
• People who are classified as the short-term uninsured (up to two years without insurance, recent college graduates, seasonal workers and those who are invincible).
• The long-term uninsured who simply have fallen between the cracks and remain uninsured for a long time.

What is the number of Wisconsin citizens that fall into each category?  It is quite surprising to me.

First, the group that already qualifies for government programs but has failed to enroll represents an estimated 204,529 people.

Second, the group classified as middle-class who either cannot afford to or have chosen not to buy insurance is estimated at 174,998 people.

Third, the short-term uninsured is estimated to contain 68,359 people.

Based on these estimates, the long-term uninsured group is comprised of an estimated 98,984 people, or about 1.8 percent of Wisconsin's population.

Does this mean we still have a serious problem as far as the number of uninsured in Wisconsin and the country? Absolutely we do. Does it mean that we have to turn the present system on its head and move to "universal health care" (the euphemism for single-payer coverage)? Absolutely not.

It does mean that we need to bring all those who do not have insurance into the insurance system.

It means that costs incurred by those providers who are not paid for the services rendered are being shifted to the third-party reimbursement system. That simply magnifies the increases in health care costs and, thus, insurance premiums, year over year.

It also points up the truth that many do not want to accept: our problem is a health care cost problem and not a health insurance cost problem. Health insurance premium increases mirror the increased costs of health care, not the other way around.
Insurance by its nature was always intended to help each of us defray the unexpected catastrophic expenses we might incur.

We have come to expect that health insurance will cover everything.

It's as if our auto insurance covered the cost of gasoline and oil changes, in addition to collision and comprehensive damage expense. It's as if our homeowners' coverage covered the cost of a new garage door opener when it quit working or a new coat of paint for the house every few years.

Reform of our health care delivery system is too important to permit ourselves to be confused by sleight of hand. We have to get it right, for we'll most likely not have another opportunity to do so!

Al Campbell is a licensed insurance intermediary who has been involved in a wide range of health care industry positions in more than 34 years in the industry. He is a former president of the Wisconsin Health Underwriters Association and is president of United Resource Group, a company providing online enrollment services for agents and their employer clients.

 

Editor's note: Be a blogger …
Is there an issue that you feel passionate about? Share your thoughts with the readers of Small Business Times by writing an entry in the Milwaukee Biz Blog. Just e-mail your blog entry, and a digital head-and-shoulder photo (if you have one) to SBT executive editor Steve Jagler at steve.jagler@biztimes.com.