30 Oct Health Care Reform is Working Its Way Back on to the Political Agenda
MILWAUKEE – The people who run St. Joseph’s Regional Medical Center here have a problem: Too many patients are using the emergency room like a walk-in clinic, an expensive practice that ties up valuable medical resources which should be used for critical care, not runny noses. To discourage people from using the ER for minor ailments, the hospital announced last week it will impose a $150 minimum fee.
The story is a symptom of a larger disease. About 44 million Americans lack health insurance and the costs of caring for them when they become ill are being shifted to taxpayers and the medical system as a whole.
It’s one reason why health care reform is creeping back on the political agenda after being left for dead following President Clinton’s failed 1993 initiative. Behind the occupation of Iraq and the economy, health care reform may emerge as a leading issue in the 2004 national and state elections.
The debate is already underway in Wisconsin. The fourth Wisconsin Economic Summit will leap into the fray Tuesday with a report by 36 health-care experts. Earlier this year, the Competitive Wisconsin business group devoted its meeting to rising health-care costs. An Oct. 10 seminar organized through Madison’s Meriter Hospital attracted reform advocates from Massachusetts to California.
Renewed talk will not quickly produce action, however. Proposed solutions range from a “single-payer” system similar to what exists in Canada to a privatized model, which uses tax credits to encourage people to become better health-care consumers. Others think the current “managed care” system – itself a product of reform – can be tweaked to work better. Still others think overhauling the antiquated Medicare system, which reflects medicine as it was practiced in 1965 rather than today, will break the logjam.
The best place to start is to assess what’s working:
Although one in seven Americans aren’t covered by health insurance, six in seven can get care either through an employer-sponsored plan, Medicare, Medicaid or some other insurance plan. In Wisconsin, the coverage percentage is much higher – 10 out of 11 people are covered – because of better regulation and a culture that encourages employers to offer insurance.
Improved medical technology is controlling costs through early diagnosis, by saving and improving lives, and by improving the efficiency and productivity of the system. Not all cost savings are immediate, but they will benefit society over time.
Life spans have increased by about 30 years in the last 100 years, which is more than the preceding 100,000 years. Dramatic improvements in public health and safety practices deserve much of the credit.
Chronic disability rates in patients 65 and older are falling, saving nursing home costs and allowing people to stay productive longer. That trend may help to prevent a severe labor shortage when the “Baby Boomers” hit retirement age.
Given those successes and more, is it necessary to junk the U.S. health coverage system? Statistics show the uninsured problem – which is driving costs – is clustered around the working poor and their children, minorities, people who work for small businesses, and people who live in very rural or very urban settings.
There may be political will for a targeted solution; there likely won’t be consensus for reform that redefines health care as an entitlement. Public support is soft for the notion that health care is a “right” to be guaranteed by society to all, regardless of age and ability. It’s softer still for adopting a system where that “right” is defined far outside the doctor-patient relationship. If you believe health care is a right, you may also believe it’s a violation of that right to ration health care or to entrust a bureaucracy to decide who gets what treatment and under what conditions.
Indeed, the insurance system does some of that that now. But insurers must work with employers, patients and the physicians, who help set the rules. A majority of Americans are not likely to trade their reservoir of trust in the medical profession for faith in a system run by bureaucrats with a different set of values.
The question is not whether health care delivery needs reform. Everyone seems to agree change is coming – perhaps even in the next presidential term. The question is whether we’ll be smart enough to borrow some of the best ideas from other nations and use them to build upon what’s already working at home.
Still is president of the Wisconsin Technology Council. He is the former associate editor of the Wisconsin State Journal in Madison.