Journal Sentinel (Milwaukee, WI), December 19, 2009
Wisconsin Democratic Sens. Herb Kohl and Russ Feingold are almost never in the headlines on health care reform. Hands over eyes and ears, they are marching forward in lockstep with President Barack Obama toward some kind of a muddled conclusion.
They remain committed to some reform concoction, despite alarm bells ringing and red flags flying at home on government-managed health plans. Last week, it was revealed that the unfunded liabilities for retirees of the Milwaukee Public Schools System will reach $5 billion by 2016. No real fix has been proposed for that staggering obligation.
A day later, it was disclosed that Wisconsin’s Medicaid program will be $1 billion under water over the next 18 months.
“Medicaid, as it is, is unsustainable,” said Republican Sen. Alberta Darling (R-River Hills). “It’s just a program majorly out of control.”
The response of the Doyle administration will be accounting gimmicks and mandated price controls. The controls inevitably will lead to more providers refusing to take on Medicaid patients.
The two U.S. senators seldom weigh in on such local issues, but they are relevant to the national debate. Undermanaged public plans invariably bust budgets, and some go broke.
The senators also must be ignoring the huge shift in public opinion against the congressional concoction. Three recent national polls show a majority or plurality in opposition to the proposed reforms.
That big swing to the negative is not because people in the country are less intelligent than the wise men in Washington, D.C. It’s because Congress has not dealt with the ways and means of paying for universal coverage and because the substance of the insurance reform changes in major dimensions weekly. No one really knows what’s in Senate Majority Leader Harry Reid’s plan.
The public has deduced that Congress doesn’t know what it is doing as it tries one unproven idea after another for reshaping one-sixth of the U.S. economy.
Just in the last two weeks, Medicare expansion was shoved forward as the major platform for covering the uninsured and then quickly withdrawn when its huge price tag was tallied.
Here’s a simple example of how the Democratic proposals don’t compute. The Obama administration has put the price of covering 30 million more Americans at $848 billion over 10 years. Yet in Wisconsin, one of the best public plans costs about $6,000 per life. Multiply that out and you get a price tag of $1.8 trillion over 10 years.
Sally Pipes, of the right-of-center Pacific Research Institute, thinks the price tag will more likely be $2.5 trillion. “Taxes will rise – not just for wealthy Americans, but for all of us – deficits will grow, premiums will increase, care will be rationed, and, as in Canada, long waiting lists will develop,” she wrote.
History agrees with her projections. Every national health care program has far exceeded its original cost estimates. That’s what’s happening in Wisconsin.
There is a good possibility that the conceptual flaws in the pending national legislation will prove fatal. No faction is happy with the current rendition of reform. Liberals won’t win their dreams of a single-payer system or the fallback public option. Conservatives worry that the reform will break the bank and coverage will be rationed. Coverage of abortion remains a hugely divisive, possibly unresolvable issue.
Congress would be best served by calling time out for 2010 and coming back in 2011 to do real reform. Start over and build the plan on successful reforms in the private sector.
That includes consumer-driven plans that have been ignored and even possibly undermined in the current proposals. A recent Cigna study of consumer-driven plans found savings on medical costs climbed to 26% over four years when individuals were put in charge of spending tradeoffs.
Real reform would include putting primary care back to center stage. Costs drop by one-third because prevention, wellness, chronic disease management and integrated care are effective at that level. Federal pricing reform could make that happen, but has been largely ignored in the Washington circus.
Lastly, centers of value where lean disciplines have been brought to bear should be rewarded rather than penalized. Currently, the better their efficiencies, the less they get paid. They deserve bonuses and more business.
Those platforms would constitute fundamental reform of the delivery of health care. It would be a new business model.
Congress could sell a health care package that improves health and cuts costs. They will never sell one that does the opposite. Feingold, Kohl and company may ram it through, but they won’t sell it to a majority of Americans.