Back to the drawing board

Impressarios of statewide health plan need to consider stronger patient wellness component

Editorial by Sean Fitzgerald

It’s back in the saddle for supporters of the Healthy Wisconsin plan which was rolled out during the recent state budget negotiations and fell through on account of its estimated $18 billion price tag.

The plan drew almost unanimous dissent from Republicans who considered the statewide universal health plan an undue burden on small employers, one that was likely to force many of them out of business. It also drew almost no critical analysis from Democrats, who blindly supported the measure with zero concern for the nuances such a plan might have on the long-term wellness of state residents.

The effort should still be commended for advancing statewide discussion on universal health care in Wisconsin. It’s a discussion that’s not going away. But we need to find a common ground less imposing on small business which still recognizes the efforts of larger business to keep their employees healthy and well-educated consumers of health care.
As it was most recently written, Healthy Wisconsin would have created a comprehensive health plan for all state residents, and wouldn’t have required co-payments or deductibles from patients to receive treatment. It would have been funded through a special health care tax paid by employees – amounting to about $3 billion annually – and a new tax levied on all employers, regardless of whether or not they want to participate, which would have provided the additional $15 billion a year to support the plan’s cost.

Don’t get me wrong – I believe the plan has certain merits for providing health insurance coverage to hard-working state residents who simply can’t afford a policy on their own and work for an employer who doesn’t provide health insurance benefits.

But I’ve long been critical of the plan’s shortcomings in recognizing the role employers have taken in encouraging and driving wellness initiatives among their workforce. These companies – like the employers we’ve honored in our annual Alla Tua Salute! Corporate Wellness Awards – have invested thousands of dollars up front with the intention of supporting healthier employees who become sick and injured less frequently, thereby using health care services less often and driving down insurance premiums.

The idea of Healthy Wisconsin – as it moves forward – needs a more substantial focus on wellness and preventing the kinds of chronic diseases which increase insurance rates and health care costs for all of us. I’ll again throw out the idea of having the state pay for an annual comprehensive health risk assessment for each state resident, benchmarking key indicators for health such as body mass index, cholesterol levels, blood pressure and more.

It’s a concrete approach to ensuring each state resident comes in contact with the health care system at least once a year. It also would create a track record of a patient’s year-over-year history of their own personal health metrics, empowering individuals to make decisions to improve their own health.

For a little over 5 million state residents at an estimated mass-purchasing cost of $50 for each HRA, the bill to the state would be roughly $25 million. That’s a healthy and well Wisconsin, both for the body, and for the pocketbook.

Pooh’s honey pot
Like Winnie the Pooh finally warding off a hive of bees in acquiring his prize of elusive honey, Gov. Jim Doyle successfully tapped into the state’s growing Injured Patients and Families Compensation Fund to help caulk a $175 million crack in Wisconsin’s 2007-09 budget.

The third time was a charm for Doyle, who tried unsuccessfully to access dollars from the physicians’ liability reinsurance fund back in 2003 and again in 2005, each of the budgets he’s presided over since taking office in early 2003.

But don’t savor the sweet nectar, yet.

Attorneys for the Wisconsin Medical Society filed suit against state government in early November to prevent the fund transfer, arguing it’s not tax money. And it’s not. The fund has been built up to nearly $750 million in the three decades since it was established by physicians as insurance to cover catastrophic claims from patients above and beyond the limits of a physician’s malpractice insurance.

Wisconsin residents have been fortunate not to have needed to draw down the fund with lawsuit awards in the tens of millions of dollars.

If there’s going to be any kind of transfer from the patient’s compensation fund, it needs to be applied to specific health improvement measures, such as the statewide health risk assessments suggested above.

These are health care dollars, provided by physicians to ensure Wisconsin residents are as healthy and safe as possible in a time when modern medicine has its hiccups. It’s not a stopgap for the state’s general fund.