Let's Get Healthier Now

Why Madisonians should care about health insurance reform

I recently visited my primary care doctor seeking treatment for several weeks of debilitating back pain. The outpatient visit included X-rays, a painkiller prescription, a referral for an MRI and an appointment with a pain specialist, who administered steroid injections to reduce my inflamed spinal nerves, and several physical therapy sessions. My doctor also told me to change my lifestyle, by which he meant stop running and start swimming.

My insurance will cover at least eighty percent of the total costs and I will owe a few dollars for co-payments. I have barely thought about the costs, focusing completely on pain reduction, functionality and recovering my health so I could actively return to work. This experience reminded me of a Three Stooges joke:“Hey, when did you get a weak back?” “Oh, about a week back!” Nyuk, nyuk, nyuk. But the uninsured aren’t laughing and neither should we be.

What would I have done if I was uninsured? In Dane County an estimated 33,000 of our neighbors are living below the federal poverty line and 29,000, including 5,000 children, who go without private or public health insurance during some part of the year. That’s about six percent of our citizens who do not have access to high-quality, affordable health care that the rest of us take for granted, especially if we have employer-based insurance (seventy percent of us), a generally expensive individual policy, or are recipients of Medicare (Parts A, B and D) and/or a Medicare Supplemental plan, or BadgerCare. When the uninsured must pay for health care, they have adjusted their lifestyles to make do without adequate shelter, food or new shoes for their children. Unlike me, swimming is not an option.

The annual cost of insuring this segment of our community is about $50 million, a cost to all single Dane County household property taxpayers of about $250 per year on average—the cost of a typical veterinary bill for our pet cat or dog, or 125 cups of Starbucks coffee. According to the National Priorities Project estimates, the cost of the Iraq and Afghanistan wars to Dane County taxpayers could pay for the health care for almost one million people (the number of citizens in the entire region of Dane County and the surrounding seven counties) for one year.

We take for granted our entitlement and willingness to publicly support quality schools, trash and recycling collection, clean water and fire and police protection, but we do not have the same assumption of equal protection of all citizens for access to affordable, quality health care. Trash collection is a (public health) right, but it seems health insurance and access to care are privileges in the United States, except for our U.S. Senators and congressmen, who enjoy the benefits of a virtually free federal government–run health plan at taxpayer (our) expense. And some are willing to arrogantly deny the same benefit to those who don’t have it. We are unlike any other modern industrialized nation in denying this same access to all of our citizens. The Commonwealth Fund rankings of industrialized countries' health status and quality place the U.S. at fifteenth, near the bottom.

As a society we pay a big price for denying health care to all citizens because health care represents twenty percent of our gross domestic product and climbing. It is inextricably connected to the fate of our overall economic well-being. We pay more for insurance, we pay more in taxes. And the uninsured get no care or poor care at best.

Here’s what it means to be uninsured:

• The uninsured will suffer with unattended illness, pain and disability, missing several days of work if employed.
• The uninsured are more likely to be diagnosed with a disease in an advanced stage.
• The uninsured seek care in hospital emergency rooms, which lack adequate primary care follow-up, increasing insurance costs for everyone else.
• The uninsured are charged 2.5 times more than the insured and pay more for medical care without the ability to negotiate discounts the insured receive.
• The uninsured go without screening and preventive care and forgo needed medical care.
• Preventable conditions such as breast cancer will advance to more expensive and possibly untreatable stages.
• The uninsured are sicker and are 25 percent more likely to die a premature death.

Most people are unaware that Medicare, signed into law by President Johnson in July 1965, had its origins as far back as 1906 at the University of Wisconsin economics department. This social net program now covers fifty million seniors. In the last ten years, continuing our progressive history, governors Thompson and Doyle expanded access through BadgerCare (Wisconsin’s Medicaid program) to thousands of Wisconsinites, including 42,000 people in Dane County, or about nine percent of the population.

But we haven’t finished the job. Thousands of people in our community remain without insurance, and the recession has caused applications to increase and related costs to potentially drive huge government deficits. The law that President Obama recently signed expands insurance coverage to virtually all Americans and assists the states with funding Medicaid expansion. Coverage for the uninsured will be phased in starting in 2014. Can our uninsured neighbors wait that long?

We have the moral responsibility and the cultural and intellectual capacity to demonstrate national leadership once again by organizing health policy leaders, insurers, and providers in Dane County to develop and demonstrate how the new plan can be effectively financed and administered, including meaningful and effective cost controls, that includes all of our citizens. We have the experience and innovative talent to lead the way.

While we’re at it we should change Wisconsin’s license plates from “America’s Dairyland,” since California has surpassed us, to “America’s Healthy State,” and then live up to that vision of our future.

Martin A. Preizler retired in 2008 as president and CEO of Physicians Plus Insurance Corporation. He is now the Dean of the Edgewood College School of Business.

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