SCHIP Expansion is Wolf in Sheep's Clothing...

How does this continue to happen? How can people continue to have the wool (no pun intended) pulled over their eyes…other than by willful ignorance?

The threat of Presidential veto of the newly proposed SCHIP expansion has again met with the usual press reports. He is denying the poor children their rightful coverage, etc., etc. It is interesting that, even with the Bush-bashing that has gone on for years, the current Congress rates even lower amongst the general population.

This is not about the children! The truth of this matter is simply that this expansion of SCHIP (BadgerCare in Wisconsin) is a ploy to include more adults in the program rather than more children. The additional children we all want in this program can be afforded under the President’s proposed SCHIP increase. But, in order to pervert this well-performing program, those who would see government-run healthcare are using this program as their “Trojan Horse”.

They reason that by adding multiple billions of dollars, more and more states (like Wisconsin that already uses 75% of the current funding to bring adults into the program) can use the increased funding to apply to adults. This happens as the qualifying poverty-level income multiples are increased. This permits people earning far in excess of poverty-level incomes to participate in government-funded health care plans. As this group increases, the private sector health plans lose more and more people…exactly what those who seek a total single payer system desire.

This is back-door socialism. It appears there are enough ignorant Republicans who’ve signed on to support this travesty to at least have gotten this through the Senate. Among those Republicans is Sen. Hatch (R-Utah) who spoke at the Capital Conference hosted by the National Association of Health Underwriters early in 2007. He spoke eloquently as to how this perversion wouldn’t be permitted to happen. He must’ve found some politically-expedient reason for supporting it. This “go along to get along” mentality is a serious threat to us conservatives. And, any number of liberal Democrats and middle-of-the-road Republicans are happy.

As an aside, the tobacco tax increase that has been included as the funding mechanism will succeed in putting cigars out of the reach of mere mortals. With the tax increase going from the capped amount of $0.05 per cigar to a capped amount of $10.00 per cigar, only the “fat cats” will puff cigars. This staggering Federal increase coupled with the hefty cigarette/cigar tax increases added by many states, will effectively kill that industry. Tobacco is a legal product by the way. This reeks of hypocrisy…but why should any of us be surprised at that?

That “industry” is the goose laying all these golden eggs, and it will be killed by the “do-gooders”. We’ll then all awaken to find ourselves taxed to cover the certain budgetary shortfalls thus created by these mandated programs. Back-door socialism will have created government-run health care and we’ll be unable to do anything about it.

This must be headed off in the House of Representatives even with President Bush’s stated position of vetoing the bill in its present form.

Senate Dems Use Interesting Tactic to Mount Health Plan...

Senate Democrats used an embargo of the press as they pushed an 11th hour health plan proposal out front of every other proposal. They scheduled an informational hearing for 11:00AM today (Monday), but refused to release details of their health plan proposal until Monday morning.

That seems a very strange way to encourage true debate on this most critical subject. Why, if your health plan is a genuine proposal and worthy of debate, would you keep the information to yourselves. How can we even think of this plan as worthy given the manner in which it is being exposed to public scrutiny?

It appears to be an extension of the Wisconsin Employee Trust Fund package of health plans with provisions for taxes on both employers and employees to pay for the program. The tax rates proposed appear, at first glance, to be low considering that the coverage is quite extensive with minimal co-payments and small deductibles. The plan would be made mandatory for all citizens of Wisconsin except those who are covered under existing federal plans or BadgerCare.

We encourage debate on all proposals…but we need to know the details of each well before the debate begins. These same Senate Dems plan to vote on the Budget Bill on Tuesday, and this plan is now going to be part of that Budget Bill. It appears to be simply a ploy! They cannot be sincere in this effort using such tactics.

BadgerCare Publishes List to Embarrass Employers...

Wisconsin offers its version of the SCHIP programs called BadgerCare as we’ve discussed previously. Wisconsin has received approval from the federal Department of Health and Human Services to offer BadgerCare to adults as well as to the children for which the program was originally intended.

As a matter of fact, The DHHS Secretary, Michael Leavitt, points out that 75% of the Wisconsin program’s funds are spent on adults. Another tidbit is that Wisconsin covers nearly twice as many adults as children. Not bad for a children’s health program, huh?

Since the state wants to embarrass employers with employees participating in BadgerCare, we’ll certainly assist by adding the link to the list at http://dhfs.wisconsin.gov/badgercare/pdfs/employers0307.pdf .

Obviously, since “everyone” hates Wal-Mart from what I read in the news, Wal-Mart is at the top of this nasty list with 897 employees. Never mind that Wal-Mart employs more than 27,800 people in Wisconsin, just ridicule them for this 3.2% that managed to obtain BadgerCare.

How could that happen? Well, BadgerCare has established some rules that may explain this “unintended consequence”. First, if an employer offers its employees health insurance coverage but doesn’t pay at least 80% of the premium cost, the employee may be eligible. If the employee is earning less than 185% of the federal poverty level, then that person and his or her dependents are eligible for BadgerCare.

How much is 185% of the federal poverty level? For a single person, it is $1,574 per month. For a husband and wife with two children, it is $3,183 per month. For a family of 8, it is $5,329 per month.

Could it be that BadgerCare is too permissive in its attempts to cover children (when nearly twice as many adults as kids are covered)? Could it be that the 80% level of premium contribution placed on employers is too high? Could it be that BadgerCare is intended to bring as much federal largess into our state as possible (ignoring that we over-taxed Badgers are also paying federal taxes)?

Oh, and another thing! Among the culprit employers are these:

The United States Postal Service
The YMCA
Goodwill Industries
The State of Wisconsin

Uninsured In America...

Stuart Browning has produced at least three pieces depicting issues within the health care debate.

The piece titled Uninsured in America is found here .

I hope you'll agree that this needs to be shared with as many people as you can get it to as quickly as you can.

We'll look at two more over the next few days.

Wisconsin Health Plan Follow-up...Chapter Two

Another interesting tidbit that was included in the Lewin Study but wasn’t highlighted is this:

Of the some 2.958 million persons currently receiving health insurance benefits through an employer in Wisconsin, the cost for the Wisconsin Health Plan (WHP) will be less than the current costs for only 736,000 persons.

That means that the WHP, a lesser plan, will cost more for the other 2.222 million persons.

Is that not significant enough to warrant mention rather than to be buried on page 49?

How many other nasty surprises are yet to be found?

Is this really what Wisconsin citizens desire?

Wisconsin Health Plan Follow-up...Chapter One

Further exploration of the issues surrounding the Wisconsin Health Plan has turned up some very interesting items.

It seems that the Lewin Study discusses an Option 1 that was really the original Plan up until March, 2007. This “option” is actually the original legislation introduced as AB 1140 and is the plan that was the subject of the Legislative Fiscal Bureau analysis. This “option” was presented to everyone as the health care solution that would be fully funded by an assessment of from 3% to 12% of payroll to be paid by employers, and an accompanying assessment of 2% on employee wages.

An independent analysis by the Wisconsin Hospital Association at the time concluded that this plan was under funded by anywhere from $3 billion to $5 billion. This was met by strong disagreement from the author of the WHP.

Buried in the Lewin Study is the fact that the original Plan was indeed under funded by $3.6 billion. It seems strange that this has not been published. If one didn’t know better, it could almost appear as if the author of the Plan was being a bit disingenuous simply to assure that his Plan would continue moving forward. Apparently the end does sometimes justify the means. When you know best what is right for the 5 million citizens of the state, it simply would not do to have facts derail the proposal.

In fact, the March 2nd version of the report pointed out the fatal flaws of the original Plan, and yet that information has not seen the light of day other than in wonk circles.

Stay tuned…more to come!

Wisconsin Health Plan Study Raises Questions...

There are many questions about the Lewin Study and the Wisconsin Health Plan.

So far, we have heard, through the press, that the Study affirms this is a great idea, will save money for everyone and answers the health care needs of all but 17,000 people in Wisconsin.

All this begs details to support these conclusions that appear to have been drawn by the WHP creators. Rep. Jon Richards (D-Milwaukee) is trying to “fast track” his WHP but is trying to do so without sharing all the facts.

What we haven’t seen or heard is what questions were asked of the Lewin Group? Were those questions agreed to by all member organizations referenced in the press releases? Have there been changes made to the original Plan? Have there been critical questions asked but not answered? If so, what were those questions? Posed by whom? Etc., etc. etc.

Stay tuned. We’ll continue to dig for answers.

National Association of Health Underwriters Offers SCHIP Position...

Congress is currently in the midst of reauthorizing the State Children's Health Insurance Program (SCHIP), the state/federal block grant program that funds health insurance coverage for low-income children. It is this program that funds Wisconsin's BadgerCare plan for children. The National Association of Health Underwriters (NAHU) feels that during the reauthorization process, Congress has a great opportunity to make it simpler for states to voluntarily use SCHIP dollars to subsidize private group coverage for eligible children who have access to such private coverage through their parent's employer.

Doing so would have the following benefits:

More families would accept employer-sponsored coverage for their children, lowering the number of uninsured children.

The administrative burden on low-income families would be lessened, as families could be covered together on the same health insurance plan.

It would reduce the “crowd-out” of the private market that occurs when parents decline employer-sponsored coverage in favor of SCHIP coverage for their dependents.

It would lower costs by taking advantage of any premium dollars employers are willing to contribute toward their eligible employee dependent premiums—money that is now often “left on the table.”

It would also reduce SCHIP costs because the risk associated with covering the children with employer-sponsored coverage would be borne by the private market plan rather than the public program.

Licensed health insurance producers, who are already helping millions of business owners purchase health insurance coverage for their employees nationally, could provide outreach and enrollment assistance at virtually no cost to the SCHIP program.

We believe this is a wise approach and urge that our state Senators and Representatives give careful consideration to these points.

Canadian-style Health Care Decried by Canadian...

Brett Skinner, Director of Health, Pharmaceutical and Insurance Policy Research for the Fraser Institute, Canada’s leading think tank is urging that California and other states so inclined avoid the Canadian approach to health care.

“Canada is currently witnessing the failure of its own single-payer health insurance system. Faced with this example, why would Americans want to adopt such a system for themselves? The fact is that the Canadian model is an example of what not to do in health care,” said Mr. Skinner.

He went on to say:

“Canada’s public health insurance monopoly is failing and millions of Canadian patients wait so long for treatment that they are no better off than uninsured Americans.”

The article states that the current average wait time from one seeing his or her family physician to being able to see a specialist is 18 weeks. Statistics show that of the patients who received health-care services in 2005, 11 percent waited longer than three months to see a specialist, 17% waited longer than three months to get necessary non-emergency surgery; and 12 percent waited longer than three months to get necessary diagnostic tests.

While Canadians are forced to wait for treatment, the system legally prevents them from seeking treatment elsewhere and paying for it from their own pocket unless they choose to leave the country.

Most important for any state in the U.S. is that the report produced by the Fraser Institute shows that the Canadian system is not financially sustainable in the long run.

Wisconsin would do well to take Mr. Skinner’s words to heart.

Jack Lohman's Capital Times Opinion Piece...

Mr. Lohman has used an interesting technique to continue his quest for a government-run statewide equivalent of Medicare.

First, because our political system permits contributions to politicians, and because some of those contributions originate with health care or insurance entities, political corruption is part of the “health care crisis”.

If it is, why do we not tackle political corruption as a separate issue and not throw it into the same basket with health care? Health care in and of itself is far and away a tough enough situation to resolve properly without the added impediment of political corruption tossed into the mix.

Next, he restates his premise that a single payer system of health care would be a windfall for business, the economy of Wisconsin and the citizens who would be the consumers of health care in this brave new world.

Medicare relies upon the private sector insurance companies and health care administrators to pay all its claims. Those costs have been shown to be about 12% of the total claims paid, not 31%. The government cost of operating the system is some 2% to 3% of the total cost. That total administrative cost is about the same as the cost of private sector plans in the state under our free market approach.

“A small payroll tax” of 10% to 15% would be levied on the state’s employers instead of the money currently being spent for the free market version of health care. That would impact the roughly 50% of Wisconsin’s smaller employers that do not currently offer health insurance to employees. A new tax of “just” 10% to 15% would virtually guarantee that those employers would cease operation or move from Wisconsin where that was possible.

The reference to Medicare costing more per capita then would the program Lohman espouses is concerning. He maintains that the state-run program would actually save money over Medicare in that all citizens would be rolled into the pool thus spreading the risk. He ignores the fact that Medicare reimbursements are barely more than $0.50 on each billed dollar. The amount unpaid by Medicare is transferred to the free market programs through increased retail fees at the point-of-care. That alone is a big part of the health care crisis which is largely a health care cost crisis as we’ve argued before.

An alternative would be for those same health care providers to decide whether or not they could continue in business if all reimbursements were now at or below the level of Medicare reimbursements. Another alternative would be for the state to hire the providers of care to take all the egregious “profit” out of the equation. Yet another alternative is for rationing of the then available health care services by the state agency charged with running the health system. Each of those alternatives certainly has a nice ring to them; it’ll be really difficult to decide which to use. Maybe we can have some of each.

And then there is another “small tax” to take away all co-pays, deductibles, dental and vision expense. That would complete the loop. The entitlement mentality that is a large part of the current problem would have become the mentality of us all, and we would’ve driven more jobs out of Wisconsin.

But, we would’ve completely eliminated the insurance industry, all the agents, etc. And that seems a primary goal for effective health care reform from Mr. Lohman’s perspective.

Finally, the argument returns to that of “Business Ethics 101”.

We are finally in agreement: all sides of this debate must be completely honest and ethical because this is far too important a debate to permit it be limited or twisted.

Fixing an Ailing State Health Program...

Maine created Dirigo as the panacea to solve the uninsured problem of its citizens. Dirigo has been, by most counts, a failure having attracted only 13,000 participants.

For the second year in a row, a new bill is coursing its way through the political process that would put another twist on this failed program.

Dirigo would become self-funded and apparently Maine would be its own reinsurer. This is intended to permit the replacement of Anthem that had the audacity to earn a profit of some $3.6 Million from its work on Dirigo.

States have every right to experiment with what their citizens believe ought to work, but they really should be more careful than is the case with some.

Maine will find itself in the health care authorization business. Rationing is the term that comes to mind. Political forces will be pushed and pulled by the heartbreak that illnesses and need for treatment bring. Politicians seem to believe that the supply of money is endless, and will be hard-pressed to save themselves from approving new coverage to gain votes.

Inevitably, there will be budget pressures and those will lead to increased cost-sharing with those covered, or increased taxes, or more stringent rationing…and likely a combination of the three.

Wisconsin needs to take note as it debates the issues involved with health care.

Canadians don't care for Sicko...

…so read the headline for an article written by Peter Howell for the Toronto Star on May 20, 2007.

He stated that Michael Moore took quite a verbal beating during an interview at the Cannes Film Festival where Moore has been touting his latest “documentary”. I quote from his article:

“We Canucks were taking issue with the large liberties Sicko takes with the facts, with its lavish praise for Canada’s government-funded medicare system compared with America’s for-profit alternative.”

“…Sicko makes it seem as if Canada’s socialized medicine is flawless and that Canadians are satisfied with the status quo.”

“Other Canadian journalists spoke of the long wait times Canadians face for health care, much longer than the few minutes Moore suggests in Sicko.”

“Sicko, to be released in North America on June 29, is by turns enlightening and manipulative, humorous and maudlin. It makes many valid and urgent points about the crisis of U.S. health care, but they are blunted by Moore’s habit of playing fast and loose with the facts. Whether it’s a case of the end justifying the means will ultimately be for individual viewers to decide.”

The U.S. health care industry knows this is coming and feels alternately threatened, angered, frightened and somewhat helpless. What can be done to blunt this latest of Moore’s film adventures?

Those who care must become much more knowledgeable about Canadian, British, French and Cuban health care issues and how those systems compare to that of our country. Moore has changed his original tactics and now attempts to cajole, instead of club, folks to get them to see his point of view.

His tactics require that spokespeople for the industry assure that they too change their tactics. They can no longer simply criticize the messenger; they must become sufficiently knowledgeable as to be able to refute the wild claims one-by-one.

We are disadvantaged by the fact that his public relations machine is running at full speed and has been for awhile. We have yet to see the film in its entirety and do not yet understand the nature of his various claims and/or charges. We must begin to act now in order to counter the various “issues” soon after the initial screenings in this country.

Agents certainly understand many of the faults of the current U.S. health care system. They must not be seen as defensive, however, when it is they who have been preaching to the choir for the past decade or better.

Agents simply need to occupy the high ground of truth and reason. The Coalition for Sensible Health Care Solutions is a solid platform on which to build consensus.

Hospitals Threatened by Gov. Doyle...

Governor Doyle has threatened the hospitals in Wisconsin by stating they would receive no Medicaid rate increase unless they accepted his 1% of gross revenue hospital tax proposal.

The Wisconsin Hospital Association is opposed to the tax with a chief reason being their fear that the additional Federal money that would flow into the state as the result of this “tax” would not go entirely to the hospitals. They also stated that the acceptance of the Governor’s proposal in this instance would cause such an approach to become the approach of choice for years to come.

The assessment would generate some $202.5 million in 2008 with only $136.9 million going back to the hospitals, and would generate some $212.7 million in 2009 with $147.3 going back to hospitals.

It seems obvious that the hospitals have every right to be concerned even in the face of the Governor’s threat.

By the way, does anyone have any idea where all this newfound money will come from? Of course. We all pay our taxes to the U.S. and the state; and any hospital shortfalls will be collected from those who use those facilities.

We citizens just seem to have really deep pockets…at least to the Governor!

Enroll in SCHIP and Drop Private Coverage?

The Associated press has just reported on a Congressional Budget Office report that said for every 100 children who enroll in SCHIP (State Children’s Health Insurance Program), there is a corresponding reduction in private coverage of between 25 and 50 children.

CBO officials also pointed out that when SCHIP was created, it had been estimated that about 40% of the participants would previously have had private insurance. If those parents were actually at or beneath the federal poverty level, I have no problem with this. Those families could certainly have found an excellent use for the freed money.

If, however, these were children whose parents only became eligible because they lived in a state that raised the income by doubling or tripling the federal poverty level to attract entrants, I don’t think that was ever intended.

Sen. Grassley, R-Iowa was reported to have said, “This report tells us that Congress needs to make sure that whatever it does, it should actually result in more kids having health insurance, rather than simply shifting children from private to public health insurance.”

And, we Wisconsinites have more adults in the SCHIP program than children. If that were the intent, wouldn’t it be better called SAHIP…the State Adult Health Insurance Program?

Yet another perversion of a well-intended program that leads one to ask…”This makes us want government run health care why?”

Public Policy Forum Discusses Health Reform…

The Public Policy Forum held a panel discussion in Milwaukee on Wednesday, May 9th to discuss health reform in Wisconsin. Three proposals were discussed:

Wisconsin Health Care Partnership Plan which is the single payer plan developed by the Wisconsin AFL-CIO. It would be financed by a flat tax that this group estimates to be $340 per month per employee. Seems like that is a number we heard in the Massachusetts “Connector” plan debate…that has increased several times over the past months. It claims that it will reduce the 27% of every premium dollar going to administer health care insurance today. We seem to have a disagreement on that number, as well; since our information suggests the real cost is closer to 12% as borne out by federal studies.

Fortunately, this plan appears to be DOA from all indications.

The Wisconsin Health Plan which has been developed largely by David Riemer. It tends to use the state employee program model and would be funded by a tax on all employers. Last I heard, the proponents of this plan were talking about maybe a 12% tax, but only when pushed to give an estimate. Our information suggests that this tax would be much closer to 17% at the outset. The plans would be limited to those selected by “a commission” and each person would be required to select coverage from that list. This smacks of too much government control for my tastes. It also will drive businesses out of business and that certainly won’t be good for heath care or anything else.

BadgerCare Plus is the plan espoused by Governor Doyle. It would supposedly expand health insurance coverage to 98% of our state citizens. First, that still leaves 2% that are uninsured and that isn’t a real good solution since it would retain cost-shifting to the insured. We need to be sure everyone is covered. This plan piggybacks on federally-funded programs that are intended for children, would subsidize families with incomes beneath a certain point, etc. Our state already has more adults covered in the children’s health plan than it does children. The poverty level that determines subsidization is already set at twice the federal program’s original intent and there are those who would increase it again. There are as many as 200,000 people in our state that qualify for the various government programs who simply do not enroll. Why will this be different? And, what happens when federal funding begins to be restricted due to the increasing costs of Medicare, Medicaid and Social Security? Will providers’ reimbursements, already too low in this program, be reduced further?

Any successful reform plan must involve the effort of the private market and of government. Government’s role should be that of support, working with the private sector to get control of costs, and using its influence to assure transparency in those costs, transparency in the quality of care and transparency in the outcomes of the providers of that care. The consumer will take care of the rest.

Basic health care plans must be made available. Tax-advantaged programs must be featured. New tax-advantaged programs such as a Health Coverage Account should be made available to help low income people to be able to afford the basic health plans.

That sounds like a sensible solution.

Common Sense in Health Care Debate...at least do no harm!

As the debate over health care and the changes needing to be enacted in Wisconsin continues, we need to be ever mindful that wise people in other states have already made their share of mistakes.

Maine thought that "Dirigo" would cover 130,000 citizens in the first year. That was nearly three years ago. There are some 18,000 citizens covered. Dirigo was to be the vehicle that assured universal coverage.

Connecticut's governor proposed a magic cure-all program. The program wasn't proposed with any cost numbers, but those were developed later. It seems that the Connecticut program might accomplish its goal...but the cost would be triple that of Connecticut's state budget annually.

Illinois's governor has proposed a plan. It threatens to tax employers out of business. Even the Reverend Jesse Jackson has seen the light and stated that health care coverage at the cost of employment is not at all a good trade for the citizens of Illinois.

All this reminds me of what I'd always thought was a part of the physician's oath. There is an erroneous attribution to Hippocrates having to do with the phrase, "first, do no harm." He did author a similar plea, but did so in his Epidemics, Bk. I, Sect. XI. One translation reads: "Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things — to help, or at least to do no harm." (Emphasis added)

It is imperative that we do no harm as we settle on the set of initiatives required to set our Wisconsin health care community on the right path for the future as we see that today. Let us incorporate the wisdom of Hippocrates in the process.

Advanced Healthcare, Aurora & the Future...

I am the patient of an Advanced Healthcare doctor. My first reaction to the early news that Advanced Healthcare and Aurora were negotiating a joint relationship was one of wait and see.

Now, some weeks later, there is the outward indication of a significant change in relationship…a formal announcement by the two parties has been issued.

My initial reaction to the announcement over the week-end that this likelihood seemed nearly a fait accompli was one of concern. I was concerned for me as a patient, for my doctor as a participant, for Community Memorial Hospital as a threatened institution and for the whole healthcare topography in S.E. Wisconsin.

I had an unexpected opportunity over the week-end to experience healthcare first-hand. As the result, I also had the opportunity to talk with a couple of physicians…one a member of Advanced Healthcare and the other a member of another group [but who would be impacted by any issues ultimately surrounding the viability of Community Memorial]. I also had the opportunity to interact with employees of Community Memorial Hospital, although I chose to not engage any of them in this discussion.

The Advanced Healthcare doctor told me that he had mixed emotions as did many of his peers. He also stated an interesting statistic as follows: a handful of years ago, Advanced Healthcare was one of a couple of hundred similarly-sized group practices in the U.S. but today it is the sole group practice of its size left in the U.S. Each of the others has been acquired, has merged or has somehow been absorbed by another entity. He reminded me that even though each physician sees his patients as a sacred trust, the corporate folks understand that healthcare is a business. And businesses must remain competitive in order to survive. If one group of physicians lost its edge, many of its patients would quickly migrate to another practice that had the edge. We patients expect our physicians to be “loyal” to us, but we can move without those same feelings flowing in the other direction.

The non-Advanced Healthcare doctor told me that there were mixed emotions of a very strong nature inside and outside the systems involved. He said little else, I presume because of the highly-charged situation of which he is a part.

I saw no sign that staff members had changed in any way as the result of this news. Some probably had no idea that such news had been issued while others felt they would be okay no matter what. It is, after all, difficult to imagine that a hospital of the size and reputation of Community Memorial with its partnering relationship with Froedert could not survive very ably in almost any situation.

Maybe the other suitor earlier reported will step up to the plate with an offer to Advanced Healthcare that transcends the deal in the current discussion. If so, it could be that my concerns would be for naught; or it could be that I’ll have a whole new set of concerns.

If we simply take a look around us, we’ll see that there has been consolidation of insurers and consolidation of hospital groups. If the physician groups do not scale up in size, they will have lost much of their negotiating leverage with both the insurers and the hospitals. We cannot foretell what such consolidation will mean to the cost of healthcare; it is easy, however, to postulate increased costs given fewer alternatives and more buildings and more expensive equipment and less competition [in the form of fewer competing entities].

Physicians generate the bulk of patient flow for hospitals by their admitting profiles. So these physicians have significant leverage at the moment.

Could our local hospital emerge strong as ever? Certainly it could.

Could it emerge as a weaker entity? Certainly it could.

Could it simply go away as we know it today? If Aurora were to acquire or merge with Advanced Healthcare and then build a northern tier hospital as has been discussed; and, if Medical Associates were to conclude negotiations with ProHealth located in Waukesha and began referring patients in that direction…certainly it could.

Whatever your thoughts, this is an exciting and/or troubling time for we consumers of healthcare in this area.

If There Is Any Doubt About Government-run Healthcare...

We need simply look at the gyrations occurring in Congress as the “great debate” over SCHIP and Medicare Advantage takes place to see exactly where we’ll be if Healthy Wisconsin were to become the law in Badgerland.

SCHIP is being re-engineered to bring in more and more adults and to permit families of four earning over $80,000 per year to join. This is a very obvious expansion of government-run healthcare.

Medicare Advantage funding is being threatened because it represents an incursion of the private sector into the world of government-run healthcare (Medicare) that is a threat to all those whose goal is just that…government-run healthcare.

Doctors in Medicare would be favored by some of money freed up by the reductions in Medicare Advantage while SCHIP would get the rest because there simply isn’t enough money to go around even with huge increases in tobacco taxes. Medicare Advantage could disappear as the direct result of this move. In this instance, oldsters who had selected Medicare Advantage will be forced back into Medicare parts A & B with lesser benefits available to them at higher costs. This subtle form of rationing should give us all pause. Future forms of rationing promise to be far less subtle.

Politicians running healthcare is oxymoronic. They will be unable to resist the temptations of all that power…and you and I will suffer…just as those on Medicare Advantage programs are about to suffer. What will it be next? Will it be mandatory health prevention as suggested by one presidential aspirant? What will happen with all that data that is collected? And then where will it go? Will we ultimately see consciously controlled death rates since death is less expensive than living with and treating a disease? That happens in single payer countries around the world today. What makes us think that it wouldn’t happen here as well?