October 3, 2007
“I have so many good ideas I don’t know where to start,” my new friend said. He and I were working to find solutions to high-priced health insurance. My friend came from the world of small business, I from the Senate.
The occasion was a gathering in Chicago last week of people from 14 states that were all considering serious health care changes. My friend and I are part of ‘Team Wisconsin’ that included eight people representing state agencies, the Governor, the legislature, private business and advocacy groups. We spent three intensive days working, learning and sharing ideas.
The event, called the “State Coverage Initiative,” was paid through a grant from Robert Wood Johnson, a foundation that was formed years ago by Johnson and Johnson – the baby powder people. For many decades this foundation has been supporting changes in health care.
Now RWJ saw several states moving toward real change and wanted to help in the efforts. Wisconsin benefited from the expertise of people from all across the country and from the many consultants that came to work with ‘Team Wisconsin’.
One tricky problem we tackled was the health-insurance challenge that individuals and small businesses face. Most of the time, the health coverage that is affordable is very poor insurance. Often, good coverage is not available or very expensive.
One insurance agent summed up the situation nicely for me. “Health insurance for the individual or small group is the poorest value of any product I sell,” he said. “I am embarrassed to tell people what they will have to pay and how little they will get.”
The problem is that small business and individuals are in small risk pools by themselves and end up paying much higher rates; the answer is to put everyone – or as many as possible – in a single large risk pool. This is what the Senate’s health care plan does.
The immediate future of the Senate plan, “Healthy Wisconsin” is still part of the state budget debate. It does seem likely that when the budget is final, the plan will not be included in the budget. But “Healthy Wisconsin” will not go away. Far from it.
The Senate is committed to the plan and “Healthy Wisconsin” will be introduced as a separate bill. This will begin a new series of public hearings. The public process will give us an opportunity to address some of the concerns raised in the first round of health care debates.
One problem, raised by small business, is that the amount small businesses would pay is too much. For firms that have low wages, have low margins (like grocery stores or dairy farms) or are new in business, there is simply not the money to be able to afford paying health insurance for employees – even when the premiums are based on wages.
The small business that doesn’t offer insurance then places the employee in a difficult situation. If there is not a spouse that can cover the employee, many employees have only two options, to pay very high rates or to go without insurance.
The business that does not provide insurance – in a sense – is being subsidized by all of those businesses that do pay for health insurance. Most of the people who are sick eventually get care – even if it is through the emergency room. And hospitals recover their losses from people unable to pay by charging others more. We are all paying now for a system that isn’t working.
One state deals with the problem by requiring insurance but exempting businesses under a certain size. Some require that the person, not the business, obtains coverage but then makes the price of a policy low enough to be affordable; some have lowered the cost by putting all individuals and small groups in a very large risk pool.
And there are many more solutions. The challenge is to put the rhetoric aside and start thinking of solutions. The Senate has put forth a bold plan to deal with the health insurance problem but there is no counter offer out there – and no real discussion of solutions from those opposed to Healthy Wisconsin.
Real solutions require thinking in a bold way – thinking outside the box. In the end, it’s the leaders that are thinking outside the box that are going to succeed.