Rep. Gregg Underheim (R - Oshkosh)
commented on my last post, specifically my quip regarding the Republican health care agenda. You should all read his comments before proceeding. Underheim knows what he's talking about, and I'm flattered that he took the time to share his thoughts. He knows his stuff.
Underheim is right on the money when it comes to improving transparency in the health care system. Where else do we routinely purchase goods or services without having any idea what the cost is?
However, I would respectfully ask the Representative the following question. If you thumb through the newspapers, what is your leadership pushing hardest: health savings accounts, medical malpractice caps, or the transparency agenda? Unfortunately, the most significant element of the plan is often completely forgotten by legislative leaders, in part because it doesn't rack up as many points with special interest groups.
I looked through the January and February press releases on Dick Wheeler's
website. Guess how many Republican releases I found specifically regarding health care legislation?
One. It's a "kitchen table priority" for Senate Republicans, whatever that means. It also made the Assembly Spring Agenda
release sent out in Green Bay. Mind you, it was listed below the Taxpayer Protection Amendment and another tax giveaway to businesses. Perhaps that indicates where the caucus' priorities are. If Republicans are really accomplishing something meaningful on health care, why aren't more of Underheim's colleagues talking about the issue?
While Underheim is correct to point out that there are market-driven improvements that should be made in order to increase transparency and restrain the growth of medical expenses, we should also recognize three facts:
1. There will always be individuals in any market-driven system that are unable to afford preventative medicine
2. Preventative medicine is cheaper than catastrophic medicine
3. Our government has already made a commitment to take care of many catastrophic medical expenses for the poor and the elderly.
You can think what you want about number 3, but it's not going to change anytime soon. And with that in mind, it makes infinitely more sense for the government to invest in number 2 for those individuals that fall under number 1. Programs like BadgerCare require investment now but save the state money in the long run.
I am a huge advocate of consumption taxes, so I have no problem with the concept of a tax-free health savings account. Hell, I'd prefer all savings be tax-free. But it is fundamentally misguided for Republicans to suggest that HSA's will somehow be a Godsend to the uninsured.
HSA's only work for people that actually have money left at the end of the month. For most lower and lower-middle income families, an HSA is absolutely worthless because there's no money left to save. Even an employer match into the HSA does little for them since they've got nothing to put up against the employer's funds. HSA's are fine, but let's be honest about what they do and what they don't do. They do virtually nothing to make health care affordable to those who can't access the system in the first place.
Medical malpractice lawsuits make up such an insignificant portion of health care costs as a whole that, in aggregate, it's hardly going to make a dime's worth of difference to consumers if monetary caps are in place. Unfortunately, lots of the rhetoric in this debate is nothing more than talking points from doctors and trial lawyers, two groups a little too vested in the issue to be trusted. In the studies I've read, it seems as though there is some correlation between malpractice premiums and availability of health care in rural areas. But surely there are other ways that government can ameliorate that situation other than a misguided, one-size-fits-all, we-know-better-than-a-jury approach to malpractice verdicts.
Ultimately, real reform requires everyone to acknowledge that our country is unlikely to stray from its blended system of health care delivery anytime soon. We're never going to get government out of the business of paying for health care for some Americans. We're also unlikely to move to a single-payer system to health care.
What we need to move this debate forward are more legislators like Underheim, guys who do their homework, ask good questions, value debate, and want to get things done. It's unfortunate that those qualities aren't as valued in politics as they should be. Leaders on both sides shoulder responsibility for the acerbic environment that promotes screaming and shouting from the peanut gallery of their caucuses instead of listening to the reasonable minds in their midst.
Underheim is leaving the Legislature at the end of the year, and that's a huge loss for Wisconsin. He's one of the good guys in a day when the good guys are becoming harder and harder to find. Wisconsin is better off for his service, and his presence under the dome will be sorely missed.