Critiquing Healthy Wisconsin: Where's the Substance?

Conservatives were up in arms yesterday over the announcement of the Healthy Wisconsin initiative.

The Senate GOP had the fear-mongering in full effect with a press release stating that pregnant women, children, and seniors could lose access to their doctor under the initiative, while others focused on using politically-charged soundbites like "big government" and "socialized medicine" to generate alarm over the proposal.

There was little to no substance in any of these attacks. That doesn't mean, however, there are no substantive challenges that could be made to the Healthy Wisconsin initiative.

Here are a couple of points conservatives -- and liberals -- might want to try on if they're interested in a substantive discussion on health care reform.

The Deductible
If free marketers usually get one thing right and progressives usually get one thing wrong about health care reform it's that over-utilization of health care services is a serious problem. Some of this over-utilization is on the provider end -- for instance, utilizing unnecessary treatments and tests to generate more reimbursements -- but much of it is on the patient end.

Providing incentives for consumers to use health care wisely and consciously is an important piece of any universal health care reform plan. The Healthy Wisconsin initiative does this through its use of a $300 deductible for individuals and a $600 deductible for families. Aside from care of children and pregnant women, along with proven preventive care measures, other services under the proposal would be subject to the deductible.

It's good that the Healthy Wisconsin proposal involves cost-sharing through a deductible, co-pays, and co-insurance, but why not raise the deductible and include a HSA, which would make the plan virtually identical to the well-vetted Wisconsin Health Plan?

That way, if a portion of the deductible was state-funded through the HSA, it would give consumers some breathing room knowing that the first non-preventive treatment they receive won't be coming out of their regular bank account. Yet, since it still would be coming out of their HSA, the financial disincentive for over-utilization would remain.

Plus, then there's the added bonus of having a tax-sheltered account that could be self-funded (or employer-funded) to cover the remaining portion of the deductible or other cost-sharing, or rolled over from year to year to prepare for the more expensive catosphrophic or chronic care that could be needed in the future.

Special Affinity Groups
There is a clause in the Healthy Wisconsin bill that would allow health networks to restrict access to participants who are part of certain pre-defined "special affinity groups," such as farmers or teachers.

Part of the purpose of fundamental health care reform is to put everyone in the same boat when it comes to health benefits. This is important for practical purposes, such as community rating, but it's also important for conveying trust to the public that the system is equitable. Siphoning off a portion of the population works against this trust and -- to an extent -- the viability of community rating.

Perhaps there's a good practical reason to restrict particular health networks to a certain trade group, but I'm not seeing it on the surface. This is one point that Dems should explain in more detail.

The Healthy Wisconsin initiative -- in spite of likely being added to the Senate version of the budget today -- is very much a work in progress. The time now is much better spent parsing the substantive points of it rather than clinging to divisive and hyperbolic soundbites.

UPDATE: You can see a more reader-friendly detailed account of the Healthy Wisconsin plan here.