Our Superficial Public Policymaking

Considering it stands virtually no chance of going anywhere, State Senator Roger Breske (D-Eland) has received a pretty good amount of press (here and here) for his plan to introduce standalone legislation to bring back the hospital assessment.

In his press release, Breske notes the oddness of including a transfer from the patient compensation fund in the budget but not the hospital assessment that would generate millions more in matching federal dollars than it would cost. It would be interesting if his legislation actually includes a provision to dump the patient fund transfer.

Granted, I don't think dumping the transfer would make the bill any more palatable to the GOP Assembly, which is interesting considering how Republicans have gone after Doyle for segregated fund transfers in the past and how much attention the right has given to medical malpractice suits when it comes to rising health care costs.

To be sure, while the patient fund has had an average annual surplus of $130 million over the past two decades, it's been pointed out that a surplus is necessary to keep premium rates down.

As the Journal Sentinel noted yesterday regarding the patient fund transfer, "pulling $200 million from the fund will mean higher premiums going forward." And, as conservatives love to point out, those types of costs on businesses just get passed along to consumers in the form of higher costs.

Yet, in spite of all of this, the GOP leadership agreed to the patient fund transfer relatively early in the negotiation process -- about a month ago, to be exact -- while absolutely refusing to budge on the hospital assessment that would generate more funds than it would require, leading some health systems to pledge to lower health care costs if it was implemented.

This is the result of the budget process becoming about a final overall figure rather than what makes the most sense for the state.

The hospital assessment fell into the $1.7 billion figure Republicans were denouncing since February, and reducing that amount became the goal, which meant that the hospital assessment had to go, especially if the politically safe cigarette tax was going to be the one big tax that was allowed to stay.

The patient fund transfer, conversely, wasn't part of the $1.7 billion, so it wasn't as big of a problem if it stayed, even if it actually does what Republicans wrongly, for the most part, claimed the hospital assessment would do -- increase health care costs.

It's amazing, and quite sad, that the word "tax" is allowed, without much or any consideration for the actual effect, to have such a hold on public policymaking in the state.

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SIDE-NOTE: Just to clarify, I do think the patient fund transfer is a poor public policy choice, but that's separate from the issue of increasing funds for state health care initiatives, which is what the transfer is intended to do. Increasing those funds is a reasonable goal that is worthy of debate, but doing so through a transfer from a segregated fund -- particularly one that isn't funded by public dollars -- is unwise and should be unnecessary.

I don't mean to suggest in this post that it's the job of Republicans to reject a move like the fund transfer -- it shouldn't have been proposed in the first place -- but it is interesting to examine why the transfer wasn't given much or any resistance, while the far more sensible hospital assessment was somehow a deal breaker.

UPDATE: Check out the Recess Supervisor's excellent and interesting take on the Breske bill.