I've always enjoyed reading Christian Schneider's work. He's a smart commentator, and it didn't surprise me at all when the Wisconsin Policy Research Institute lured him out from behind the puppet
to become one of its more prominent voices.
But I must say that his recent work on the Healthy Wisconsin plan is not among his better stuff.
There are certainly points where someone could critique Healthy WI
, such as its use of affinity groups, its capping of extra payments for fee-for-service coverage, the fact that no HDHP choice exists, etc. But rather than hitting on these substantive points or others like them, Schneider has been tossing out some critiques that are, well, rather superficial.
The first was a post
about how Healthy WI is supposedly going to draw a bunch of free-loading low income people to the state where they'll be able to enjoy publicly-sponsored health care through their job at Dairy Queen.
However, considering most low income families can already get free health care through BadgerCare and virtually all low income individuals would be able to get it through BadgerCare Plus -- a plan that even Republicans are considering
-- the charge that Healthy WI would draw free-loaders to the state comes off as baseless rhetoric. (I offer more about why it's baseless here
Schneider followed up that post with another last week
on how cutting health care spending must inevitably hurt the quality of care, just as cutting a proportionate sum from the UW budget would hurt -- at least in the eyes of Dems -- the quality of higher education in the state.
This argument way oversimplifies the health care market, which is far
more complex than the UW budget. There are multiple layers within the health care market, mostly due to the existence of third party payers, which has created fragmentation that's led to administrative inefficiencies, cost-shifting, overutilization, poor disease management, etc. Restructuring the system as a whole to close these inefficiencies, stop cost-shifting, cut overutilization, etc., does nothing to the quality of health care delivery
except make it more consistent and coordinated.
Indeed, this argument would mean that there's no way to cut health care costs without negatively impacting quality. So that means someone like John Torinus must have wreaked havoc on the quality of care for Serigraph employees when he instituted cost saving measures in recent years. And when the state revamped its health plan, a move that saved millions
, it must have put a major dent in the Cadillac that state employees have been riding. (I can't speak for Serigraph, but I can say that the quality of care received by state employees didn't drop a bit after the system overhaul.)
And now Schneider's latest post
is an attack on Healthy WI via one of the right's favorite, if grossly misleading, points of comparison: the UK. The post deals with the decision by the UK health care board to limit Alzheimer's drugs to later-stage patients due what was determined to be limited cost-effectiveness for early-stage patients.
Using this as an example of rationing, Schneider writes: "While supporters of Wisconsin’s proposed government-run health care system continue to speculate as to how the program will work, they forget that similar programs already exist."
Similar programs? Health care in the UK is entirely controlled by the government -- it owns the payer and it owns all of the providers. No one is proposing anything close to that for Wisconsin. What's being proposed is a coordinated system of private
payers and private
providers, very similar to what state employees have now.
(Side-Note: You want to talk about a lapse in logic, conservatives have made a sport out of deriding the rich "Cadillac" health care benefits enjoyed by state employees for years. Yet, when an offer is made to bring everyone under a similar system with benefits that are virtually as rich as what's currently offered by the state, conservatives attack the offer as a dastardly ploy for more government control that will inevitably make private sector health care worse.)
If conservatives want to pick a point of comparison abroad, the best place to look is probably Germany, which has a publicly-coordinated system of mostly private payers and private providers -- which is financed through an employee/employer payroll assessment -- just as Healthy Wisconsin, the Wisconsin Health Plan, the Healthy Americans Act, and the many other serious reform plans propose for the US.
If there are any allegations of substantial rationing in Germany, those would be far more on point than instances in the UK or Canada. (And, of course, it's always important to consider rationing in other systems in the context of the rationing that already takes place
in the US system.)
In the end, I struggled with whether to center this post on Schneider's commentaries since my preference isn't to single out other voices in such a focused manner. But, similar to my reasons for critiquing John Torinus
, I see Schneider as an important and respectable voice in the political sphere.
And, on the issue of health care, I just think Schneider can do better, and I know the debate itself deserves better.
Labels: health care, healthy wisconsin