Op Ed

Evers, GOP Leaders Need Health Care Ideas

They could learn from local experts like Albrecht Free Clinic in West Bend.

By - Feb 5th, 2019 02:01 pm
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Tony Evers, Robin Vos and Scott Fitzgerald.

Tony Evers, Robin Vos and Scott Fitzgerald.

Down at the ground level, here at the Albrecht Free Clinic (AFC) in West Bend, it is blatantly obvious that our political leaders need to do some fresh thinking on the delivery of care for Americans who are uninsured or under-insured. 

The clinic treats hundreds of people who can’t afford care elsewhere, including people on Medicaid. Patients in Washington County who are living at less than 200% of the federal poverty level are eligible. 

Here’s the major rubs: 

*It’s the high costs of care that are the underlying issue for driving up premiums by at least 5% per year and often more on state exchanges. 

* The uninsured rate in the country jumped to 13.7% in the fourth quarter, up from a low of 10.9% in 2016. 

* Dentists in the county and some doctors will not treat people eligible for Medicaid, because Medicaid payments are not enough to cover the basic cost of care, much less make a buck. 

So, the clinic has stepped up. It has been in operation for 22 years for medical care and added dental services about three years ago. The clinic can only operate because of donations and because doctors, dentists and their staffs typically donate four to eight hours a month of their time. It has recruited 56 medical volunteers, 26 dental volunteers and 47 non-medical. 

It saw more than 450 patients in 2018 for medical issues and more than 300 for dentistry. 

Obviously, if the cost and price structure of medical care were less outrageous, there would not be that kind of demand for free care. 

Meanwhile, over in Madison Gov. Tony Evers has focused on expanding Medicaid with mostly federal dollars, knowing that the Republican legislative leaders, Speaker Robin Vos and Senate Majority Leader Scott Fitzgerald, will not go along. The governor is also sending confusing messages about how to remove the state from law suit to torpedo Obamacare, with Vos and Fitzgerald standing pat. 

It’s the same partisan debate that has been going on since Obamacare passed in 2011. The thinking of this timid trio is in a rut. What’s missing at their level is the kind of problem solving that is going on at the Albrecht Free Clinic.

Why don’t Evers, Vos and Fitzgerald pull in the smartest innovators for delivery of care – there are many in Wisconsin – and come up with a better model? 

For example, we know from QuadMed and other on-site or near-site providers in Wisconsin that proactive primary care sharply reduces costs by keeping employees out of expensive hospitals. Why not build a medical home into every health plan? 

We know that Medicare is better managed than Medicaid, so why would Evers not ask for a federal waiver to use the Medicare platform to deliver care to the poor. Better yet, use Medicare Advantage that almost 40% of Medicare recipients have switched to. It offers more choices of services because of competition among health insurers.

We know that fixed, bundled prices (no more than $3,000 for a colonoscopy or $30,000 for a joint replacement) save 40% or more on elective procedures. Why not build bundled prices at top quality hospitals into the pricing structures of public health plans? That’s what Walmart does for its employees. 

Why not promote lean disciplines in the Medical Industrial Complex as has been done in several hospital systems in the state. These are the same disciplines that have made American manufacturers competitive with suppliers from low labor cost countries. 

I have said many times that fixing the disaster on the economic side of U.S. health care is more about management science than political science. It’s about problem solving.

An example at the local level is what Dr. Robert Gibson, AFC volunteer medical director, is doing to stem the opioid crisis in Washington County. “For patients without insurance who can’t afford a month Vivitrol injection that costs up to $1,000, the clinic has been able to help,“ he said to describe his Medically Assisted Treatment program.

Dr. Thomas Albiero, the volunteer AFC dental director, is finding ways and funds for 30 people who need dentures at $1,000 apiece. “We love to see patients smiling again and having the confidence to attain or keep gainful employment.”

To break out of their rigid partisan mindset, Evers, Vos and Fitzgerald should make a joint trip to the Albrecht Free Clinic, where problems are being solved, not debated for political gain.

John Torinus is the chairman of Serigraph Inc. and a former Milwaukee Sentinel business editor who blogs regularly at johntorinus.com.

Categories: Health, Op-Ed, Politics

2 thoughts on “Op Ed: Evers, GOP Leaders Need Health Care Ideas”

  1. mkwagner says:

    It is good to see John Torinus beginning to appreciate the complexity of healthcare reform, a little late. However, his ideas for reform are dated and don’t address the depth of the problem. He seems to reject Gov. Evers (and I might add, the voters) demands for accepting the Medicaid expansion money. Does he realize that reducing the uninsured rate substantially will reduce the upward spiral of yearly cost increases for everyone? That is one step, not the whole solution. Ensuring affordable coverage for those with pre-existing conditions and eliminating the life-time maximum benefits as well as numerous other components that pushed (and incentivized) care providers and insurers to shift from our current disease management model to the proactive preventive care model, John touted. these incentives were the components of the ACA Republicans refused to fund, calling them onerous and needlessly expensive. Of course they were onerous, change is hard and expensive. That same can be said of John Torinus’ idea of opening wellness clinics.

    There are 2 critical facts of which John appears ignorant: (1) over the next 10 years, healthcare in this country will costs is projected to reach $50 trillion or more. We spend more on healthcare than any other developed nation. For all the money we spend, we have poorer outcomes: higher rates of infant mortality, cancer, diabetes and heart disease as well as a shorter life span.

    (2) The Affordable Care Act is based on a plan developed by the Harvest Institute, initially proposed to Congress by Charles Grassley during the healthcare debate in the Clinton administration. The plan was the basis of healthcare reform implemented in Massachusetts under Mit Romney’s governorship. Republican opposition has more to do with their racist pledge to defeat every proposal of the Obama administration. That’s why they have been unable to come up with a workable alternate plan.

    I wish that we could just accept that the Reagan administration’s experiment to push healthcare into our capitalist marketplace was at best naive and at worst, a disaster. Instead of controlling costs, this experiment sent our healthcare into a spiral of increased costs and decreasing accessibility. Unfortunately for the residents of Wisconsin, as a result of the racist policies of our Republican governor and legislature, we bare the brunt of their costly decisions.

  2. Alan Bartelme says:

    John assumes that Vos and Fitzgerald want to solve the problem. They do not. If they did, why didn’t they do anything for the past 8 years when they could have implemented their Republican Utopian solution with Walker?

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