I have been invited to respond to calls for a single payer health system as envisioned by Sen. Mark Miller’s Wisconsin Health Security Act (SB 51). Thank you for the opportunity, but real debate of a complex issue cannot be confined to a 650 word column or one of the many 20-minute forums the Miller camp has staged throughout the state in recent months.
I will do what I can in the space allowed.
Full disclosure: I am an independent health insurance broker. Along with 20,000 members of the National Association of Health Underwriters, my peers and I help more than 100 million Americans afford the expensive miracles performed every day by health care professionals. I know quite a lot about the financing of health care; I know very little about the delivery of health care.
Those that advocate for a government-run health system postulate eliminating insurers’ egregious profits and wasteful administrative costs will more than offset the cost of bringing some 45 million uninsured into a mandatory one size fits all system. Rubbish!
As reported by the Centers for Medicare and Medicaid Services (CMS), private health insurance administrative costs nationwide average 14.1 percent of premiums paid; factoring out taxes and other assessments, the figure drops to 9.9 percent – not the 30 percent or more often cited. A related observation: when I quote comparable health plans with a Wisconsin-based not-for-profit insurer, they are often the same or a little higher than those of the largest for-profit national insurer. Is it possible markets create such a result? Who will drive efficiency and innovation in a government-run monopoly?!
We all know the status quo is unsustainable. Is there any doubt the private sector is on the cusp of breakthroughs in information technology that will even further reduce the cost of financing and administering health care. So, let’s look at where 85 to 88 percent of every health care dollar is being spent to see opportunities for real reform.
That brings us to consumerism; most notably high deductible health plans (HDHP) coupled with health saving accounts. We Americans want to control our own destiny. Those who hated HMOs would like "Big Brother Health" even less. HDHPs are merely a way to take ownership over our health while at the same time making coverage choices for all more affordable. With premiums 35 to 40 percent lower than first dollar co-pay plans, this real savings – unlike overstated administrative costs – makes coverage far more affordable.
Properly set up, higher out-of-pocket costs at the time of claim are offset by the premium reduction with one big difference; if you don’t use the more expensive first dollar co–pay plan, does the insurer send you a refund? (Now come on: I’m advocating a true insurance product that costs one-third less – everyone I talk to loves the idea of giving insurers less premium!) As for that canard about putting off routine care, virtually all HDHPs cover wellness at 100 percent (not subject to a deductible or co-pay).
Literally millions of Americans have bought into this concept, and the effect on the delivery of health care has been profound. For example, it is not a coincidence that everyone is talking about wellness. Or that providers are sharing information on price and quality transparency.
Consumerism is chipping away at the status quo. And the pace of change will only accelerate.
I beg those serious about this "debate" to read "Your Health Matters: What You Need To Know About U.S. Health Care," authored by Greg Dattilo and Dave Racer (Alethos Press). This carefully documented book sets straight three myths about Canadian style health care that have been repeated so often they are mistaken for fact: to wit, under a single payer system, everyone has access, it costs less and outcomes are better. The truth may literally save your life!
Jon Rauser is president of The Rauser Agency Inc., Milwaukee.
