When I was a Congressional staffer during the early 1990s national health care debate, one of my peers was on the Clinton Task Force. She told me then what most in the industry will tell you now: if we could all eat right and exercise, never break a leg, and eliminate our bad genes or family history of disease, we could cut over half of our current health care costs.
Add into the mix, a clumsy American process for "end of life" decisions, and you get a whopper. Not the sandwich, though that might harm you too, but the majority of long-term health care costs – the stuff that moves the economic demand curve permanently upward – are caused by things we either choose to not deal with or things we have no control over.
Now sit tight everyone. Because if you regularly read the John Torinus business column in the Milwaukee Journal Sentinel, you might be fooled into believing there is some government conspiracy brewing in Madison to take a bad situation and make it worse.
And, big surprise, the last two columns from Torinus have trashed a plan to cover every Wisconsin resident and restrain the growth in costs that are forcing people to drop coverage, stay in crummy jobs, and/or eat up a larger and larger share of their paycheck (or credit card debt) just to keep themselves alive and healthy!
Argh, never mind such hardship. According to some, survival of the fittest is in full force. Consumer-driven health care is what the 1980s brought to the American worker, coupled with a national political movement toward what’s been called the devolution of the federal government – the Reagan Revolution.
What those genius chapters in American history have delivered is actually quite tragic and devastating. We now can boast the largest ever divide between the haves and have-nots and a nation increasingly unable to handle even the most basic crisis of the 21st century: roads, schools, rivers and bridges are rotting; health care and energy costs are sky-high with the burden hitting the working class and senior citizens the hardest; and an overarching moral crisis of national identity and distrust of public institutions.
What Bush, Reagan and John Torinus have in common is a never-ending love for lecturing us all about the power of markets, how consumer choice will save us from big government, and how there is zero connection between the consumerism they peddle and the resulting nation of lazy, overweight kids playing video games, low-income workers eating lunch at the drive-thru, or seniors living their last years in the fear, confusion and scam-fest known as entering into a nursing home.
So you see, the "business community" wants everyone to start acting like health care consumers, like we are consumers of other products and services in a market economy. But is taking care of diabetes or depression, the same as buying a dishwasher? Is falling down the stairs the same as buying a pair of shoes?
Here’s the kicker though: the same "consumer in driver’s seat" mindset is exactly the kind of "business knows best" garbage that we were fed during the 1980s. Back then, the political landscape was different. Iranian hostages were just freed by Reagan, federal budget deficits were for the first time doubling every year, and state/local governments were being required to pick up more and more of the bill for public services. At least gas prices were cheap.
Another component of the new Federalism was less popular over the last 25 years, but the "don’t trust government" crowd has tried at every chance they get: eliminate the New Deal-inspired programs of Social Security, Unemployment and Worker’s Compensation (all three programs were born in Wisconsin), and starve the living daylights out of Medicaid and Medicare health care programs to avert European or Canadian-style "socialized medicine."
Back in the efficient and all-knowing private sector, we were greeted with another byproduct of the big thinkers of that age: HMOs. If anyone has an old newspaper around, they might remember employers dropping traditional insurance plans for workers and retirees in favor of health maintenance organizations (along the same time pensions were dropped for 401k plans). HMO is a buzzkill, so now we use words like "consumer-empowerment" or "managed care" or my favorite, "health savings accounts." That feels better now doesn’t it?
HMOs were set-up to incorporate a fiscal and physical gatekeeper known as your primary care doctor. Charitable hospitals, usually run by religious groups, would shift from "not-for-profits" to business models that actually parallel that of a massive, for-profit corporation. And good old-fashioned insurance firms, like Blue Cross Blue Shield, would need to keep up with the times and join the for-profit movement so they can "invest in life-saving and quality improvements … blah blah blah."
So thanks to these trends, we now have some of the highest health care costs in the world, yet we collectively as a society are getting sicker. Specialized doctors, expensive technology and drugs, hospital systems that keep building and building new and more expensive facilities, and a fragmented primary care system characterize this awful lifestyle choice.
Yes, I said choice. We have already chosen the route that Torinus and his buddies want us to embrace now. It not only has failed, it has (like New Federalism) put states like Wisconsin at a competitive disadvantage with other states and other nations in the world. It is how one explains spending nearly twice per capita on health care services and still having high rates of infant mortality, widespread chronic yet preventable disease, and people who are middle class or working class feeling economic insecurity that rivals the 1930s.
That’s why Democrats are working on health care reform, that’s one of the reasons I chose public service as a job and it’s why I don’t sleep well at night sometimes. God did not put us on this planet to just enjoy or entertain ourselves, that is… to "consume."
And our nation did not get built to just replicate a colonial mindset that some people deserve better outcomes in life because of their blood line, regardless of work ethic or moral compass. No, we in America want better. And if I can purchase a quality health care plan with the dollars paid for by the people that I serve … then so should they!
Representative Josh Zepnick is a Democrat representing the Ninth Assembly District on Milwaukee’s south side.
