First, do no harm

The indispensable Wisconsin Taxpayers Alliance reports that the percentage of Wisconsin residents without health insurance dropped at the same time that the uninsured rate in the U.S. increased between 1999 and 2006:

Despite rising spending, Wisconsin managed to increase its health insurance coverage, in contrast to national trends. In 2006, 15.8% of the U.S. was uninsured, up from 14.0% in 1999. The state’s uninsured rate during that time fell from 9.5% in 1999 to 8.8% in 2006. The state ranked second highest nationally for its low rate—tied with Hawaii and trailing only Rhode Island (8.6%).

Much of the difference in coverage was due to a higher rate of employer-sponsored insurance in Wisconsin, 67.1% compared to 59.7% nationally. In addition to more businesses covering their employees, the state’s expanding health insurance programs helped keep the rate of uninsured low. The BadgerCare program, covering low-income children and their parents, had enrollments rise 254% between 1999 and 2006. And traditional Medicaid for those in poverty or with specific needs saw an 86% increase in enrollments.

This news came in a WTA report with less good news — that Wisconsin per capita health care spending went from 6 percent less than the national average in 1985 to 6.2 percent more than the national average in 2004. The two main contributors to the increase, according to the report, were spending on hospitals (16.2 percent less than the U.S. average in 1985, 8.3 percent more than the average in 2004) and on spending on physician/clinical services (2.8 percent less than the national average in 1985, 12.4 percent more than the average in 2004).

This is, on the whole, more positive than negative for Wisconsin, if you believe reducing the number of uninsured people is more important than health care cost containment. (An NBC News/Wall Street Journal survey from March 2007 on what people viewed as the number one health care priority reported that the two issues are one–two in people’s minds — 38 percent of those surveyed said health care costs, 35 percent said the uninsured.) No one need go without health care, but going without health insurance means that health care for the uninsured usually occurs in hospital emergency rooms, which is not financially efficient. High health care costs affect everyone with insurance, but the reasons for high health care costs certainly include the uninsured population.

This is a more complicated topic than can be delved into in one blog entry. But one point voters should think about in November is that we should not want a cure for our health insurance problems that is worse than the disease. Hillary Clinton’s health care plan would require that all Americans purchase insurance, something Sen. John Kerry (D–Massachusetts) is a “nonstarter” in the Senate. Barack Obama’s plan would mandate coverage only for children, and would extend federal subsidies for those who fall through the crack between not being able to afford health insurance and not qualifying for government programs, in part by forcing employers to either provide health insurance to employees or pay a percentage of payroll toward government programs. John McCain’s plan is based more on cost control through more consumer choice, including a $2,500 tax credit ($5,000 for families) to promote purchasing health insurance. (Compare the three plans HERE.)

The “worse than the disease” rule also applies to Healthy Wisconsin, the plan that insists that higher taxes on business and unemployment for tens of thousands of health insurance industry employees in Wisconsin is the price we must pay to fix the problems in our health care system. (As a capitalist, I prefer paying health insurance premiums to insurance companies — who employ people, pay dividends to shareholders and reinvest their profits — to increased taxes, and it’s impossible for me to understand why business people would feel differently.)

There’s a real contradiction between how people feel about the health care system and how people feel about their own health care. A Kaiser Family Foundation poll in 2006 came up with these results:

• 54 percent of people were dissatisfied with the quality of health care in this country.
• 89 percent of people were satisfied with the quality of their own health care.
• 80 percent were dissatisfied with the cost of health care in this country.
• 57 percent were satisfied with the cost of their own health care.
• 56 percent would prefer a completely government-run health care system to the current health care system.
• The percentage of people who would still prefer government-run health care dropped to: 35 percent if such a system meant higher taxes or premiums for them, 33 percent if a government-run system meant waiting lists for non-emergency treatments, 29 percent if their choices in doctors were limited, and 18 percent if some treatments covered by the current system wouldn’t be covered in a government-run system.
  

This is what I mean by “first, do no harm.” These poll results have been similar ever since health care and health insurance became a big campaign issue for politicians in the early 1990s. There is a real disconnect between what people think is going on in health care nationally and their own health care experiences, based on polls like this one. I’m not sure why that is, but the lesson here is to avoid like the plague any health care or health insurance reform proposal that makes things worse for the majority of people who are in fact satisfied with their own health care.