November/December 2006

On the Ground with...

Rep. Curt Gielow (R-Mequon)

interview by Bob Jacobson

Rep. Curt Gielow is co-sponsor of AB-1140, the Wisconsin Health Plan. This bipartisan plan was developed by Rep. Gielow in partnership with Rep. Jon Richards (D-Milwaukee), former state budget director David Riemer, and Lisa Ellinger, a former policy advisor to Gov. Doyle. Riemer and Ellinger are currently director and assistant director respectively of the Wisconsin Health Project, a nonprofit organization created in 2004 to address the twin problems of dramatic increases in health care costs and growth in the state's uninsured population. The Plan, which would be administered by a private, nonprofit coporation, would cover all Wisconsin residents under age 65, with a few exceptions. It aims to create an effective purchasing pool and incorporates “consumer driven” incentives to, hopefully, drive down health care costs and promote health care quality. Participants would be able to choose coverage from a menu of care providers -- including their current physician -- who are already operating in the state. For more information on the Wisconsin Health Plan, visit http://www.wisconsinhealthplan.org. 

BJ: Historically, Wisconsin has done quite well in ensuring that a high percentage of state residents have access to health care. And yet in recent years we've seen the number of people without health insurance growing. Why do you think that's happening?

Rep. Curt Gielow

CG: I think the number of uninsured is related in some part to the economy, but in large part to the fact that health insurance has become unaffordable, and many people have chosen to be uninsured because they don't want to spend that much money. The uninsured population in Wisconsin, which is estimated at about half a million people, or just under 10 percent of our population, is believed to be those who are truly uninsured and don't have access to it at all. And then there's a segment of that population who are the "young invincibles," who say it's expensive and I'm just not going to buy it. That's risky. As we know, in this country everybody can get health care by showing up in an emergency room, but that's not the right way to do it and it's the expensive way to do it. But I think the most significant growth in the uninsured is related to fact that more and more people simply can't afford health insurance.

What do you think is driving the skyrocketing cost of health insurance, and how is that related to the solutions that have been proposed?

Health care is a big black box that most people don't understand. It's a perverse industry in that it doesn't respond to supply and demand as other industries do. It works backwards. The more supply there is--for example when you build another hospital--the cost goes up instead of down. Another thing that I personally attribute this to is that years ago the insurance companies invented products that made it financially painless to go to the doctor or the pharmacy, and therefore gave you the ability to overutilize the system without a lot of financial pain. Utilization went up, because we've completely removed the patient, or the customer, from the cost. It's the only industry where you buy the product and you have no idea what it costs and you really don't pay for it yourself, and you really don't know how it got paid. And any time the consumer is removed from the business and a third party is interceding--in this case the insurance company--they can do whatever they want with pricing, and the end result is that the consumer continues to see an increasingly expensive insurance premium. In this country we have a workforce-focused insurance scheme, so employers take the brunt of that. Employees are paying an increasing share recently, but they're still sheltered to some degree. So my contention is that the consumer needs to get on top of this formula, and the consumer needs to know how health care is bought and paid for and what it costs, and they need to then make intelligent decisions about utilizing it. Maybe you don't go the doctor for a cough, but you go buy a bottle of Robitussin. I'm not suggesting that you don't get health care when you need it, but that overutilization is what's driving up the cost. There are other issues in addition. Technology is driving the cost. Aging America is driving the cost. We're now living longer, and we've got drugs and devices that are keeping us alive through things that we used to die from. And we have replaceable parts. So all of these things come together to cause health care costs to rise.

You've pointed to a complex array of factors that feed into each other, but it seems that from your perspective the central issues have to do with the combination of empowering consumers and holding them more accountable for their own health care. How does your proposed solution address these issues?

As you know, I'm co-sponsor of something called the Wisconsin Health Plan, which is trying to bring some private sector approaches to this issue, but is also acknowledging that insurance for everybody is a good idea, because everybody gets health care anyway; they just get it in the wrong place at the wrong time for the wrong price. So giving everybody some kind of basic health insurance is a good idea. If you believe that, then you can stop all the cost shifting that results in those who have insurance paying for those who don't have it; we have to raise your premiums because I don't have any insurance, and when my health care costs are eaten by the hospital, they simply stick it to you in your premiums. So we can eliminate that cost shifting by insuring everybody. If you buy into that idea, then the question becomes how to do that, and how to slow the overutilization by educating people about how to be good health care consumers. That's a real challenge because people have traditionally placed their doctors and caregivers on a pedestals and have not asked questions about the kind of care they're getting. It's whatever you tell me to do, doctor, I'll do, because insurance will cover it. I think we've got to take a little more assertive role as consumers, but that means getting educated. That's another challenge, because when you're in a clinical environment with a lot of lingo, there are a lot of people who are not going to feel confident conversing with a physician about complicated matters related to their own health. I believe that dialog has to happen. Knocking caregivers off of pedestals and challenging them is important.

However, this takes a commitment to the philosophy of the common good. I feel that as a society, we've been losing interest in the common good, and have gone to a "me, me, me" society. And I'm concerned about that. You see it in school referendums, where people vote no because "my kids are not in school anymore, so now it's your turn to pay." It didn't used to be that way. People used to understand that education for everybody is a common good. I don't see that commitment to the common good in education anymore, and I fear that it's missing in health care. My plan is a work in progress. It's not an end product; it was intended to keep the debate on the table, about how we could structure this differently. For the last year and a half to two years, it has generated a debate. A lot of people don't like it, a lot of people do like it, but at least they're talking.

To some of us, the notion of insuring everybody is a no-brainer, and it's just a question of how to pay for it and administer it. When you package it in such a way that it's largely market-driven rather than a huge government program, you would think that would make it palatable to a pretty wide range of folks. And yet it seems to be incredibly slow going getting ANY type of broad coverage plan into place. What's stopping it? What are the big obstacles that the plan is running into?

I think the history of universal health care has not been good. And yet we look around the world and we see that our health care in this country costs twice as much as everywhere else, and our infant mortality and other outcomes are not any better, in fact they're worse than a lot of places. But other countries do it kind of on a rationing system, and that's not going to work in the United States. I don't have a right answer for what you've just asked. I think maybe those of us who see it more clearly expect that everybody ought to see it that clearly and that this ought to be a slam dunk. I think that with the polarization and partisanism that we have in America, which have gotten worse, if one side says it's good, the other side automatically says it's bad. I think we've got to shed some of those partisan biases. Health care ought to be an apolitical issue. We need to get to the table and talk about what makes good public health policy. I would hope that I was at least beginning a debate that went in that direction. The reason it's been slow is that there are some recalcitrant partisan people who believe there are some dirty words in that sentence about universal health care for all, and in their minds consequently it can't be good. I don't want to be stopped by those people. I want us all to come to the table and at least talk about what is for the common good and not kill the debate just because of our partisan positions. I'm disappointed, but I knew going in that this was a slow boat and we weren't going to speed across this gap. I believe the solution to health care from an insurance standpoint is probably a 70 percent solution, meaning that because it's political, both parties have to dislike 30 percent of the solution. They can agree on most of it and hold there nose on the rest. We need something that is equally distasteful to both parties in order for it to be successful. I'd like to find that middle ground.

If people have an opinion on this, they need to let their legislators know. I don't think there's enough political pressure on either party to convince them that they have to do something. I don't think the pressure is hard enough on the Republicans to get beyond our ideas about consumer-driven reform and health savings plans. Those are good ideas, but they're not enough. On the Democratic side, they need to go beyond big government as the answer. So that's why I thought the Wisconsin Heath Plan was a legitimate middle ground. I just want to urge people to keep the debate going.