To Improve the Health of the Community

The Appleton Post-Crescent has invited me to be a guest columnist.  This means that I can submit a column roughly every three months.  My first contribution was published online Friday, March 9th and appears below.

Nonprofit health care organizations, such as ThedaCare and Ascension, exist to serve their local communities. Their nonprofit status gives them both benefits and responsibilities. The benefits include exemption from local and state taxes, a polite way of saying that our taxes go up so that they pay nothing. Their responsibilities, as stated by Dr. Imran Andrabi (president and CEO of ThedaCare) in his Feb. 25 column, include using ThedaCare’s resources “to improve the health of the communities” they serve.

Improving the community’s health means more, however, than adding the latest medical equipment. It should be broadly interpreted to include making health care affordable for everyone in the Fox Valley.  The United Way’s most recent ALICE (Asset Limited Income, Constrained, Employed) Report found that 42 percent of Wisconsin households cannot afford to pay for basic necessities. Over the past decade, Fox Valley household income growth was essentially stagnant while medical expenses grew by over 50 percent. Inability to pay medical bills has become the largest contributor to increased household bankruptcies.

Health insurance should prevent this. But for many, health insurance — and health care itself — has become unaffordable. Those who get no subsidies when buying individual health insurance often face high double-digit premium increases for bare-bones high deductible policies. Even those with Medicaid, Medicare, or employer sponsored insurance can’t escape increased hardship in the form of reduced access to caremarkedly higher out-of-pocket expenses or increased premium share.

This unsustainable trend requires nonprofit health care organizations and their boards of trustees to meet their fiduciary responsibility to offer services at affordable prices. Yet the services offered by ThedaCare and Ascension don’t come close to being affordable.

If a couple with household income of $65,000 or higher wants to purchase insurance in the non-group market, the annual premium is almost $22,000 to purchase a Bronze level plan that requires each person to meet $7,300 out-of-pocket deductible payments before insurance begins to pay the bills. The premium plus out-of-pocket expenses easily rises to more than the couple pays each year for housing or food.

Dr. Andrabi correctly opines that both cost and quality objectives can be achieved. But if ThedaCare and Ascension are to fulfill their mission of improving the health of the community, they must deliver affordable health care and allocate resources to services that can be shown to improve health. This requires communicating with informed members of the public in a transparent way, not just delivering public statements written in secret. We’ve been told that it would be “inappropriate” for ThedaCare board members to speak with or even listen to us. That’s neither communication nor transparency. That’s silence and mystery.</p>

For many reasons, the share of our income claimed for medical services has increased dramatically. These include unnecessary care, cost-ineffective care, and high medical care prices due to increased consolidation and provider pricing power.

The Fox Valley Health Care Transformation Initiative seeks to disrupt these destructive and unsustainable trends. It targets local health system accountability in two ways: 1) development of a public sector-based purchasing cooperative as a countervailing market force to health systems consolidation, and 2) direct communication to the boards of ThedaCare and Ascension regarding the unaffordability of medical care in the Fox Valley.

We can’t wait for politicians in Washington or Madison to solve our inefficient and inequitable health care system or for more decision-making to be moved out of the Fox Valley. It’s time to implement that adage “think globally, but act locally.” Visit to learn more and then share your insights with others.

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