No Con Economics

In his August 5^th column in the Appleton Post-Crescent, Christian Schneider argued that voters, similar to politicians, are “willing to say anything to realize their ambitions” and, in particular “to be in charge.” Schneider’s observation suggests that they believe that “might makes right.”  Yet the fundamental purpose of democracy is to ensure that the people’s will–and, one hopes, sound values and principles–matter more than entrenched political power.

Shared values should prevail over the power of privileged groups and self-serving politicians.  Arguments based on shared values and compelling evidence won’t matter, however, if those with power don’t change their decisions. They won’t do so without serious outside pressure.

How does this apply to health care in the Fox Valley? If you like the current state of affairs regarding health care (cost, quality, and access), do nothing; if you don’t, then check out the Fox Valley Health Care Transformation Initiative (www.foxvalleyhealthcare.com) and come to my talk on October 16^th at 7:00 PM in the Wriston Auditorium at Lawrence University.

A well functioning health care marketplace ought to satisfy at least four criteria:  effectiveness, efficiency, equity, and enterprise.  Since medical care receives substantial taxpayer support, including an estimated $705 billion in 2017 for the under 65 non-institutionalized population, in addition to the $702 billion on Medicare[1], the powerful should be accountable for how taxpayer money is spent. Those without employer sponsored insurance or who earn too much income to qualify for Badgercare or subsidies on the federal market exchanges do not benefit from this largesse.

Tax subsidized health plans should provide:

• Only services that improve health (effective).
• The least costly services that improve health (efficient).
• Tax payer support that falls as people’s ability to pay rises (equity).
• Payment and regulatory policy that encourages improved quality and/or reduced cost in the delivery system (enterprise).

The Fox Valley’s two primary health care systems (Ascension and ThedaCare) are neither transparent nor accountable enough to determine whether they deliver on these desired principles. Furthermore, in my opinion, both use their not-for-profit legal status and growing revenue and market dominance to enrich and sustain their own organizations and doctors rather than deliver quality health care affordable to all in the community. Available information[2] – suggests that health care in the Fox Valley is expensive, wasteful, and leaves many people without access to care. Ascension’s and ThedaCare’s executives and boards of trustees have virtually no accountability to this community despite receiving their not-for-profit status from the community and the state of Wisconsin.  For example, financial decision-makers for Ascension no longer reside in the Fox Valley, and ThedaCare has chosen to place almost $100 million of its assets in accounts in the Caribbean beyond the reach of any domestic inquiry.[3]  Ascension has used Fox Valley generated revenue to support their operations in Southeastern Wisconsin.[4]  ThedaCare used some of its treasury to buy out, and remove as a competitor, Fox Valley Hematology and Oncology.

So, what can those of us not in positions of power do?

• Become informed about how healthcare money is spent and what it buys,
• Vote for local legislators and local public officials (such as city and county administrators) who care as much about the population they serve as the employees of the organizations they govern, and
• Choose healthier life styles and cost-effective health care.

If we continue to let those in power abuse its use, the future will look like the past, only worse.  More resources will continue to flow to the medical care community at the expense of education, housing, criminal justice, the environment, transportation, and business development.  Our children and grandchildren will pay for our indulgences.

[1] The Congressional Budget Office and Joint Committee on Taxation estimate the net federal subsidies for the non-institutionalized population under 65 to be $705 billion in 2018  https://www.cbo.gov/publication/53826 and for Medicare see https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/ .

[2] At the state level according to Wallethub ( https://wallethub.com/edu/states-with-best-health-care/23457/) and at the local level according to Citizen Action’s 2018 annual report (http://www.citizenactionwi.org.)

[3] Schedule F from the IRS 990 form https://www.guidestar.org/FinDocuments/2016/391/509/2016-391509362-0eb413b8-9.pdf.

[4] See https://ux.postcrescent.com/story/money/business/health-care/2018/03/02/ascension-wisconsin-begins-another-round-layoffs/390256002/.