Kanavas's Revisionist History

by folkbum

Well, it's not just revisionist history; it's also a repeat of a lot of the same lies and scare tactics that we're hearing from the GOP generally, including Wisconsin's Rep. Paul Ryan.

State Sen. Kanavas (R-Brookfield) has a blog, and on that blog he has a post--a post about health care reform efforts past and present. And Kanavas gets almost every detail in his post wrong. He starts this way:

We are all very familiar with the health care debate raging in our nation’s capitol and in town hall meetings across the country. The issue of whether or not the federal government should grab control of our current system and create its own socialized brand of medicine has been making national headlines for months.

If today is not your first day here at my blog, then you already know what's wrong here. There is no effort underway in Washington to "grab control" of the current health care delivery or insurance industry. The ubiquitous HR3200 has no such provisions, nor does anything coming out of the Senate. The White House's principals for reform are nothing like that, either. Current proposals are far from "socialized medicine"; if we rated HR3200 on a scale from 1-10 where 1 is what we have now and 10 is the UK, where they really do have socialized medicine, HR3200 would score a solid 1, still.

But, I wonder how many people remember what happened right here in Wisconsin just two years ago. [. . .] Democrats in the Wisconsin legislature were running around the state holding public hearings touting an Obama-like government-run health care plan. For the most part, no one really knew anything about it. You may vaguely remember they had a plan, but folks are sure to be soft on the details and likely know little of the plan’s potential impact on our economy or the size of state government.

The first sentence of that excerpt from Kanavas contains no factual errors, but the rest is just awful. For one, none of the current proposals for health insurance reform are from President Obama; to suggest that anything is "Obama-like" is kind of weird. (As is calling reform plans written by and introduce in Congress "Obamacare." "Hillarycare" was not a misnomer--her commission wrote the plan sent to Congress--but Obama is the author of nothing.) Further, the plan passed by the state Senate in 2007 was not "government-run health care," as nothing in that plan, called Healthy Wisconsin, was about the state providing the care, running the hospitals and clinics, or employing the doctors and nurses.

Kanavas continues to err when he says that no one knew anything about the plan. Healthy Wisconsin was modeled on something called the Wisconsin Health Plan, which had been circulated for two years prior, scored by the Legislative Fiscal Bureau, and studied by the Lewin Group (not to mention that it was also supported by then-State Rep. Curt Gielow, a Republican). Republicans like Kanavas offered a lot of misinformation about the plan then, certainly, to make it seem more confusing than it was, but it was not an unknown.

Healthy Wisconsin, for those of you who don't remember it, was a plan that took the burden of health insurance out of the hands of employers. It was paid for by a tax on businesses and individuals that was pretty significantly less than the average cost at the time. People would have a variety of plans run by private insurance companies to choose from (paying additional premiums for anything more than the standard plan) and the whole thing was managed by the state. If that sounds familiar to you, you might know this as the way the state currently offers insurance to its own employees. (At the time, I found it deliciously ironic that the same people who complained daily about the Cadillac benefits given to government employees were those most ferociously opposed to a plan that gave everyone access to those same benefits.) This is nothing like what is currently being considered in Congress, despite Kanavas's attempts to claim that it is so.

Their plan would have implemented a tax on Wisconsin business to pay for a government-run health care model. Much like the plan being tossed around in Washington, the Senate Democrats would place your health care decisions in the hands of bureaucrats. Luckily for us, Republicans, who controlled the State Assembly at the time, were able to purge the plan from the budget.

Three more sentences from Kanavas, three more falsehoods. First, a lie of omission: As I noted above, the plan was financed not merely by a tax on business, but also a tax on individuals, and premiums charged to individuals opting in to more expensive plans (plus some significant copays and deductibles). Also omitted is what I noted above--the tax was far lower than the average cost of providing health care was. For most businesses, that would have been a cost savings. In addition, there were likely to be property tax savings, as well, as local governments moved onto the cheaper plan. Second, neither Healthy Wisconsin nor the proposals in Congress puts any decision in the hands of bureaucrats in any government agency; Healthy Wisconsin, like the current state benefits plan, offers employees a range of different plans with different levels of care run through traditional insurance companies, not the state equivalent of a death panel. Third, it was not Assembly Republicans who "purged" Healthy Wisconsin from the budget; Senate Democrats traded it away for Republican support for BadgerCare Plus and other health initiatives.

The rest of Kanavas's post consists of variations on these same things: "socialized health plan," "government-run model," "government should be involved in your health care decisions," "the socialist dream," and so on (plus repeated problems using the possessive apostrophe). He does also include the well-debunked notion that a plan like Healthy Wisconsin would draw freaks and freeloaders here for free health care--Christian Schneider's legacy lives on.

So, large or small, state senator or Congressman, the Wisconsin GOP is perfectly willing, it seems, to shell out the lies, distortions, and scare tactics in the name of stopping health policy reform. It's sad, really, that Wisconsin, as the birthplace of the party of Lincoln, should be home to so many who do such a disservice to the memory of Honest Abe.

A Day that Ends in -y

by folkbum

So Patrick McIlheran is bashing the teachers union:

Doyle and several other governors say they want any federal stimulus to bail out their budget deficits with $250 million in aid to schools. Not for building new ones: No poised shovels here. It's just to fend off cuts, says Doyle. While federal spending on schools has risen 40% in the past eight years, without such further insulation, "we will see a great falloff in the quality of our schools," he said. [. . .]

Our state spends, per person, a bit above the national median. Wisconsin incomes are lower than average. The budget's a mess not because we're undertaxed but because the state chronically spends as if its taxpayers were richer than they are.

Fiscally insulating school spending does nothing about this. Even if the feds could bail out our state without robbing someone else, it simply would preserve a level of spending that we couldn't afford anyway. A bailout forestalls real change.

Real change wouldn't ruin our schools, either. Wisconsin school spending is driven by high labor costs. Salaries aren't so out of line. Benefits are, sixth-highest per pupil by federal figures. Not coincidentally, most school districts are locked into high-cost, traditional health plans, a primary seller of which is an arm of the state's leading teachers union, WEAC. [. . .] So why does Doyle want Washington to salvage states' bad school spending habits? Got me; I suspect he's being a pal to WEAC.

At least the man is consistent: He blamed UAW for the failures of GM, Ford, and Chrysler, after all, so why not blame the union for the bankruptcy of our schools.

Problem is, the union is not why Wisconsin's benefit costs are so high and why they have skyrocketed in the last decade or two--the high cost of health care, generally, is. From the paper he works for, so, you know, he should have read it:

The Mercer survey found that the cost of health benefits in the state averaged $10,037 for each employee--18% higher than the national average of $8,482. [. . .] This year, total health-benefit costs for Wisconsin employers increased 4% for each active employee, compared with a 6.3% increase nationally, according to the Mercer survey. The increases would have been higher if employers hadn't raised deductibles, co-pays and other out-of-pocket expenses.

I--a teacher!--am one of those whose "deductibles, co-pays and other out-of-pocket expenses" was raised last year. But consider the stat at the beginning of that blockquote: Wisconsin's health care costs are 18% higher than he national average. Not school labor costs--it doesn't sound like schools were even in the Mercer survey--but health care costs generally. I am not sure how WEAC is to blame for that.

In fact, studies have shown that WEAC is not to blame. Again, this is from the paper McIlheran works for:

High health care costs in the Milwaukee area stem from the market power of health care systems, according to a study by the Wisconsin Policy Research Institute.

The study contends that health care systems have increased their market power by employing physicians, which gives them a referral base for their hospitals, which makes it harder for would-be competitors to enter the market.

To be fair, the article does allow the systems comprising near-monopolies outside of the Milwaukee area to claim, without data, that they are not as expensive as Milwaukee area providers. However, it is clear that statewide, our health care costs are higher than average and it's not the fault of WEAC or public employees' unions.

So what to do about expensive education spending? Well, one thing would be to let the feds give us some money. (They already owe us 35 five years of promised special education money, after all.) Another thing would be to implement some kind of health care reform that would make it possible for not just schools but everyone else in Wisconsin to get health care at a lower price, something like--though not necessarily it exactly--Healthy Wisconsin, which could have been saving local school districts (and, hence, taxpayers) hundreds of millions of dollars had it been enacted two years ago.

But why talk about something that would help people when you can just bash the union? At least, that's Mcilerhan's ploy.

A Few Thoughts On Family Care

by capper

With all the hubbub about the state budget, the focus has been mainly on the Healthy Wisconsin initiative and taxes. One part of the budget that hasn't received much attention is Family Care. Family Care is basically an initiative that will alter how the elderly and people with disabilities will receive funding for their services. It is an invention of Tommy Thompson, with a pilot program initiated in 2001 in five counties. Last year, Governor Jim Doyle signed it into law that every county has to go to a Family Care system.

Currently, the Democrats want to fully fund the initiative to expand Family Care state wide, while the Republicans want to scale back the funding, and slowing down the expansion of the initiative. Meanwhile, while the state keeps bickering about the budget, counties are trying to plan ahead for the expansion of Family Care without knowing how much funding, if any, they are going to receive.

There was already programs in place to allow seniors and disabled adults to receive services that would allow them to remain in the community. They are broadly grouped into a class called Medical Assistance Waiver Programs, and included the Community Option Program (COP, the Community Integration Program (CIP), the Brain Injury Waiver, and Birth To Three. They are basically convoluted ways of diverting money that would have gone to a nursing home or other institution, and using it to keep people in their own homes or community-based group homes. The programs are the result of federal lawsuits saying that seniors and disabled adults were having their civil rights violated by being forced into institutions.

The objective of these programs were two-fold. One objective was to allow more people to have more independence and freedom, thereby resolving the lawsuit. The second object was to save taxpayer dollars. These programs were based on a total sum model, in which each county was given a lump sum of money, and they used the money to help people remain in the community, or be reintroduced into the community from nursing homes, state institutions, etc. The savings could range as high as $400 per day per person, and averaged around $200 per day per person receiving these services, and at the same time, increase the quality of life of that person. The downside was that there were many more people who needed these services than could be helped with the amount of money allocated. This created waiting lists. In Milwaukee County alone, the current waiting list for disabled adults is between 2,000 and 3,000 people, and some of these people have been waiting for more than ten years to get into programming.

Family Care is supposed to eliminate these waiting lists, and save the taxpayer even more money. The premise is to base the system on an HMO type model. Each county would received a flat rate per person in that county identified as needing services. The rate would be base on the average cost of the services these people need, which can range from an area of $50 to over $300 per day. Sounds good so far, right?

But problems have already risen up in the counties already using the Family Care model, and more problems are being found as other counties are exploring it. One is that the reimbursement rates to the agencies providing services, especially in smaller counties is much lower than the waiver program. This has forced many of the smaller agencies to close as they could not afford to provide the services anymore. The larger companies also reduced services offered. This created a new waiting list, just at a different point in the system.

Another problem is that many counties are finding it too expensive to administrate the program, especially at the onset. Milwaukee County's Department of Aging had deficits of millions of dollars during the first few years. Dane County was ready to bow out of the system, stating that they would have enact a major tax hike to make up for the lost funding, before the state reached a special deal, spreading the start up costs over several years. Several counties are combining into regional units to help share the costs.

And the savings from Family Care are not clear. I have seen some reports that indicate the savings can be quite large, but Milwaukee County's savings have been negligible so far.

I think that Family Care could be a good idea, if administered properly. In an effort to make it more effective, many counties are contracting and/or subcontracting these services to private companies, which are more interested in their profit margins, than in ensuring the client's needs are being met. Unfortunately, it increasingly appears, like with HMO's, the needs of the client is being disregarded in interest of the bottom line.

For further information about Milwaukee County's progress towards moving to Family Care, one can go to http://www.planningcouncil.org/longtermcare/ . There are also going to be forums held at the following places and times:

Tuesday, October 2nd from 12:30-2:30 pm
Goodwill Industries
6055 N. 91st St.
(Park in the far west side of the employee lot)

Monday, October 22nd from 12:30-2:30 pm
Milwaukee Center for Indpendence
2020 W. Wells St.

Tuesday, October 30th from 5-7 pm
Washington Park Senior Center
1859 N. 40th St.

It's time to let Healthy Wisconsin go

by folkbum

My pick in the WisPolitcs budget bingo has long passed, so I got nothing on the line here when I say this: My Democratic State Senators, it's time to drop Healthy Wisconsin.

There's a lot that I like about Healthy Wisconsin. It gets close to many of the things I see as necessary to real health care reform and it sounds a lot like the health care reform package I proposed a couple years back. But it was never going to pass this way. You know it, I know it, Governor Doyle knows it.

But now you have the perfect opportunity to do a couple of things. One, get the budget done--that's the most important thing. There are hundreds of municipal and schools employees all over the state losing sleep over this. There are dozens of bills tied up in the legislature yet because the budget isn't done. Forty-nine other states are using us as the Bad Example. It is time to wrap things up, people.

Two, this is a chance to score some points. I know, I know, this isn't supposed to be about political points. This is about the Willothepeople. Fine, whatever (tell that to Mark Rahmlow). Just call it a Happy Accident, a lucky side benefit of tying up the budget process now. The Republicans have convinced (some of) your brothers and sisters in the Assembly to pass a piecemeal budget. This is not acceptable, as Seth explains:

So unless the GOP has also announced a willingness to bend on it's "no tax-increase" policy and strict funding cap, it means that the extra funding is going to need to come out of somewhere else; yet, "somewhere else" is nowhere to be seen.

In other words, while the GOP may be mostly agreeing to the Dem proposal on K-12 funding--as Speaker Huebsch has stressed for the media in recent days--unless they're also bending on their strict stances on overall funding, it just means they're going to agree to even less down the line.

And therein lies the difficulty with piecemeal budgets, which is why state budgets--at least in Wisconsin--simply don't get passed that way.

In the process of getting to the pieces, though, the Republicans have abandoned some of the more significant abominations of their unserious show budget, particularly in the area of K-12 education. It's time to lose the show part of your budget, too.

All you have to say is, fine--now meet us where we are. Give us a complete budget. I bet you Jim Kreuser and Co. could be easily convinced to raise enough hell to get the Republicans back in for a Healthy Wisconsin-less budget. Take what the Assembly already passed, add the remaining Senate or JFC pages, and you have a real, workable, complete budget that Jim Doyle can sign--with the BadgerCare expansion, the cigarette tax, the child care provisions, the Department of Children and Families, and so on.

Two things could happen: One, the Assembly relents right away and passes a complete budget and the Democratic Senate looks magnanimous in victory ("It was important to hold out for a complete budget . . . We're glad the Republicans finally saw fit to serve the people, not the special interests . . . We are happy to see the Republicans agreeing with us about the level of school funding . . ." and so on). In other words, they blinked first, and you can capitalize on it.

Or, two, the Assembly refuses anyway, and the Republicans again look like obstructionists. Doyle on one side ("I'd really like to have a budget to sign") and the Senate on the other ("We set aside our controversial plan to do what's best for the people"), and the Republicans will be the monkeys in the middle. Any further hold-up will seem petty and will serve only to give ammunition to our side for November, 2008.

But it can't happen until, in a big, noticeable way, Democrats drop Healthy Wisconsin. Call a press conference, promise to make it a top priority in the spring, remind people how much health care is sucking out of the pockets of workers and the coffers of business . . . However you do it, just do it.

The aforementioned Seth suggested exactly this several weeks back. It was too early at the time, but Seth makes a good point when he says,

The turn from restless to impatient is clearly coming in the media coverage of the budget, and just as it's in the best interest of the state to get something accomplished, it's in the best interest of the Dems to be ahead of the curve rather than being pulled under it.

That curve is moving fast, and now is the time. Get this done, claim the win, and get back to work passing Healthy Wisconsin as a stand-alone piece. Also, campaign finance reform, please. Oh, and K-12 funding reform. Some pro-real people tax reform would be sweet, too. Maybe some pie. And a pony. Have we talked lately about light rail?

Must Read on Health Care

By Keith Schmitz

The right wing here in Wisconsin is of course blowing a lot of smoke up your chimney that providing health care for everybody with something like the Healthy Wisconsin plan is unworkable, unAmerican, unwhatever.

Most people on the other hand, seems to respect personal money advisor Jane Bryant Quinn and in this week's Newsweek she lays out in in easy to read, common sense prose why universal coverage makes sense, and why what we are doing now doesn't.

She throws up the right's clay pigeon arguments against putting a coverage program in place and shoots them down. Here's my favorite:

Eeeek, your taxes would go up! Maybe not, if Sheils is right. Both the Congressional Budget Office and the General Accounting Office have testified that the United States could insure everyone for the money we're spending now. But even if taxes did rise, you might still come out ahead. That's because your Medicare plan would probably cost less than the medical bills and premiums you're paying now.

My question here is really what role do the for-profit players (except drug processors and med device manufacturers) play in the health care system other than driving prices up and driving people out of hospitals? If you are all buzzed up about the great return your IRA is getting on these investments, then try not to think about there might come a time when a medical problem might wipe all those savings away, something that is all too common in this country.

I'm getting sick and tired of seeing this group or that holding fund raisers to pay for someone's medical bills. People have better things to do with their time.