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Everyone would have been able to afford insurance, even if they had a pre-existing condition.
The insurance industry helped kill the idea, using a series of ads featuring a middle-aged couple named “Harry” and “Louise.” They were able to create enough doubt that Congress eventually scrapped the idea. It never even came to a vote.
How about the Wisconsin State Senate “Healthy Wisconsin” plan? It was passed without regard to the plans of the Assembly or even the governor. It was patterned after the Clinton plan and was derisively described as “government-run health care” by Assembly Speaker Mike Huebsch, a West Salem Republican.
Now the Mayo Clinic — hardly a bastion of wild-eyed radicalism — is promoting a health care reform proposal with an insurance component very similar to the Clinton and state Senate plans.
It will be unveiled in
La Crosse at an invitation-only event Monday at the Radisson Hotel. There also are opportunities today and Monday for the public to weigh in by video testimony. A multimedia trailer will be parked near Barnes & Noble at Valley View Mall from 11 a.m. to 4 p.m. today and outside the Radisson Hotel from 11 a.m. to 3 p.m. Monday.
The concept for the health insurance proposal is called “managed competition.” Instead of having businesses be the main providers of health insurance, this plan would establish a government-appointed board, patterned after the Federal Reserve Board, that would define what constitutes essential health services.
People would be able to buy insurance through large purchasing pools — with a variety of plans with different levels of costs and features. The plans are being compared to those offered by state and federal governments. The plans would not discriminate against individuals based on their pre-existing conditions, and the purchasing pools would be large enough to spread the risk for insurers.
Franciscan Skemp Healthcare CEO Dr. Robert Nesse said he believes there is “enough money in the system” to pay for universal coverage, but only if cost-control measures are put into effect.
That’s where the Mayo-supported plan differs from the earlier political efforts. It includes measures to ensure that care is coordinated, costs are contained and quality is high.
Mayo should know about cost and quality. It was recently recognized for both by the Dartmouth Atlas of Health Care, an annual publication that tracks quality, costs and other trends.
This year’s Dartmouth atlas tracked Medicare spending for patients in the past two years of life. The medical center at the University of California, Los Angeles, was the most costly, at $93,000 per patient. The Mayo Clinic and the Cleveland Clinic were most cost effective, at $53,000 and $55,000, respectively.
Mayo is proposing changing the way Medicare reimburses health providers for treatment of patients. Instead of paying by the procedure, Mayo proposes paying a certain amount for treatment over time. That would discourage providers from thinking mainly in terms of ordering more tests and procedures — and encourage them to think more broadly about care.
That’s what Mayo does. Its physicians are paid a salary, rather than paid by the procedure. A recent editorial in The New York Times said the highest cost institutions are those in which doctors are paid on a fee-for-service basis rather than by straight salary.
While the universal coverage issue gets the most attention from politicians and the public, don’t underestimate the significance of cost and payment-reform plans. Their impact could be huge.
Consider this: Medicare reimbursement has been stagnant or declining. Health providers are seeing their revenue decrease because of it.
Mayo Clinic is a nonprofit operation. But it uses the revenue that it makes over and above costs for research — a vital tool to increase health-care quality. A recent story in the Minneapolis Star Tribune said Mayo’s profit margin has been cut from 4.6 percent in 2004 to 1.8 percent to 3 percent today.
“We’ve become activists,” Nesse said, “because we don’t see any future that supports our ability to provide good care unless we change.”
Coming from Mayo, with its expertise and reputation, that’s an astounding statement — and a powerful boost for the cause of health care reform.
Call Richard Mial at (608) 791-8232 or e-mail rmial@lacrossetribune.com.
