Volcanic pressure is building up nationwide over soaring health care premiums and fast-shrinking coverage, but George W. Bush will surely plug up any eruption of reform at the national level during the remainder of his term.
What he can't prevent is the pressure already breaking through at the state level, which will likely intensify as the Democratic presidential candidates continually reinforce the reform message. As we've seen, even Republican governors in Massachusetts and California are implementing reform plans, though both of them carry profound flaws. Thus far, the efforts of Mitt Romney and Arnold Schwarzenegger have garnered the most attention -- but progressives have reason to look closely at some very exciting developments in Wisconsin, where a major push for statewide universal health coverage is underway.
"Wisconsin now has the chance to do what it did at the turn of the century and set a national model for other states and the nation," says a hopeful Robert Kraig of Citizen Action of Wisconsin, one of the principal leaders of the Wisconsin Health Care Reform Campaign. "We don't think that Massachusetts and California should be the ultimate models. We believe that success in Wisconsin could have huge implications for the new president coming into office in 2009."
Health care has been a particularly explosive issue in the Dairy State, where premiums are the third highest in the nation (26 percent above the U.S. average). Moreover, premiums are rising much faster in Wisconsin than nationally (9.3 percent versus 6.1 percent in 2006). Workers' share of premiums has been climbing 4.2 times as fast as wages, employer coverage is plummeting, and hospital chains are in the midst of a hugely expensive and duplicatory building binge. Public discontent began to produce momentum for policy action last year.
Setting the stage for the current legislative push was a carefully-planned effort in the run-up to the 2006 elections by health reformers. To crystallize public anxiety over the health care issue and to strategically target some key legislative races, progressives succeeded in getting referenda for universal health care with cost controls passed in 11 municipalities, by a combined 82 percent margin. The Democrats recaptured the governorship, won an 18-15 Senate majority, and gained eight seats in the Assembly to considerably narrow the Republican edge to 52-47.
Since the election, the Wisconsin Health Care Reform Campaign has grown to 31 members, including the AFL-CIO, other labor groups like the SEIU, the AARP, the Wisconsin Alliance for Retired Americans, Planned Parenthood, and a number of religious and disability groups.
Most significantly, the campaign includes backers of not just one, but three different proposals for fundamental reform. Early on, reformers realized that while they could not reach consensus on a single specific proposal, they nonetheless shared basic principles about reform substance and strategy. Substantively, they were all committed to universal coverage, cost control, and expanding patients' freedom of choice. Strategically, they all recognized the urgency of the state's health crisis, the need to educate and mobilize grassroots forces, and ultimately, the imperative to force legislators to act on health care.
"One crucial factor holding us together is the absolute gravity of the problem and the desperation for a solution," explains Darcy Haber, State Senator Kathleen Vinehout's chief of staff. "At this point we just need to get everyone health care coverage The other key to solidarity is the organizing insight of people in the field," says Haber. "They recognized the danger of potential factionalization among Democrats and progressives. Early on, the organizers and advocates agreed not to fight against each other."
The Campaign's three proposals for comprehensive reform, while embodying the same essential principles and each establishing a risk pool of the state's entire workforce and their families, vary in substance:
- The Wisconsin Health Plan, chiefly associated with former state budget director David Riemer, a moderate Democrat, aims at rewarding insurers who combine networks of high-quality providers with a reasonable cost. While the most "market-oriented" -- even including a small-scale Health Savings Account feature -- it would automatically enroll every Wisconsin citizen for health care coverage.
- The Wisconsin Health Security Plan applies many aspects of the Canadian single-payer model to Wisconsin, most notably the replacement of 450 private insurers with one public entity in order to eliminate the costly and often infuriating bureaucracy imposed by private insurers. It would be funded by payroll taxes on both employers and workers.
- The Wisconsin Health Care Partnership Plan hopes to build on employers' familiarity with the state's Workers Compensation program, the first in the nation, which imposes a fee on all employers to cover the care and income of injured workers. Devised by state AFL-CIO President David Newby, the plan also includes a mechanism for a unitary fund to handle claims, thereby cutting out the costs imposed by private insurance bureaucracies.
Meanwhile, Republicans have put forth a "Smart Medicine" proposal focused on high-deductible Health Savings Accounts, but it is widely dismissed as a classically Bush-style plan almost exclusively aimed at giving the healthy and wealthy tax breaks. Most observers consider the plan D.O.A.
Crucial new momentum for comprehensive reform has been generated by Democratic Governor Jim Doyle's budget proposal, which expands the state's coverage of low-income families so that about 98 percent of Wisconsinites have health coverage (about 600,000 are now uninsured). Doyle's proposal would consolidate all existing programs for low-income people (chiefly Medicaid and the S-CHIP program for children and parents) and expand them to childless adults, to be funded by a combination of higher tobacco taxes, a new hospital tax (Wisconsin's nonprofit hospitals recently reported a surplus of $1 billion for 2005), and $60 million in new federal funding.
If enacted, Doyle's budget provision would establish a "floor" of coverage that will make comprehensive reform less expensive and more achievable. At this point, it appears likely that Doyle will sign any progressive health reform that comes to his desk, insiders say.
With Senate Democrats taking the lead, the spotlight will come to rest on the three reform plans. The advocates of reform in the legislature will have to navigate some very tricky waters, first in shaping legislation and then in fighting for enactment.
Thus far, the coalition is working surprisingly smoothly on the formulation of a unity plan, despite the difficult question of how to handle the role of insurance companies (which would mobilize fierce resistance if a single payer plan effectively eliminated their position). The development of a plan that combines private insurance with a choice of enrollment in a large public pool -- somewhat along the lines of John Edwards' campaign proposal -- remains a possibility. Regardless, the Health Care Reform Campaign is hoping to have its unity plan ready in May.
Once the plan is unveiled, it will immediately face an all-out media offensive from a coalition likely to include the insurance industry, hospitals, Big Pharma, and Wisconsin manufacturers. Already, national health-insurance lobbyists have visited state senators' offices to warn them of a full-bore lobbying and media campaign. Preliminary indications are that the anti-reform coalition would use its massive resources and sophisticated techniques, honed in previous issue campaigns on corporate taxes and malpractice "reform," to oppose any of the three reform plans based on their mandatory character.
Indeed, while a handful of vocal business leaders have recognized the economic threat posed to their self-interest by the current health system, business organizations and leaders in general have shown a high degree of "class solidarity" with the very insurers who are driving up premiums, as Robert Kraig puts it. Ironically, as Kraig says, "If the insurers are involved [as central players in a reform proposal], the costs of reform are much higher for the rest of the business community."
Ultimately, the outcome of reform in Wisconsin may be determined by the ability of the Health Care Reform Campaign's generate its own media coverage through local events and demonstrations. This activity would be aimed at driving home the failures of the status quo, dramatizing the massive support for reform, calming uncertainties about the impact of reform, and targeting vulnerable Republican legislators, whose votes will be needed in the Assembly.
For reformers, a vital task will be to translate somewhat amorphous grassroots support for reform into active, explicit backing for the unified reform plan that will emerge from the Senate. "Once the Senate gets down to a viable unity plan, the blitzkrieg will be unleashed, and we will need to be ready," says Kraig. "We have public opinion on our side, but the opposition will play on doubts, anxieties, and fears so that people would rather hang onto an imperfect status quo."
Reformers plan to counter this attack with a strong message and highly visible, vocal grassroots action. "We will have to be stout and reassuring in our message, so that people know what they're getting, they have a clear sense that the new system will given them control, and that it will provide peace of mind," says Kraig.
Building upon the public's highly negative experiences with insurance company's and hospital administrators, the campaign needs to use public "street heat" to intensify the level of public anger, focus it relentlessly on insurance, drug, and hospital decision-makers, and pressure specific "swing" Republican legislators.
"We're going to have to spark a public backlash against the culprits blocking health care reform," says Kraig. "We need to get people indignant about particular actors and to call for government to be their watchdog in the health economy."
Roger Bybee is a Milwaukee-based writer, progressive activist, and former editor of the official labor weekly Racine Labor. He has written for a number of state and national publications and websites on issues such as health care reform and corporate globalization.
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