Curmudgeon's Corner

We in America spend more on health care for every person in the country than does any other country in the world. Arguably, we have the best health care available to us although in certain other countries some outcomes are better and some techniques are more efficient. We have heard the drum beat about a “health care crisis”, yet our health care is the envy of the rest of the free world.

Our state and our nation are re-entering the arena of debate on both health care reform and on the reform of the health care delivery system. These are two different issues although they tend to nearly always be framed together in the press and by the politicians seeking to make the changes.

Health care, from my perspective, is about how our care is delivered. It is about who provides the care and in what setting using what tools. It is about what medicines and therapies are employed, and at what cost with what effectiveness.

Health care delivery, from my perspective, is about who owns the facility. It is about the proliferation of health care facilities even where it seems the need is being satisfied. It is about the insurance policy (if any) and who pays the premium. It is about what appears to be the cost to the end-user and what it actually costs the end-user. It is about “out-of-pocket” expense, how long we wait for appointments and so on. It is about health care for the uninsured whether they’re uninsured by choice or by circumstances beyond their control.

These two pieces of the “health care” pie are very much separate and distinct. Sometimes those who speak or write will combine or confuse these things based on ignorance. Sometimes those who speak or write will combine or confuse these things based on knowledge and their attempt to twist a certain outcome in the minds of the audience. The "health care crisis" is more about cost and covering the uninsured than it is about health care.

Our job, yours and mine, is to understand the difference, and to learn how best to get to the bottom line as it concerns us. Our job is to avoid reflexive reaction, and to study and hold our tongues until we’re pretty sure we understand the subtleties and nuances. We’re going to need to know who the speaker is and who is being represented by the speaker. Not everyone in this debate will be someone whom we can all take at face value. To do so would be to play the fool…and none of us can afford to be fools in the discussion of something so important.

The recent Wisconsin Policy Research Institute (a not-for-profit institute established to study public-policy issues) report points out that our health care system is complex. It is an imperfect market that relies largely on third parties for payment thus eroding the incentive for both consumers and providers to economize. This is likely a better definition than any other of the "health care crisis".

To help you understand my biases, I operate a company that serves insurance agencies, employers and employees with online enrollment services for employee benefits. I am a licensed insurance intermediary in Wisconsin and have been for a long, long time. I do not sell insurance although I maintain my license to stay aware of what is happening. I do have “skin” in the game just as you have. I am a consumer of health care.

I intend to spend some time in this blog over the coming weeks to discuss this subject and the things that are newsworthy at the time. I invite your e-mails so that we might establish a dialog. Your questions are as important to me as are your comments. Please let me know who you are so that I may be as informed about you as are you about me.

In the final analysis, changes are very likely to be made and we all should be participating in the process since we’ll all live with the results.