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Time is now for health insurance reform

America has long struggled to effectively provide health care for all. Previous efforts at major reform often found the American Medical Association and the AFL-CIO—physicians and workers—at odds.

Not this time.

The Wisconsin State AFL-CIO and Wisconsin Medical Society believe that fundamental reform is urgent and must address three issues: access, cost containment, and basic system design.

Access. Daily some 14,000 individuals lose insurance coverage and join close to 50 million who are already uninsured. Those who are insured face escalating premiums and high deductibles and co-pays that discourage and even prohibit needed care. No democratic society with our resources should tolerate such a situation.

To assure access, every private or public insurer should offer an “essential health benefit plan” affordable to all, with insurers competing against each other on the basis of patient costs and services. All Americans should have such a plan available. Low- and moderate-income families should receive subsidies that make such insurance affordable. Just as we protect our citizens on the basis of gender, race, etc., no one should be discriminated against for “pre-existing conditions.”

Cost. We spend a whopping 18 percent of Gross Domestic Product (the value of all goods and services we produce) on fragmented forms of health care that fail to cover everyone. No other industrialized country spends more than 11 percent GDP on health care, yet many have healthier populations and cover everyone. In the absence of reform, the Council of Economic Advisors estimated on June 2, 2009, that our 18 percent will grow to 34 percent of GDP by 2040, with the uninsured rising to 72 million. This financial drain is crippling our nation’s economy and making companies uncompetitive in the global economy. We can control costs if all employers pay fair shares of essential health costs, insurers truly compete, and we reward providers for quality of care.

System design. We need more emphasis on prevention, wellness and chronic disease management, through investments in resources and incentives for quality improvement. The system should reward value, not volume, and compensate for better health outcomes rather than the number of tests or procedures performed. These basic reforms alone would substantially improve the overall quality of care while potentially reducing costs.

With reform we seek to address quality and costs, strengthen the doctor-patient relationship and increase choice—all at the same time.

Affordable, quality health care for all can be accomplished with good-faith efforts, but we cannot debate endlessly, resulting in another dead-end. People are denied insurance for pre-existing conditions, forgoing care due to high co-pays and deductibles, declining to fill essential prescriptions, filing bankruptcy due to catastrophic medical expenses, or losing jobs and health coverage at the same time. This situation is unsustainable for workers, health care professionals, businesses and our economy as a whole.

The time to act is now.

The Wisconsin Medical Society and Wisconsin State AFL-CIO pledge to do all we can to ensure passage of legislation that guarantees access to quality, affordable care to all Americans.

Susan L. Turney, MD, is chief executive officer of the Wisconsin Medical Society. David Newby is president of the Wisconsin State AFL-CIO. Turney can be reached by contacting Wisconsin Medical Society communication director Kendi Parvin at (608) 442-3748 or kendi.parvin@wismed.org. Newby can be reached through Sara Rogers, executive vice president of the Wisconsin State AFL-CIO; phone (414) 771-0700 Ext. 12 or solidarity@wisaflcio.org.