When I was a kid in the 1950s, my parents’ health insurance, Blue Cross Blue Shield, was nonprofit. Everybody chipped in money to help pay for the unlucky few who might need expensive medical care. It was a way that grown-ups worked together to take care of each other. We all took care of each other, like we should. So what happened?
Blue Cross Blue Shield offered “community-rated” nonprofit insurance plans in the ’50s. They equally divided estimated costs of people covered for the next year to set premium charges. There were no high-risk groups. Older, sicker people paid the same premiums as the younger healthy. Premium costs were stable. Everyone was equally in it together for the long run.
During the late ’50s, for-profit health insurance companies started selling cheaper insurance premiums to younger, healthy people, whose claim costs would be low. By creating a cheaper low-risk group, insurance could undercut nonprofit premiums enough to add profit fees for itself. When healthier people abandoned the community-rated plans to buy cheaper for-profit insurance for the short term, Blue Cross Blue Shield was left with fewer healthy people in their pool to help pay claims for older, sicker patients. Premiums climbed. Eventually, all insurance plans were forced to charge different rates based on age and health history, just to keep enough healthy people in their plans as well.
We now have a fragmented system created by the marketplace and controlled by for-profit insurance. People are divided into “risk groups” based on sex, age, prior health and employment. Each group is charged different premiums. Profit is made with each risk-group premium charged and with each claim deferred or denied. The institutional mission for private insurance is to create profit for stockholders and the board of directors—not to serve the larger community’s health needs. This is the exact opposite of what had made community-rated nonprofit insurance work for a diverse population. We’ve gone from taking care of each other in need to every man for himself... if he can afford it.
During my 43 years of family practice, I have seen private health insurance add nothing to quality of care, care provider efficiency and availability, improved communication or advocacy for patients. It has wormed its way into our health system as a middleman, and it manipulates and profits from the fact that we will all age and eventually need more health care, for which we will pay a higher premium. Administrative costs are more than twice as high in as in other nonprofit national health systems. The dysfunction and drain on our resources have become unsustainable.
A national movement to establish Medicare for All is growing, and in Wisconsin, we can model a statewide public option of BadgerCare for All. It would offer a lower-cost nonprofit health insurance to all Wisconsinites, regardless of age, sex, health or finances. Such health insurance would be a state-sponsored service for many, not a corporate profit industry for a few. Hospitals, doctors and care institutions would remain private and independent, giving patients freedom to choose. Since private insurance would need to compete to provide better service at a lower cost, BadgerCare expansion would expose the inflated costs, manipulations and inefficiencies that health insurance profiteering has inflicted on the public. We need affordable, community-wide affordable health insurance, but first we need a strong seat at the table in state government to make it a reality.
Gov. Scott Walker’s recent proposal to direct $200 million into private insurance participating in the Affordable Care Act shows that he wants to look supportive of ACA stability for now. However, his plan would subsidize private insurance only and would weaken protections for pre-existing conditions for ACA-premium buyers and severely penalize those who have had a gap in coverage. “Medicaid savings” to help fund his plan would be created by introducing more obstacles to BadgerCare enrollment, such as with drug testing and work requirements, and would deny health care to many more in need.
Walker’s shell game to finance the ACA for the middle class by cutting BadgerCare funds with “Medicaid savings” is clearly designed for short-term political gain. Weakening BadgerCare at the expense of our most vulnerable and needy is no way to care for each other at times of crisis and need.
The Badgercare Public Option bill is for everyone, not just a few. Let your state representatives know you support the idea.