The Milwaukee Post

July 7, 2017 • Milwaukee County Post • 9 By JOHN TORINUS Most Republican leaders at state and national levels are proving that they are as clueless about reforming health care eco- nomics as the wonks who designed Obamacare. At the state level, Republicans and Democrats on the Joint Finance Committee voted 16-0 to walk away from self-insurance for state employees and the many millions of dollars in savings that would follow. They are completely out of step with large hospital corporations, with large health insurers, with 80 percent of corporations with more than 200 employ- ees, with half of state governments and with an increasing number of local gov- ernments and school districts — all of whom have converted to self-insurance. What do those legislators know that the rest of these payers don't get? With their vote to protect the medical industrial complex, which lobbied mightily against the change, the legislators defied Gov. Scott Walker, who does understand health care economics and showed the political courage to take on the powerful complex. Nor are the Republicans at the federal level following Walker's lead. Their American Health Care Act is a kissing cousin of Obamacare, the Affordable Care Act, which they sought to repeal for seven years. The GOP plan deploys tax credits instead of direct subsi- dies, but that's a distinction without much of a real difference. The Republicans are keeping ACA's cov- erage of existing conditions, retaining guaranteed issue, continuing child cover- age up to 26 on parents' plans and will stick with most of its core benefit requirements. The biggest GOP reform looks to be a sharp curtailment of the ACA's major expansion of Medicaid, a poorly run and highly expensive program. But that is going to be a killer issue for the GOP at election time in 2018. People who lose cov- erage are unlikely to back the Republican budget-cutters — unless they are given a better choice in the marketplace. Whether it's the ACA or the AHCA, there is no real hope that costs in the bloat- ed medical industrial complex will be reduced, that premiums in the individual policy market will do anything but soar or that Medicaid will stop busting state budg- ets. Meanwhile, two huge sectors of the health care marketplace have done better, both enabled by President George W. Bush's Medicare Modernization Act of 2003. They are the Medicare Advantage plans and employer-provided coverage. Both have bent the inflation curve in health care. Both are popular with Americans. So why would Speaker Paul Ryan and the Trumpians not look there for answers? Self-insured private corporations have deployed incentives and disincentives, such as Bush's 2003 health savings accounts. Many have installed medical homes, often on-site. Some have started to use value-based purchasing that entails bundled, low prices. Many have held costs to less than $15,000 per employee, compared with more than $20,000 in the general mar- ket. In the Medicare realm, Tom Hefty, for- mer CEO of Blue Cross Wisconsin, which administered Medicaid and Medicare pro- grams nationwide, points out that Medicare is far better managed than Medicaid. He stresses that the Advantage pro- grams preserve con- sumer choice among various vendors. It therefore preserves competition. Studies show Medicare Advantage saves money compared to direct payment by the federal government. More than 30 percent of Medicare-eligible people have moved to Advantage plans and cus- tomer satisfaction is high. The savings — estimated by one source at $1,200 per year — from Advantage plans allow them to fill gaps not covered by stan- dard Medicare. Advantage premiums are manageable. Consumers have a choice of plans — and an option of going back to standard Medicare. (If you like your Advantage plan or your Medicare plan, you can keep it.) So, Hefty asks, why don't Democrats (who hypocritically have no improvement amendments for the failings of the ACA) and Republicans (whose AHCA is not much of an improvement over the ACA) get together behind Medicare Advantage for all — while preserving private-sector choices? Even Bernie Sanders and Elizabeth Warren would like this solution. President Bush, a Republican, introduced the Medicare Advantage program. It could be bipartisan and therefore healing for the country. Political reality is that a failure by the GOP to come up with a compelling replace- ment for Obamacare could cause the public to default to a government solution. It is not looking good for a GOP plan to make it out of both houses of Congress. Default is possible. Even if a compromise bill emerges, it will have to be rammed through Congress by GOP leaders and President Trump. As proven by President Obama, the partisan ramming of the ACA in 2010 undercut its acceptance as a sustainable solution. Expect no Democratic votes for the AHCA, so it will be under partisan attack from the get-go. In the event of such a default or an unpopular bill in the context of the 2018 congressional elections, smart politicians could find a safe harbor in programs that work — Medicare Advantage and employer plans. Put another way: Why go with a market for individual insurance policies that was busted by Obamacare or with Medicaid that is out of control? Medicaid spending is driving out all other state budget priorities. Yet, that's where the ACA and the AHCA go for solutions. Instead, they could blend more of the private-sector reforms onto Medicare Advantage for a model that could be popu- lar, has proven to work and could be suc- cessful for the long term. (John Torinus is chairman of the board of Serigraph Inc. in West Bend and blogs regularly at www.johntorinus.com. His col- umn runs occasionally in the Post.) Medicare Advantage a model for reform Torinus Humboldt Park Fourth of July donations greatly appreciated To the editor: I would like to thank everyone who gave us time or donations to help the Humboldt Park 4th of July Association. Without your help, we would be unable to continue our great Independence Day celebration at Humboldt Park. In 1910, our organization was created to give a full day of activities with some pro- fessional fireworks. Before this time, too many people were being injured or lost their eyesight while playing with fire- works. The local Bay View people said that enough was enough. They wanted a safe alternative for families instead of the injuries that people got. It was decided that a morning parade should start the day. Family games for chil- dren would follow. A decorated children's vehicle (trikes, bikes, coaster wagons and doll buggies) were to be judged, followed by an afternoon parade with all of the partic- ipating vehicles in the parade. The parade was to end at the park chalet for all of the vehicles to be seen by the audience. This was to be followed by a talent contest for the various age groups. At 7 p.m., they would have the posting of the colors and then the various prizes for the day's event would be announced. Then would come an evening program followed by fireworks shot off by professionals. In 1911, the City of Milwaukee liked what we were doing at Humboldt Park, and created the Milwaukee 4th of July Commission. After this, many city parks had programs like ours. Without donations or volunteers, our program could cease to be. I wish to thank everyone who helped us in our Independence Day celebration at Humboldt Park. Without our volunteers we would be lost. I wish to thank all of our volunteers for their dedicated work. Our president, Matt Mazur, and his staff did a super job this year. I would like to see our Independence Day program continue into the future for future generations of families to enjoy. H. John Manke South Milwaukee OPINION LETTERS TO THE EDITOR

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