HCCD Report Wisconsin 54212

Report on Health Care Community Discussion
Fish Creek (Door County) Wisconsin
December 30, 2008

Overview of Discussion, Participants: Our group consisted of 10 participants meeting in a home over a soup dinner. We met for approximately two hours and spent the majority of our time discussing the questions in the moderator and participant guidelines.

Door County Wisconsin is a summer resort area and artists’ and retirees’ destination. As a consequence, it is home to a number of self-employed people, small business owners, and older people (with few large employers in the area). Our group was representative of this population. All but one of us have health insurance – two through teachers’ retiree programs, three through Medicare/supplemental insurance, and the rest individual policies.

There was universal agreement in our group that significant healthcare reform is necessary and should be a high priority in the near future. We believe that the healthcare problems in the US are connected to the other economic problems here. We also agreed that an expansion of Medicare or some like form of single-payer system is a course we’d like to see pursued.

Perceptions of Biggest Problem in the Health System: Answers included the high cost, the lack of reality when it comes to costs, the incomprehensible nature/lack of transparency of so many aspects of healthcare, the fact that healthcare choices are not consumer-driven, and the fact that the US has the most expensive healthcare in the world but is low on the list (number 37, it was maintained) in terms of quality.

One participant noted – and there was broad agreement that this was true – that five people (for example) with like health conditions and like finances might end up getting five different treatments with five different costs, all depending on who they were, what type (if any) insurance they had, geography, age, etc. We all agreed this was ridiculous.

There was universal agreement that the large number of uninsured and underinsured people in the country is a societal problem – not just for those who are un- or under-insured but for everyone.

Choosing Doctors and Hospitals: Most participants said that their choices depended on word-of-mouth and which providers are in-network under their insurance policies. For example, a couple participants noted that the only doctors and hospitals available to them in the Door County area are those within the Ministry Health system, because Aurora – the other major provider group in this area – is not a preferred provider under their insurance; one participant indicated the opposite was true in her case.

Our group did not discuss how public policy should promote quality health care providers, but the writer of this report notes that one way would be for provider cost and healthcare outcomes information to be widely available.

Difficulties Paying Medical Bills: One participant noted that after surgery, she learned that the anesthesiology group who had worked on her case was not a preferred provider in her group, and she ended up in a dispute with this group and her insurer over who was responsible for the out-of-network costs. She ended up not having to pay more than in-network costs but only after considerable efforts that not everyone might be able to undertake. She also noted that, in total, her out-of-pocket costs for cancer treatment, including two surgeries but not chemotherapy or radiaion, were approximately $18,000 – something that she was able to pay over time but, again, an amount that many people could not afford.

Another participant noted that, when his wife was treated, the institution did not want to take the couples’ insurance card but, rather, asked for cash at the time of treatment – about $10,000 cash.

Several people noted that better “deals” can be cut with providers if an individual says he or she does not have insurance than if the individual indicates that he or she is insured – observing that this is both illogical and unfair.

One participant noted that healthcare costs are the most significant cause of personal bankruptcies in the US.

Insurance Exchanges, Medicare: We all agreed that Medicare, despite its problems, is a well-functioning system and that an expansion of it to cover a broad spectrum of people would be advisable. Most participants thought they didn’t have enough information about insurance exchanges to make an informed judgment about them, but there seemed to be broad skepticism about letting insurance companies continue to “run things.”

Employers’ Costs and Roles: While we agreed that, historically, offering healthcare benefits was a way for employers to attract and retain employees, some participants questioned the continued viability of requiring employers to carry this burden. One participant, who had run the HR department of a medium-sized company, discussed how much time it took to sort through options, communicate options, etc. and the difficulties of making coverage and cost decisions. Others agreed that this was a burdensome problem for employers, noting the time and costs it takes for employers to simply keep up with ever-changing rules such as those under COBRA and HIPAA.

Obtaining Preventive Services: Most of our discussion was about the problems the un- and under-insured face getting preventive services. For example, how can one of these people pay for a $4,800 colonoscopy?

Public Policy Promotion of Healthier Lifestyles: We universally agreed that public policy should promote healthier lifestyles and would favor greater childhood education, and efforts on a local government level, to promote such measures as healthier eating, more exercise, and abstinence from smoking. We lamented the problems of alcohol abuse, wanting it to be treated as a disease and not as a “bad behavior.”

Other Key Discussion Points: We agreed that some of the difficult decisions to be made in healthcare reform will be decisions on, for example, “baseline” or “floor” coverage and coverage above that. We talked about the fact that most healthcare expenditures occur at the end of life and whether that was “right” and, if not, how it could be changed. We talked about whether there was an “excess” of technology. We complained about pharmaceuticals’ advertising. We would like to ensure that dental care is treated as a part of necessary healthcare.

Our group thinks that, although healthcare reform surely involves challenges, other countries provide good models, and we are not averse to some experimentation.