Brew City Brawler

The Journal Sentinel heeds the Brawler's advice on Healthy Wisconsin -- belatedly

Better late than never, right?

Bemoaning a MJS editorial that tiredly called for "bipartisanship" in addressing health care reform in the state, and took some curious shots at Healthy Wisconsin (specifically calling it "a plan too far" that, echoing the New York Dolls, tries to do "too much too fast"), the Brawler on August 13 wrote:

Finally, the Brawler deeply hopes that the JS edit board realizes soon that the state GOP will make a good faith effort to address health care reform around the same time George Bush makes a good faith effort to get out of Iraq before he leaves office. It ain't going to happen. The state GOP is too wedded, ideologically and, more importantly, financially, to the current system to make any significant changes to it.

The Brawler also noted that it was Healthy Wisconsin -- not the so-called proposals by the Assembly GOP -- that addressed the "musts" raised by the MJS  for health care reform (cost control and access among them).

So the Brawler was happy to see this in the MJS lead editorial today -- though obviously it would have been nice if this had been written a few months ago:

So while Assembly Republicans were right to insist that Healthy Wisconsin did not belong in the 2008 state budget, the plan, while not perfect, has enough merit that it shouldn't be buried. It must be put back on the table and thoroughly vetted as a starting point for health care reform.

The Brawler is a humble man, so he'll cede credit for the JS edit board's apparent shift to the Committee for Economic Development. Funny what happens when a group of local business leaders calls for universal coverage, aina?

UPDATE: Headline fixed and graf added for further context.

Big lies about consumer-driven health care: The John Torinus and KI edition

John Torinus -- WMC board member, Serigraph chairman, Milwaukee Journal Sentinel business columnist -- and other "free market" health care reformers like Leah Vukmir loves them that word "consumer" when it comes to health care.

Consumer-driven.

Consumer-empowered.

Consumerism.

In the Torinus world, consumers -- who will know how the cost of their desired medical procedures and who will have the freedom (and time! and savvy!) to comparison shop among different providers -- are the ones who will lead us into a New Jerusalem of lower cost health care.

In a July column, Torinus looked to KI, a Green Bay manufacturer, to offer us a glimpse of this utopia:

KI in Green Bay is one more data point in why the top-down state Senate plan for universal health care in Wisconsin does not compute.

KI is arguably the place to benchmark in the private sector for best practices on simultaneously delivering health care and controlling health costs. Its self-insured plan offers a full set of benefits, stresses wellness, prevention and fitness and brings it in for less than $6,000 per employee....

As a KI director, I have had the chance to see its results from installing a consumer-empowerment plan. Its incentives prompt judicious behavior by its workers in how they use and purchase medical treatments, in their lifestyles and in following disease regimens.

KI's benefit plan is well regarded by its 1,429 covered people, and its price to employer and employee is near the lowest in the state for a full plan. The price tag for KI and its workers came to $8.8 million in 2006.

Weirdly, his column in the Journal Sentinel left out some information that Torinus shared with executives gathered at an April 2005 breakfast in Pewaukee sponsored by the Advanced Manufacturing Network Southeast, Waukesha County Technical College and the Waukesha County Economic Development Corporation. From a topline overview of his presentation:

K.I. in Green Bay has a similar plan to Serigraph’s and it rates its employees’ health A-D through the health risk assessments.

• The A-rated employees (best health) are going to pay a very low premium.
• The D-rated employee  (poor health) will pay an increased premium.

Here's a tip: When you want to learn the real deal about a business initiative, don't pay attention to what executives tell the hoi polloi. Pay attention to what executives tell each other.

And the Brawler would suggest that there is nothing, absolutely nothing, "empowering" about being an employee with a D rating.

Not only are the less healthy getting hit up for the extra services they actually use through the high deductible and other cost sharing --  they're also getting hit for the extra services the insurance company assumes they'll use due to their risk level.

Feel that consumer power!

(And yes, the argument that "consumerism" will lead to lower prices is laughable. For some procedures, such as lasic eye surgery, sure. But the big ticket items, such as chronic care and major or emergency surgeries, don't lend themselves to comparison shopping. And someone please explain how a hospital can go about establishing itself as the low-cost provider for triple bypass surgeries.)

John -- just call it employer-driven health care and try to sell it that way!

Why does the Journal Sentinel let John Torinus write about Healthy Wisconsin or: John Torinus, meet Elizabeth McCaughey

Not once, not twice, not thrice but four times, the Milwaukee Journal Sentinel has published columns by John Torinus that enlist bogus facts -- or no facts at all! -- to attack the Senate Democrats' Healthy Wisconsin proposal.

Torinus' resume includes posts as chairman of Serigraph, board member of the WMC and a former business editor of the right-wing Milwaukee Sentinel. But his performance at the Journal Sentinel calls to mind Elizabeth McCaughey, the right wing hack who distorted and misrepresented, to no small effect, the Clinton Health Security plan in the pages of The New Republic in 1994.

From Theda Skocpol's "Boomerang: Health Care Reform and the Turn Against Government" (p. 153):

McCaughey included outright lies about the Health Security bill, for example, falsely stating that it would prevent patients and doctors from dealing with one another outside of officially approved insurance plans. Her accusations about bureaucratic regulations forcing middle class people into low-cost managed-care plans were in fact much more true of the Cooper bill than Clinton's Health Security. But the editors of the New Republic favored the Cooper plan and were happy to use McCaughey's smear piece to sully public perceptions of Clinton's proposals.

Hey JS editors: if a news reporter blew facts as often as Torinus he or she would be (hopefully) pulled from the beat or given a good talking to. And while Torinus may be an opinion columnist, that does not give him a license to make shit up -- as he has been doing all summer long when it comes to Healthy Wisconsin.

The Brawler would suggest that Torinus' intellectually dishonest attacks are intended more to advance the interests of the WMC than to enlighten the readers of the JS.

The Brawler would like to think that the JS would resent being so used. But if it's not, the least the paper could do is make explicit that it's a conduit for WMC talking points.

Truman's words on health-care reform resonate 60 years later

The first drive for fundamental health-care reform that had any meaningful chance of success was under Harry S Truman. In retrospect, the odds always were stacked against it. Getting it through Congress would have been difficult in the best of times -- Taft's Republicans and Southern conservative Democrats were dead against it. Moreover, a then-massive, multimillion dollar PR blitz by the AMA -- which denounced national health care as "socialized medicine" (yup, Leah Vukmir et al are relying on some pretty old tropes in vilifying health care reform six decades later) -- successfully demonized it.

Instead corporate America and their political allies embraced employer sponsored health care.

In reading Harry S. Truman vs. the Medical Lobby by Monte Poen (a solid, if dry, work by a Truman fan that provides a good overview of the internal workings of the administration as it pushed health care reform), the Brawler was struck by words from a Truman address on Oct. 15, 1948 (p. 130):

What did the Republicans do with my proposal for health insurance? You can guess that one. They did nothing! All they said was -- 'Sorry. We can't do that. The medical lobby says its un-American.' And they listened to the lobbies in Congress.

I put it up to you. Is it un-American to visit the sick, aid the afflicted, or comfort the dying? I thought that was simple Christianity.

Does cancer care about political parties? Does infantile paralysis concern itself with income? Of course it doesn't.

The Democratic Party holds that the people are entitled to the best available medical care. We hold that they have a right to ask their Government to help.

With some editing -- thanks to Big Government, infantile paralysis looms less large in the American scene -- that speech could be given today.

WMC racebaits on health care reform

The Brawler (and this guy and this guy) had a fine time making sport of the WMC/CfG's clownlike attack on Healthy Wisconsin. Bogus polling, empty talking points, a half-decade old "plan" masked as something new .... a veritable three-ring circus of buffoonery!

Still, one part of the WMC's poll literally made the Brawler's blood boil. It was this part:

Seventy-seven percent are likely to oppose the plan when they find out "the plan is expected to attract new residents to Wisconsin who do not work, but want health care benefits."

First off: The use of passive voice -- "the plan is expected to" -- irritated the Brawler. Why? Because it doesn't say who exactly expects this to happen. So far as the Brawler can tell, the people who expect this to happen are a formerly anonymous, moderately amusing blogger who now flacks for the WPRI; a MU law professor who played off him; and a Journal Sentinel columnist who thinks the aforementioned professor is, like totally, smart. Not exactly a Rand study! And Seth Zlotocha, in his cold-blooded nuanced manner, neatly dispatched this argument a while back.

It's true: obfuscatory use of the passive voice does irritate the Brawler.

But it's the second half of that sentence that set the Brawler's blood boiling: "attract new residents to Wisconsin who do not work, but want health care benefits."

This is transparently racist code. Utter these words to more than a few voters -- particularly, the Brawler suspects, the Republican base -- and you conjure visions of black and brown people. Shiftless black and brown people whose only ambition is to pack up everything and move to Wisconsin to live off our fat benefits.

Why does the Brawler say this? Did he read it in a book? No. The Brawler heard the original version of this slur literally dozens of times growing up in Milwaukee in the 1970s and 1980s. Back then it was: "Black people move up here because of welfare." Though of course, the people who said it didn't say "black people." There was no evidence for this of course -- but it sounded good to a certain kind of person and an urban legend was born.

Tommy Thompson then injected a watered-down, but still fundamentally racist version, of this vile slur into the public discourse during the debate over welfare reform.

There never was any proof that Wisconsin's welfare benefits played any meaningful role in attracting people to the state. (Indeed, the Brawler has heard the "Blacks come up here for the benefits" argument in Minnesota, which, of course, was one of the states from which we were allegedly attracting welfare mothers. Truly a smear without borders.) In fact, more evidence argued to the contrary. It is the definition of a big lie, repeated to this day by the likes of Deb Jordahl.

And now by the WMC.

WMC clown show takes on health care

Wisconsin Manufacturers & Commerce, in cahoots with Wisconsin's Club for Growth and others, came out today guns blazing against Healthy Wisconsin and pimping "Healthier Choices."

Unfortunately for them, they were firing squirt guns.

WMC's survey claiming a majority of  Wisconsinites oppose Healthy WI is an absolute joke. Its "Healthier Choices" plan should be translated as "Pay more for fewer choices." In a true marketplace of ideas the WMC's broadside it would be laughed out of the discourse.

Sadly, we're in a marketplace where the WMC and CfG have millions to spend and a marketplace where Charlie Sykes will flog the thing endlessly as he  denounces Healthy WI as "a complete government takeover of health care." That's not spin, Chuck; that's a lie.

While the Brawler is disheartened that this tripe could play some role in the coming health care debate, some items still managed to "illicit" a mordant chuckle.

Such as...

... The way the survey claims a majority of Wisconsin voters disapprove of Healthy Wisconsin based on responses to survey question that says the system "will replace Wisconsin's current private health insurance system with a universal health insurance system managed by the state government." Weird, because Healthy WI does not replace the "current private health insurance system" and it won't create a regime "managed by the state government." Or did I miss the part about how the state government is going to seize the headquarters of different insurers?

... The way flack Jim Pugh claims WMC, the Wisconsin Hospital Association and the Wisconsin Association of Health Plans will "encourage the continued development of a consumer-driven health care environment in Wisconsin. Promising collaborative efforts to collect and report information related to quality, safety and cost should continue, without government interference (nice touch, guys -- Brawler), among providers and health plans." Uh huh. Can't wait to see the WHA's vigorous drive for greater disclosure. And if these groups are begging for greater disclosure, why isn't it on the Assembly GOP's agenda.

... The way the Republican polling firm responsible for this travesty, Public Opinion Strategies, appropriately has as its acronym POS.

... The way Healthier Choices is presented as something new when it feels like a rehash of past WMC calls for shifting cost and risk onto employees who can't afford it. Then you realize it's not a rehash. It's the same old hash! On page 7, it offers proposals for the 2003-05 biennium.

Is the WMC really doing its dues-paying members a service by entering the health care debate with a proposal that's been gathering dust for four years?

Its members deserve better than this clown show.

As, of course, does Wisconsin.

Now the big question: Will John Torinus write this up in his Sunday column for the Journal Sentinel?

The WMC is evil

The WMC is not only short-sighted, bad for the state, ideological to a fault and mendacious. It is also evil.

Read Pundit Nation to find out why.

The Brawler hopes Christian conservatives will explain why the Brawler is wrong.

Why there's no compromising with Republicans on Healthy Wisconsin

On Sunday the Milwaukee Journal Sentinel edit board criticized the Wisconsin Senate Democrats' Healthy Wisconsin plan as going too far (a position with which the Brawler disagrees) and criticized the Republican Assembly for not having a health plan at all (a position the Brawler finds strangely familiar).

The answer, the edit board intoned -- as most edit boards do in such situations -- is that the Dems and Republicans must reach across the aisle and reach a (word most loved by editorialists) compromise.

As an example of such reaching across the aisle, the edit board harks back to health care plan proposed in 2005 by Rep. Curt Gielow (R-Mequon) and John Richards (D-Milwaukee), elements of which are in Healthy Wisconsin.

Surely bipartisanship can flourish if the two sides sit down and work it out, the edit board clearly hopes.

To which the Brawler replied: Hogwash.

And again he says: hogwash.

If we're ever going to see meaningful health care reform in Wisconsin it will be against the wishes of many GOP legislators, not with their assistance. They're too wedded, ideologically and financially, to the status quo. Those that may sympathize with reform live in fear of being attacked as RINOs and facing challengers in their next primary.

Let's just revisit the reaction that the Gielow-Richards plan, so beloved by the JS edit board, got from Gielow's fellow Republicans (From the 6/16/05 Capital Times):

Rep. Robin Vos, R-Racine, described the plan as a form of government-mandated "Hillary-care," referring to former first lady Hillary Clinton's health insurance proposal of the 1990s.

"It's hard to know what to say," Vos told Gielow. "Radical is a kind term for this program, in my opinion."

Rep. Leah Vukmir, R-Wauwatosa, called it "nothing short of a framework for socialized medicine in Wisconsin" that would create a "slippery slope of compulsory managed care and unending tax increases."

Sen. Ted Kanavas, R-Brookfield, said he was "outraged" by the "ludicrous" plan. "I do not want a system where a Madison bureaucrat decides on a whim what doctors I am able to see or who provides care for my family," he said in a statement.

"Socialism and more government should not be the way of this new millennium," he said.

Same old shibboleths that have greeted Healthy Wisconsin -- and every other serious health care reform of the past 60 years.

The Journal Sentinel edit board has admirable goals for what it believes health care reform should accomplish -- portability, covering the uninsured, holding down costs. It's time the edit board stops pretending that Assembly and Senate Republicans share these goals. And then editorialize appropriately. 

The Milwaukee Vukmir-Sentinel

Bruce Murphy had an interesting item last week about how Dave Riemer, one of the godfathers of Healthy Wisconsin, protested to the Milwaukee Journal-Sentinel about its giving opponents of Healthy Wisconsin a weekly forum in the paper -- that'd be WMC Board Member and Sunday business columnist John Torninus -- with no rebuttal.

That may have been the reason the JS hosted a debate between the two -- a debate in which any neutral party would have declared Riemer the winner despite Torinus' posturings to the contrary -- and gave Riemer a column in Sunday's business section.

Then, proving the JS has a sick sense of humor, it gives rightwinger Leah Vukmir a prominent platform in the Crossroads section.

At a minimum, the JS should have run the columns side by side. If the JS really cared about its image, it would have run the Vukmir column on the comics, perhaps under "Zits." Because this column is straight out of the funny pages.

The column is an ideological screed, a pile of unsubstantiated assertions, starting with the headline, "Consumer control is the best course." The Brawler dearly hopes that the JS and other news outlets will consider placing the adjective "so-called" before the words "consumer driven health plans." The term gives the plans a connotation of being pro-consumer, when, in fact they're not.  "Caveat emptor health plans" -- guess wrong and you're screwed -- might be a better term.

Vuk prattles on about "an army of consumers with information and tools," provides a dubious history of health care, and talks about how the system is broken. She goes on to say how putting consumers in charge would be a "significant paradigm shift" as "consumerism" would foster competition, leading to better quality, lower costs and a pony.

"Consumers evaluate cost, quality and value in every segment of our economy -- except in health care -- because the consumer has never been in charge." Besides being punctuationally challenged, the sentence repeats the old GOP saw that health care is a market like anything else when, in fact, it's not.

She talks about the miracle of HSAs then goes on about how "consumers also must have access to relevant and objective cost and quality information about hospitals and doctors." She notes Wisconsin is a pioneer in "promoting health care transparency."

Yes, if you're going to have a consumer-driven system, you need transparency in prices. But that doesn't exist right now -- and the Assembly GOP isn't proposing anything to meaningfully change that. Weird!

She goes on to say that opponents falsely claim that consumer-driven health care is only for the healthy (Leah, you could've gotten some serious rhyming going if you had added "and HSAs for the wealthy" -- keep working on that flow!). She  denies it.

Her evidence? "At Marshfield Clinic and other places, focused, integrated health care teams are changing their approach to  comprehensive care for illnesses such as diabetes and heart disease -- significant cost drivers."

Well, if they're doing that at Marshfield Clinic "and other places," sign me up!

She then lurches to a big government is bad conclusion, including the objectively false claim that "Big government plans may temporarily address the issue of access, but they do nothing to control costs." She warns of a loss of personal freedom, though people can choose their doctors under Healthy WI. She -- fine, her staff -- offers a pithy throwaway line as conclusion and, mercifully, it ends.

Will it be all Vuk all the time in the JS on health care? The Brawler fears it may be. Leah -- fine, her staff -- has a blog in the Jsonline's backroom blog section. In Friday's installment, she demonized Healthy Wisconsin and also took shots at a fact-based critique of HSAs published by Citizen Action Wisconsin:

The document is riddled with falsehoods and myths with the clear intent of scaring those who might even consider options other than government control of health care. In future postings, I will dispel the myths and biases of the supposed "Seven Deadly Sins of HSAs."

Quite the cliffhanger! So far, she hasn't dispelled any of these "myths or biases." Presumably the WMC or WPRI or someone else is still working on that.

Does the JS believe publishing Leah Vukmir's propaganda on health care serves the public discussion on this important issue? Really believe it?

Journal Sentinel: Still clueless on health care reform

The Brawler was frustrated by the Milwaukee Journal Sentinel's lead editorial this past Sunday on Healthy Wisconsin and the Assembly Republicans' rival health care "plan."

On the one hand, the Brawler was encouraged to see the board recognizes the Republicans don't have a plan at all. "But the Republican plan, if one can actually call it a plan considering how limited it is, does far too little." Sounds familiar! The editorial sees more promise in health savings accounts than the Brawler, but the Brawler figures they had to throw a bone to McIlheran if they ever were going to get out and enjoy the weekend.

But the Brawler was disappointed with the editorial board's treatment of Healthy Wisconsin. It attacks the program as being too ambitious -- "a plan too far" -- and employs Republican demagoguery in doing so.

But it never explains what, exactly, its alleged shortcomings are. And the edit board also foolishly believes that the way to achieve meaningful health care reform -- and the board has an ambitious agenda -- is through some sort of compromise and "move toward the middle."  (To be fair, the edit board has some nice things to say about Healthy WI.) 

Here are the relevant excerpts from the editorial:

Democrats in the state Senate say that Wisconsin's health care system is in such grave condition that the only hope is the equivalent of a heart-and-lung transplant....

The sweeping overhaul proposed by the Democrats, which they call Healthy Wisconsin, sets out to do too much too fast. ...

Unfortunately, leaders in both political parties, and their respective supporters in the larger community, seem too wedded to their own fixes. The Democrats want to overhaul - Republicans say "blow up" is more like it - the current, fragmented health care system and reorganize it as a statewide purchasing pool, patterned after the state employee health insurance plan. Everyone under age 65 would get health care, and it would be financed with a controversial new payroll tax on employers and a tax on employee wages.

Republicans were correct to scold Senate Democrats in June when the Senate approved the Healthy Wisconsin plan, a combination of three existing plans, including the Richards-Gielow proposal, at the last minute. The plan should have been carefully scrutinized in the political and public arenas before the Democrats gave it their blessing and put it in the budget.

That said, the plan does have some merit, and its authors deserve credit for at least attempting to address the true symptoms. The Democrats showed political courage by tackling the problem head-on rather than merely tinkering with it.

Some critics have claimed the Senate Democrats' plan would take away individual choice. Not so. Participants could pick their own doctors and health plans. Supporters of the plan say it would use consumer information, price sensitivity and competition, similar to the state employee health plan, to hold down costs.

But Republicans and others are right to raise questions. For instance: How realistic are the projections for statewide cost savings for health care compared with the statewide cost of the new payroll taxes to finance the care? How will rates be set for doctors and other health care providers?

So after calling the plan overly ambitious and insinuating it will blow up the current health care system (curious as it leaves the delivery system intact), what are the edit board's complaints?

1. The Dems allegedly put it out at the last minute (this is a debatable point, given the prominence of health care in elections across the state in 06 but let's cede it).
2. There are questions about how will rates be set and questions about the realism of the cost projections (Though the JS elides the bigger question: What are the costs, in dollars and care, in doing nothing vs. the cost of Healthy Wisconsin).

The first is trivial. The second is legitimate, though these questions are the sort that arise around any major policy initiative and are hardly insurmountable. Neither of these criticisms support the scary rhetoric that drives the beginning of the editorial -- or the scary rhetoric that animates the JS's coverage.

But the Brawler's biggest frustration was the edit board's conclusion on how to address this mess: The Assembly and Senate need to get together and compromise.

First off, as a hybrid system Healthy Wisconsin is already arguably a compromise. It's not as if it's some crazy single payer system, some local version of the UK's much-loved NHS.

Second, defining the "middle" as the space between the Senate Dems and Assembly GOP is foolish. The Brawler would define the middle as where the people of the state reside. And polling suggests that the majority of people in the state would support something like Healthy Wisconsin. The "middle" is not some titrate of Healthy Wisconsin and the Assembly GOP's non-plan.

Finally, the Brawler deeply hopes that the JS edit board realizes soon that the state GOP will make a good faith effort to address health care reform around the same time George Bush makes a good faith effort to get out of Iraq before he leaves office. It ain't going to happen. The state GOP is too wedded, ideologically and, more importantly, financially, to the current system to make any significant changes to it.

Unless, of course, they see the alternative as being defeated in 2008.

In 1992, George Bush I proposed health care reforms including insurance purchasing pools for small companies, regulation of insurance company practices and malpractice awards to limit the cost of coverage, and tax-financed vouchers plus tax credits to make insurance more affordable for lower-income families. He also of course encouraged the spread of managed care. (Taken from Theda Skocpol's "Boomerang," page 31).

Say what you will about Bush's plan -- and it was widely derided at the time -- but it's arguably more ambitious than what the Assembly Republicans are proposing 15 years later.

The Assembly proposals also fall way short of the "symptoms" the edit board says health care reform must address: costs that exceed inflation; tens of thousands of people who lack coverage; the failure of many plans to cover pre-existing conditions; and lack of portability.

Healthy Wisconsin should do all that (Hey editors, check out the Riemer editorial in Sunday's business section!)

Nothing -- absolutely nothing -- the Republicans will offer will address those concerns. Compromising with them isn't the answer. Defeating them is.The sooner the Journal Sentinel edit board realizes that, the better we'll all be.