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Commentary: Reform or not, health care is changing

Matt Pommer

Health care premiums in 2010 for the state’s largest insurance program will increase an average 9 percent. The program covers some 155,000 people, including state workers, retirees and their families, according to state officials.

The state Group Insurance Board, which administers the program, touted the result because it was less than a double-digit increase. Private employers in Wisconsin might agree that any annual increase less than 10 percent is a good deal.

It’s important news because some say competition is the answer to soaring medical costs. The state plan invites sealed bids from health plans. Jawboning is used if a bid seems too far out of line.

Another popular idea in the health care reform debate is providing near universal coverage for Americans. Massachusetts has moved in that direction, and there has been some fallout. It’s now tougher to get a doctor’s appointment, according to a Massachusetts Medical Society study. Some 24 percent of those polled said it is more difficult. That’s up from the 16 percent before implementation of the new Massachusetts plan.

The Doyle administration contends that 90 percent of Wisconsin residents have medical coverage – Medicare, Medicaid, Veterans Administration, private insurance or other programs. It’s the second best in the nation, according to the Doyle folks.

But universal care would undoubtedly make it tougher to get appointments. It’s the law of supply and demand. A population growing older should add to a potential appointment crunch.

Critics of health care reform suggest you won’t be able to see the doctors of your choice. But even today, many of the physicians you see are specialists referred by a primary care doctor. When you arrive at a hospital by ambulance, care is likely to be provided quickly by the experts on duty, not your family doctor.

Even care after admission to the hospital is changing. A growing program of care is provided by “hospitalists” – doctors who practice solely in hospitals providing on-the-scene health care.

Who is a good primary care physician? Patients face that question when physicians retire. Some 40 years ago, Bob Clodius, then the University of Wisconsin’s acting provost, quipped he’d prefer someone in medical practice less than 10 years. Young physicians are more likely to understand the latest medical developments. He added they may be reading the New England Journal of Medicine more than the Wall Street Journal.

Matt Pommer worked as a reporter in Madison for 35 years. He comments on state political and policy issues.

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