By Steve Lund
Editorial Page EditorAre we ready for another health care debate in Wisconsin? Or should we just wait and see what comes out of Washington?While almost everyone is eager to see what, if anything, new in health care comes from the Obama administration, some in Wisconsin want to forge ahead with expanded access.The Wisconsin Primary Health Care Association, which represents the Kenosha Community Health Center and 16 similar clinics around the state, just announced that it is making plans to serve 315,000 patients a year by 2015. That would be 100,000 more patients than they served in 2008.That growth anticipates Wisconsin’s Badger Care Plus program expanding. The expansion has been in the works for a while but is waiting for funding. The federal expansion of the State Children’s Health Insurance Program, known as SCHIP, which President Obama signed Wednesday, will give Badger Care Plus a boost.The $32.8 billion expansion of SCHIP is expected to cover an additional 6.4 million children nationally. That’s more than $5,000 apiece, and kids are supposed to be relatively inexpensive to insure. That’s why there are such big numbers in every discussion of health care.The next step for Badger Care Plus is extending coverage to low-income childless adults. If the funding falls into place, that might start on July 1.That will be another incremental step toward everyone having access to health care, but the political pressure for universal health care that led to the state Senate passing the Healthy Wisconsin plan last year hasn’t gone away, even though it appears the Healthy Wisconsin plan won’t be revived. The state Assembly never reacted favorably to Healthy Wisconsin last session, and, more importantly, since the Assembly majority has switched to the other party, the governor has never supported it.David Riemer, one of the architects of Healthy Wisconsin and now director of policy and planning for Community Advocates, a Milwaukee social service agency, thinks the state needs to revive the debate about comprehensive health care reform regardless of what is going on in Washington.“If not Healthy Wisconsin, we ought to have something that covers everybody, that includes preventative care, treatment for addiction and mental health and controls costs — something that achieves the goals of Healthy Wisconsin but is more acceptable to the critics,” Riemer said in a telephone interview.“We cannot let go of this effort to bring about comprehensive health care reform,” Riemer said. “We should have something in law in Wisconsin that is ready to go if Congress stalls. I hope Congress passes something; I couldn’t think of a happier wake to attend than to put all this work I’ve done for a Wisconsin plan in a casket because we have a national solution.”Riemer said there are at least four different health plans being promoted in the U.S. Senate.“At the end of the day, they have to agree on one plan, and they have to be able to bring that plan to a vote,” Riemer said. “If you want to be pragmatic about this, looking to the state to have something ready to implement if Congress stutters makes a lot o sense.”Riemer thinks universal coverage will help drive down costs of health care, because the plans, if designed correctly, will reward the networks that deliver lower cost, higher quality care.“The problem is not that we have too few resources,” Riemer said. “The real problem is we have mismanagement and poorly organized incentives applied to the resources we have.“If we got the incentives right and the organization right, I actually believe we’d save 30 percent.”“The challenge,” Riemer said, “is to come up with something that achieves the goals of Healthy Wisconsin that’s acceptable to the body politic. If we don’t, all these trends (such as costs rising faster than inflation) are going to get worse.”Steve Lund’s column appears on Thursdays. E-mail slund@kenoshanews.com.