Part 4: Summary and Recommendation

In the first three parts to this series, we addressed the character of medical services, the role of private insurance and the history of hospital regulations. We argued that medical services are not a purely private good; thus, the local community should have a significant role in determining which services would be both desirable and financially sustainable. Our second segment described the history of how private insurance developed and became embedded in our workplace culture through the exemption from income taxes for employer sponsored insurance. The third posting in our series characterized the history of state and federal regulations of medical care in general and hospital services in particular. We concluded that the existing public/private hybrid that shapes medical care market dynamics has yielded an unaffordable hospital-driven structure that cannot be sustained in many places including the Fox Valley.

The Fox Valley Health Care Transformation Initiative has attempted to change the marketplace dynamics of health care in the greater Appleton, Wisconsin service area. We have attempted to meet with and discuss these issues with the leaders of the two predominant hospital-driven systems in the area (Ascension and ThedaCare) and have been rebuffed. We believe that a cooperative built upon a base of local school districts can provide a large volume of prospective patients. This volume begins to generate the bargaining power needed to change the dynamics of the health care delivery market structure in the Fox Valley. As a result, health care delivery could be reformed to best sustain the financial, physical, and mental health of its population.

Based on applying political scientist John Kingdon’s three streams that need to coincide for a policy window for change to appear, we believe that now is the time to act to change the health care market dynamics in the Fox Valley.

1. The problem stream – The two predominant medical care systems in the area offer an increasingly unaffordable mix of medical service that emphasizes referrals to their specialty services. Their combined market power enables them to set prices and service offerings that poorly serve the residents of the Fox Valley. This results from boards of directors/trustees who do not represent the socio-economic composition and interests of the population.

2. The policy stream – Various alternatives exist to change public policy at the state or federal levels, but, based on the past history, any choice would gore some major group’s economic interest and, thus, will generate strong resistance. Stated differently, lobbyists for medical care providers will use some of their vast income to fight for keeping the structure of medical care delivery similar to what we have presently. Furthermore, since the vast majority of medical services delivered to Fox Valley residents is delivered locally, waiting for state or federal policy makers to address our dynamics makes no sense.

3. The political stream – To change health care delivery in the Fox Valley to one that provides an affordable mix of services that sustains and improves the health of all its residents, we need countervailing market power to that enjoyed by existing hospital-based systems. Rising health care premiums, deductibles and co-pays clearly illuminate the need for a different approach to managing health-related services. The vast resources devoted to keeping our residents healthy must be determined by local needs and fit the income capabilities of local residents.

This means that now is the time to demand that the vast resources we devote to health care services be spent much more wisely. If not now, when?