This letter to the editor appeared in the Milwaukee Journal Sentinel on Sunday May 21, 2017 (JSOnline) and is from someone who actually worked with Wisconsin’s high risk pool back in the day. I am going to copy it here in its entirety but you can see it at JSOnline here:

Spread the risk

In the May 15 article on high risk pools, the Journal Sentinel cited Wisconsin’s experience as a possible model (“State’s former risk pool touted”).

I was quite involved in the creation of Wisconsin’s high risk pool and served on the Board of Governors for 25 years. While I believe that Wisconsin’s Health Insurance Risk Sharing Plan (HIRSP) was very well run, it was never affordable for the many people who needed it. In spite of many efforts to contain costs, premiums and deductibles were very high. Thus, I do not believe that high risk pools are a viable model if the Affordable Care Act is to be repealed and replaced.

It is important to note who is most affected if medical underwriting is again permitted (and thus high risk pools are needed). The majority of the people in HIRSP were older, between 55 and 65. Many had chronic health conditions such as organ transplants, cancer or multiple sclerosis. Many were self-employed or small business people. They struggled to pay the premiums and out of pocket costs. I got to know several of them through a consumer advisory committee that we established.

It fundamentally does not make sense to concentrate people with known high medical needs into one plan. By definition, the cost will be very high. Instead, it makes more sense to cover such individuals by spreading the risk into much larger pools that include persons with low medical needs. This was a key part of the ACA.

Dianne Greenley

Retired Attorney

Former member, HIRSP

Board of Governors


Well, wipe that smirk of off our collective faces, because the American Health Care Act may have some very serious deleterious effects on our coverage as well. Remember that little nugget about granting the states waivers if requested to remove any number of basic benefits from coverage offered in their states? Things like coverage for pre-existing conditions, maternity and pre-natal care, mental health care, life time coverage caps, etc, etc, etc. Well apparently if a state applies for any one of these waivers…it doesn’t just apply to insurance sold on the federal or state exchanges that were established under the Affordable Care Act (aka Obamacare), but could be applied to any insurance coverage provided in the state. Go figure…so our employer could opt out of providing those benefits and reduce costs and leaving any number of us hanging!

And that’s just the start of it. If your employer, like mine, has multiple locations across the United States, they can cherry pick which state they want to use for their insurance rules…so they could conceivably pick the state with the most advantageous waivers and minimize their costs. So even if you live here in Wisconsin you might be only able to get insurance based on the waivers and rules set down in West Virginia for instance…and you might not like them at all.

I am guessing that young people just starting a family might care about maternity benefits, Americans with chronic illness might care about lifetime caps, and I care about pre-existing conditions.

Other than being really troubling to consumers of health care who won’t actually get to control their insurance benefits, this seems to fly in the face states rights so popular with the GOP. Now Wisconsin wouldn’t necessarily control it’s insurance market anymore…it’s at the mercy of every other state. I am not sure this little quibble is even apparent to the Trump Administration or the House of Representative members who wrote the AHCA, but I would think it is of serious concern to the 49% of Americans who have employer provided health insurance.

This JSOnline article talks about Governor Scott Walker’s desire to drug test certain Medicaid applicants before they can receive benefits. We’ll get back to that in another post…but the key data point that I wanted to bring up is Wisconsin currently has 1.2 million people on Medicaid.

That population size was a big surprise to me considering the total Wisconsin population is only 5.7 million. So approximately 21% of Wisconsin’s population is on Medicaid…that seems like a pretty substantial number. And of course the state of Wisconsin and the federal government each have bureaucracies to support the implementation of the program and of course spend substantial amount of tax revenues to make it work.

But from a financial and business point of view, when 21% of any market is in play to a single public vendor at what point is it better to push the rest of the market to that vendor? Is 21% the point of ‘return on investment’ that says solidify healthcare to a single payer government program or do we have a bit to go yet?

Well that just gets to the next question. If one simple health insurance plan like Medicaid already provides benefits for 21%, what happens when we add Medicare to our view? There are currently just short of 1.1 million Wisconsinites on Medicare. Essentially another 18% of Wisconsin pays for their healthcare through Medicare.

So that breaks down to about 39% of Wisconsin residents are already being provided with healthcare services through government programs. And I am not even going to include the Veterans Administration here. But I would think 39/40% has to be near the tipping point where it makes sense to enroll everyone in Wisconsin into a single payer plan.

I imagine if we started a state by state comparison we’d find similar relationships across the nation. Let’s try Alabama, the first state on the list alphabetically. Medicaid population: 874,000, Medicare population 968,000 and total state population 4,779,000: 38+%.

At that rate doesn’t it just make more sense to consolidate all health care insurance under one single payer administrator? Cut the overhead, cut the duplication of effort, negotiate better prices and drive efficiencies in health care?

Instead of simply fighting against the American Health Care Act…why aren’t our progressive and liberal electeds fighting for single payer now? Why is it so quiet on the left side of the aisle? It’s time!

Will the Presidency Survive This President? : As President Trump stumbled from crisis to crisis this past week, he reminded the country of a lesson it didn’t really need to learn: A president’s greatest asset is trust. Once he has lost it, he can’t govern. Mr. Trump’s serial recklessness may change not just the course of his presidency but also the office itself. Whatever happens to him, it’s not too soon to wonder what will happen to the presidency when he’s gone.

We Aren’t Built to Live in the Moment : We are misnamed. We call ourselves Homo sapiens, the “wise man,” but that’s more of a boast than a description. What makes us wise? What sets us apart from other animals? Various answers have been proposed — language, tools, cooperation, culture, tasting bad to predators — but none is unique to humans. What best distinguishes our species is an ability that scientists are just beginning to appreciate: We contemplate the future. Our singular foresight created civilization and sustains society. It usually lifts our spirits, but it’s also the source of most depression and anxiety, whether we’re evaluating our own lives or worrying about the nation.

Life Behind Israel’s Checkpoints : How I wish I were fatalistic, someone who tells himself I did all I could and now will leave my destiny to fate. But I’m not like that. I start eating myself up, even blaming myself for the occupation. I tried to assure myself that it wouldn’t be the end of the world if I didn’t get on the flight. I was only going to do a series of talks on human rights. Perhaps I should stay put in my house and give up traveling altogether. But so much had gone into the planning of this week, so many people were involved. Would they understand why I hadn’t made it? Would they appreciate the complications of our life under occupation?

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Montana Republican Congressional Candidate Allegedly Assaults Newspaper Reporter : A reporter for The Guardian newspaper was “body slammed” to the floor Wednesday by Greg Gianforte, the Republican candidate in Thursday’s special election for Montana’s open U.S. House seat, the reporter and multiple witnesses said.

New book recounts Milwaukee’s baseball past : Largely forgotten today, Borchert Field lasted the same number of years as Miller Park and County Stadium — combined.

We Like Suburban Segregation : Marc Eisen‘s recent Journal Sentinel op-ed about the Milwaukee region’s segregated housing raises interesting questions. The region has a long history of such problems:

Milwaukee’s Own:

full disclosure: I know Jason Klagstad from my professional relationship with the Bill Camplin Band.

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This is just breaking and I am not going to comment at this point. But real politics in Montana just got more real:

On the eve of a special election to fill Montana’s House seat, the Republican candidate allegedly assaulted a journalist who was trying to ask him about the Congressional Budget Office’s scoring of the House health care bill.

A violent altercation ensued, and the reporter, the Guardian’s Ben Jacobs, quickly relayed the incident on social media.

“Greg Gianforte just body slammed me and broke my glasses,” Jacobs tweeted Wednesday evening. In audio released of the incident, Jacobs asks Gianforte a question about the latest CBO scoring of the Affordable Health Care Act.

“I’m sick and tired of you guys,” Gianforte said, as what sounds like a struggle can be heard on the recording. “The last guy who came here did the same thing. Get the hell out of here. Get the hell out of here. The last guy did the same thing. Are you with the Guardian?”

“Yes! You just broke my glasses,” Jacobs replied.

“The last guy did the same damn thing,” Gianforte said.

“You just body slammed me and broke my glasses,” Jacob said.

“Get the hell out of here,” Gianforte yelled.

If you prefer some NBC News: Montana Republican Congressional Candidate Allegedly Assaults Newspaper Reporter

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Is what is floating through the mind of President Donald Trump after having used the term Islamic rather than Islamist:

“He’s just an exhausted guy,” said the official, who briefed reporters only on the condition of anonymity.

But interestingly this:

Exhaustion (on the second day of a nine-day trip) is an amusing excuse to offer for such a mistake, considering how much Trump mocked Obama, Hillary Clinton and Jeb Bush for lacking stamina.

Hmmmm…we continue to see a trend here!

There was a fair amount of press on head scarves this past weekend. While visiting Saudi Arabia both Ivanka and Melania Trump did not wear a head scarf as most women in the kingdom are expected to do. And this garnered press because then citizen Donald Trump made a big todo about insulting the Saudis when President Barack and Michelle Obama visited a few years ago…when Michelle didn’t wear a head scarf. I wasn’t going to bring it up and it basically earned a shrug in the Blogging Blue editorial offices.

That is until, I got an email this afternoon from one of our regular readers wondering why Ivanka and Melania were wearing black veils at the Vatican…now although the Catholic Church no longer requires head coverings for women in their churches it apparently it is still the custom during visits with the pope. And yes Michelle Obama also wore a veil during her visit with the previous pope.

But I guess I have to agree with the letter writer (and many others in the internet): Why was it ok to ignore a rule in Saudi Arabia and then follow essentially the same rule at the Vatican?


No? Neither did I…and I didn’t make $11.5 million in salary, stock and bonuses like the average CEO. That CEO made 347 times more than the average employee in their firm. Do you think any CEO is worth that? Is your CEO worth 347 times your worth to the company?

So let’s keep that 8.5% and 347 times the average salary and an average $11.6 income for CEOs in mind as the American Health Care Act works its way through Congress and they strip out the taxes on the wealthy that provide health insurance for the least of us.

And keep that in mind when they get down to work on their Tax Cut (I mean Tax Reform) bill later this year or next. Do those people really need a tax break? At the expense of the rest of us as the federal deficit balloons even further.

The great populist, President Donald Trump, and the great tax maven, House Speaker Paul Ryan aren’t going to do anything that will decrease the gulf between you or me and our CEOs. The inequity in income will continue to grow and grow on their watch.

Is that what we really want?