Health care trends are unsustainable, but there are solutions

Wisconsin enjoys excellent quality health care and a uniquely competitive private insurance market. But ominous trends that threaten the quality and availability of care require the attention of elected officials at all levels.

Fortunately, members of both parties here in Wisconsin have shown they can agree on the problem — and on a range of pro-consumer solutions.

Health care’s rapidly rising costs are perhaps most concerning. Wisconsin has the 5th highest health care costs in the entire country, according to a new RAND Corporation study. However, another study found our state’s health care costs to actually be among the cheapest.

This conflicting information only underscores how opaque and confusing health care prices are for the consumer. We cannot make informed decisions about the true value of any product without price and quality information, but when was the last time you knew what a medical service would cost you or your insurer before the bill arrived?

This past session I co-sponsored Senate Bill 328, a price transparency bill that would strongly incentivize providers to publicize pricing data for common procedures. This would help give consumers the price information they need to judge the true value of services and incentivize better value care.

Health insurance costs are a huge concern for employers who dealt with an 8.5% premium increase for 2024 and a 22% increase since 2018. In many cases, getting care outside the traditional insurance and doctor’s office-based system can save money for both employer and employee.

One innovation is direct primary care, where a patient can get most medical services for a flat monthly fee, reducing the need for insurance and lowering prices. Another, retail health clinics, are small walkin clinics, often located inside a retail or drug store. Patients are able to get essential care for a fee that can be 30%-40% less than a doctor’s office.

Market consolidation also drives up prices. In Wisconsin and across the country, smaller health care providers are merging, eliminating competition and raising prices as high as the market will bear. While competitive forces incentivize value, monopolies limit choices and raise prices.

Another priority should be easing shortages in the health care workforce. Republicans and Democrats have agreed that empowering and trusting our professionals is a key part of that.

According to the Kaiser Family Foundation, 38% of Wisconsin’s primary care needs are currently unmet. Ominously, a 2018 report projected that 40% of primary care physicians will retire by 2035, resulting in a shortfall of 745 doctors.

One bill this past session, Senate Bill 145, would have allowed advanced practice registered nurses to deliver these essential services more independently than the law currently allows. Surprisingly, Governor Evers vetoed that bill, simply delaying a reckoning with the physician shortage.

We also face a shortage of mental health providers. Senate Bill 515 would have made it easier for licensed professionals in other states to offer services to Wisconsinites remotely. This policy worked well at a time when it was desperately needed during the pandemic. It’s still needed, but when given the chance to make this policy permanent, the governor vetoed it.

There have been several bipartisan wins signed into law, but we can and must do much more in the next session. Fortunately, there is no shortage of ideas that address these problems by reforming the system to empower consumers and our health care professionals.

In the next session, legislators of both parties must continue the work of injecting market-based reforms into health care so consumers have the tools they need to find affordable, accessible, high-quality care.

(State Sen. Rob Hutton, R-Brookfield, represents Wisconsin’s 5th Senate District, including Brookfield, New Berlin, Elm Grove and parts of Waukesha, Wauwatosa and West Allis. Contact him at [email protected]. gov.)