A vision for a healthy state

Do you ever wonder what kind of policy advice the leaders in your state get? The Wisconsin Policy Research Institute, which says it’s a free market think tank that advises government leaders on key policy issues and conducts regular opinion polls, produces a daily newsfeed that managers in Wisconsin read each morning.

Today, state administrators received in their inboxes recommendations for a “healthy Wisconsin.”

It’s a vision for the state-run healthcare program, providing universal healthcare coverage for all, modeled after the Wisconsin Works* welfare reform. It was written by political scientist, David Dodenhoff, Ph.D.:

What Healthy Wisconsin Should Cost (And Almost Certainly Won't)

...‘What, exactly, do you bring to the table?’ I have the same question when it comes to Healthy Wisconsin. The state intends to provide universal health care coverage—secure, affordable, high-quality coverage. It sounds like the health care equivalent of the dream girl. Naturally, it’s got me wondering: what, exactly, are Wisconsinites bringing to the table?

Fear not; I have an idea...There was a fundamental idea of reciprocity here: we’ll help you, but only if you’re willing to help yourself... Consider this scenario. You’re at an appointment with your Healthy Wisconsin doctor. She gives you a routine physical and finds that your weight is a potential health issue. So, she sets a body mass index (BMI) value that she’d like you to achieve within six months. She also gives you an exercise and nutrition regimen to help you reach your goal. But here’s the catch: if you don’t get within 10 percent of your doctor-recommended BMI in the allotted time, your coverage under Healthy Wisconsin is suspended. You can apply for reinstatement, but only once you’ve achieved your target BMI value. Until then, you’re on your own.

Again, you see the logic of reciprocity: we’ll help you, but only if you’re willing to help yourself.

He is proposing that the state prescribe compulsory preventive health regimens on what you eat and on your lifestyle, regardless of their efficacy, through state doctors. Ideally, healthcare would be denied until you comply.

You can already see it coming: As taxes go higher and higher to fund healthcare for everyone, resentment and blame will build among taxpayers and will be directed at those perceived to be bringing on their health problems themselves or to be costing the rest of citizens. Only fit, young and healthy people will be socially desirable.

He goes on to refute the two most popular objections to his proposals, arguing:

Here’s the first one: “You can’t have government dictating people’s behavior like that! It’s a violation of their rights!” But what rights are being violated here? Neither the state nor the federal constitutions include a right to hassle-free health care. (I checked. I even checked the emanations and penumbras.) Free health care is an act of beneficence by the state, and by the taxpayers who fund the state. It’s a gift horse. Accordingly, there shouldn’t be any complaining about its teeth. If you want the health care, you’re going to have to deal with the hassle. If you don’t want the hassle, don’t take the health care.

Here’s the second objection: “You can’t have government dictating people’s behavior like that! That’s Big Brother! I thought you people were all about small government, not government messing with the niggling details of people’s lives.”

“We people” are, in fact, all about small government. Healthy Wisconsin, on the other hand, is big government. If the state of Wisconsin is committed to practicing big government, then it might as well do so in the most constructive way possible. The most constructive way possible in this case, as in the case of welfare*, is to insist on reciprocity....

He goes on to tell readers who might object, to relax and that it won’t be so bad. To help get them started, his advice is to skip the fried foods...

Political science is not medical science. What do you get from government? Politics.

* The Wisconsin Works program reduced welfare rolls by 92% between 1986 and 2000. The human costs, however, appear to have been extensive, according to a study by Hudson Institute. Those who were unable to comply with the work requirements were those with the most work obstacles, such as disability or health problem, those with disabled children or lower education. They found themselves without homes or assistance. Minority babies and children appear to have been especially not helped by this government initiative. Examining Wisconsin Birth and Infant Death Reports, adjusting for year-to-year variability, researchers at the Wisconsin Division of Public Health found that the infant mortality rate among Wisconsin African Americans in 1998 was 17.9/1000 births. Infant mortality among whites dropped between 1980 and 1998 from 9.6 to 5.6/1000 and also dropped across the nation. But throughout this same period, there was no change in the high rate of infant deaths among blacks in Wisconsin. According to the recent report available from the Department of Health and Family Services, as of 2002-2004, infant mortality among blacks in Wisconsin continued to be nearly twice that of whites.