Sunday, July 12, 2009

Milwaukee County, Scott Walker And Government Run Health Care

Scott Walker gives a rather vague blurb on his campaign website about his views on health care:
We must make quality, affordable healthcare available to hardworking families, through market based solutions like competition, transparency, and tax incentives, not Canadian style programs that put bureaucrats in charge of your health care decisions. You should be able to choose your doctor, not have government make that decision for you.
Government’s role should be to provide a system of checks and balances and a safety net for those who need it, while encouraging competition and transparency to make the system less complicated and more manageable for consumers.
We must also ensure that there is one standard of care for everyone - regardless of age, income level, or location - and that people have the option of taking their healthcare plan with them when they change jobs or move.
I am more than a bit surprised and perplexed by his stance, especially his comment about "Canadian style programs that put bureaucrats in charge of your health care decisions." You see, for seven years, Scott Walker ran a Canadian style program that put bureaucrats in charge of a person's health care decisions.

The program was called the General Assistance Medical Program or GAMP for short. The best description I've found of GAMP, and the benefits it gave to its consumers and to the taxpayers, comes from The Commonwealth Fund (emphasis mine):
Wisconsin's General Assistance Medical Program (GAMP) provides health care coverage to indigent Milwaukee County residents who are not eligible for other forms of public coverage (such as Medicaid and the State Children's Health Insurance Program) and are not enrolled in private coverage. The county redesigned the GAMP program into a community-based primary care model in the late 1990s to achieve two interrelated goals: to provide increased primary care services, and to do so via community-based clinics. The new design was intended to improve effectiveness and efficiency of care. Prior to this, indigent patients relied on the emergency room of the county hospital, which created access barriers for enrollees and cost inefficiencies for the county. Under the redesigned model, GAMP enrollees select a participating clinic as their primary care provider, which is then responsible for providing and coordinating services. The clinic coordinates specialty care for the enrollee by working with specialists and hospitals that participate in the GAMP network. The program covered a total of 24,000 individuals in calendar year 2003, with some 10,000 to 12,000 individuals enrolled at any given time. All in all, GAMP estimated that it saved $4.2 million in 2000 (in comparison to the projected costs had the previous system remained in place). Administrators believe that inpatient and outpatient costs have been controlled largely through a Utilization Management program that ensures delivery of care in the appropriate settings and using appropriate resources.
In other words, the County designed and ran a health care system that limited people's choices by having to go through a community clinic first, and only if it was covered in the network. Yet, instead of leaving people without insurance and forcing them to go to hospital ERs, it saved $4.2 million. That's a big chunk of change for a relatively small amount of people.

Other descriptions of the program include the one from Milwaukee County itself and a report(pdf) from the state after the program just started. The County page calls the program as "nationally recognized." The state's report summarized the program with this sentence:
Inpatient hospital and specialty services constitute the majority of the GAMP budget
although, the program has successfully used primary care services provided in community based clinics and selective utilization management techniques to control and reduce inpatient and outpatient hospital costs over the last two years.
The only reason GAMP ended was because Governor Jim Doyle was able to expand BadgerCare to cover these individuals, taking the load of the county.

I wonder what it will do to Walker's base support when they find out he really is a socialist and ran a socialist health care program for most of his term as county executive.


  1. Actually, Canadians choose their own doctors, hospitals are run by private boards, doctors run their own practice, they don't work for the government and the Canadian health care system has a mere 1-2% overhead cost compare to the 31% overhead cost here in the US. The Canadian Health system IS NOT socialized medicine rather a single payer system. Here doctors have to deal with 150 private insurers. Crazy.

  2. Not a lot of substance in Walker's statement. He's clearly not offering any specifics because he doesn't have any.

    What's next?

    "...and I like puppies. Cute little puppies. Puppies are good..."