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Examining Healthcare: Bill Bathke

Magazine - posted on 9/21/2009

Bill Bathke '72 is executive vice president and chief operating officer with Wisconsin Physicians Service Insurance Corporation (WPS). He has worked for the Madison-based health insurance provider for 27 years. Prior to that, he worked in law enforcement and industrial relations. Bathke has been a member of the Lakeland College Board of Trustees since 2001.

A common battle cry in the national healthcare debate is the need for change. But when Bill Bathke reflects on the healthcare landscape during his nearly 30-year tenure at the state's only not-for-profit insurer, all he sees is change.

"I don't know of another industry that has had as much continuous change over such a long period of time," Bathke said. "Stop and think how much has changed in the delivery of healthcare services and in coverages, options and alternatives for financing of those services."

For example, Bathke's father was diagnosed with heart disease and died at age 49. Today, the care that he would have received would no doubt have extended his life and is considered routine.

"Look at the cholesterol medications that are relatively new that have had tremendous positive impact on curbing heart disease," Bathke said. "Look at the different medications for arthritis and diabetes and improvement in disease management that never existed a dozen years ago.

"Look at the imaging and surgery techniques, even robotics, that are reducing costs and improving outcomes. I see medical procedures and practices in constant change and constant improvement."

Agreeing on an affordable system that provides healthcare for all is a common objective, but Bathke cautions that the solution isn't shifting costs around. Medicare and Medicaid, two large governmentfunded programs, pay, at best, 50 cents on the dollar for services to the provider network. Thus, to recoup expenses, healthcare providers shift the shortfall in fee reimbursement to their private sector clients.

"When this happens, the premiums in the private sector go up," Bathke said. "When premiums go up, it makes it even harder for people to participate in the private financing of healthcare. If you look at it in that context, government is the problem."

"For insurance principles to prevail, you've got to pool and account for risk. You certainly don't insure a house after it's on fire. On the other hand, a person that has insurance on a home that later incurs a fire can expect reimbursement for their losses.

"If we can pool health insurance and we can account for the risk and demographically project out experience, we can fund for it on a responsible basis. People need to be part of insurance pools for it to work and to impact large numbers of people."

Government already plays a major role in healthcare with the Medicare and Medicaid programs, but Bathke sees a number of other areas where government can offer some solutions, including:

Programs like the Health Insurance Risk-Sharing Plan (HIRSP), which offers health insurance to Wisconsin residents who either are unable to find adequate health insurance coverage in the private market due to pre-existing medical conditions or who have had a significant increase (50 percent) in renewal of their present premium, are good options for some people.
Anti-trust and monopoly practices. "We see this massive movement toward bigger is better within hospitals and healthcare systems across the nation. I don't think that's the answer. I think healthcare is very much localized. The government should take a serious look at anti-trust and monolithic practices and intervene where they see such practices occurring."
Research and development. "The private sector is able to take on known risks and to actuarially account for those going forward. But the government is in a far better position to work cooperatively with healthcare providers and society on the research and development aspects of healthcare."
Tort reform. Bathke said some doctors order tests to cover themselves should they be sued. "That can work as a preventative measure against a lawsuit, but it can also add unnecessary costs and act simply as an additional revenue factor for clinics or labs," Bathke said. "Any expense done for either one of those purposes alone is an expense that needs to be looked at a second time. Those dollars can be much better spent in terms of delivery of needed healthcare. Think of the number of procedures that a physician wouldn't have to go through if it wasn't for the fear of malpractice."
Education that will help people to improve personal wellness. So much can be done to prevent problems related to obesity, smoking, diabetes, high blood pressure, drug/alcohol abuse, etc. "Today it seems that health education is delayed and is left to the workplace and many times after problems/behavior have already set in," Bathke said. "If it was part of the process from birth through life, I think it would have far greater success."

"We need to understand the positives as well as the weaknesses of the current healthcare system and know how it is impacting our society," Bathke said. "Then we can focus our energies on turning the weaknesses into strengths.

"I don't think it's the insurance companies themselves that are at fault. Somebody has got to ask 'Where are the charges originating? What's the fairness of those charges? Is there a check and balance in relationship to services provided, benefits achieved and cost being charged?'"

Plenty of people identify insurance companies as a culprit when it comes to the cost of healthcare, but Bathke said he gets letters almost weekly from families thanking WPS for its role in the care of a loved one.

"Those stories are more characteristic of what's happening," Bathke said. "I think the debate itself is very positive and should take place, but it's emotional. People really value their healthcare and they want to be able to have family members seek out quality care and have a choice in that care."

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