A Times Editorial

Health care for Main Street

President Barack Obama smartly shifted the focus of the health care debate on Wednesday night from the partisan battles in Washington to the practical impact on Main Street. In a nationally televised news conference, the president reminded Americans that reform is not only about providing coverage for 47 million uninsured. It is also about controlling premiums and costs for families who have insurance. It is about helping employers find affordable plans for their workers. And it is about reforming a system that is not sustainable.

"We just can't afford what we're doing right now,'' the president said.

Obama emphasized the efforts to make health insurance available and more affordable. He reaffirmed his commitment that health care reform would not add to the deficit. But he did not embrace specific proposals to pay for it all — and that is the hard part.

Critics have a point that there should be more emphasis on containing health care costs. Providing universal coverage without fundamental changes to how health care is delivered would be financially reckless. There should be a shift from the fee-for-service model, which encourages doctors to bill for more office visits and tests of marginal value, to a model based more on measuring the most effective outcomes for patients. But it is tough to move beyond those generalities — and many of those who argue for more cost controls play both sides by then complaining about rationing care. Controlling costs is going to require offering incentives to doctors who embrace some types of treatments and penalizing those who insist on clinging to those that may be more familiar — and more financially rewarding.

Obama and congressional Democrats are pursuing the creation of an Independent Medicare Advisory Council, which would make recommendations on Medicare payments and other reforms to the president. The president could approve or reject each package, and Congress would have an opportunity to void them. Depending on the makeup of the council, it is an idea worth pursuing. There is a similar Medicare commission now, but its recommendations are advisory and too often ignored.

It would be helpful if more members of Florida's congressional delegation made positive contributions to the health care debate instead of acting as obstructionists. Rep. Kathy Castor, D-Tampa, has been a strong advocate for better access to health care for children and notes that the Democrats' proposals also would help seniors bridge the so-called doughnut hole in Medicare prescription drug coverage. Rep. Ginny Brown-Waite, R-Brooksville, has been resorting to predictable scare tactics. She suggested in a short speech on the House floor this week that the Democrats' proposals "essentially said to America's seniors: Drop dead.'' She also criticizes the proposed cuts to Medicare Advantage, which has driven up costs and amounts to a giveaway to private insurers. If Brown-Waite sincerely cared about the seniors in her district, she would be an advocate for controlling health care costs and shoring up Medicare instead of defending the waste that threatens its future.

"Even though we have a few issues to work out,'' Obama said, "what's remarkable at this point is not how far we have left to go — it's how far we have already come.''

Do not call time out now. That is what the special interests want. The president and Congress should keep pushing toward legislation that would provide universal coverage and contain health care costs without adding to the deficit. The status quo is not an option.

Health care for Main Street 07/22/09 [Last modified: Wednesday, July 22, 2009 10:05pm]

    

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