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A Times Editorial

On reform, move past fears

The American people should not spend this summer's congressional recess succumbing to the fearmongering and outright lies that some House Republicans and special interest groups are using to erode public support for comprehensive health care reform. The stakes are too high. Members of Congress need to engage in frank discussions with their constituents about the proposals, and encouraging mobs to disrupt town hall meetings like the one Rep. Kathy Castor of Tampa held last week does no one any good. The health care bills still need considerable work, but they are moving in the right direction by seeking to make the system better, easier to access and more affordable for nearly everyone.

Americans spend more on — and get less from — their health care system than residents in any other developed nation. Some 14,000 people lose their health benefits every day. Health care spending is a major drain on family paychecks, business revenues and the federal budget. Polls show that Americans believe reforms are necessary to drive down the crushing cost that is increasingly putting care out of reach, yet they are apprehensive about change. That is understandable.

Fewer concerns are as personal as one's health, relationship with a doctor or adequacy of medical coverage. But fear alone should not drive the debate, because change is inevitable. It is clear the United States cannot sustain the current financing of its health system. The only question is when the nation will act and how it will balance universal coverage with costs and quality of care.

The real reforms

Members of Congress from both political parties have a responsibility to avoid distorting a reform effort that comes once in a generation. While President Barack Obama has not embraced a specific plan, he has laid out critical markers. Remember these when you see the dire television commercials warning of impending doom:

• Insurers could not deny coverage because of pre-existing medical conditions.

• Insurers could not charge excessive out-of-pocket fees, cap annual or lifetime coverage or discriminate against women or those with extensive claims.

• Those who are satisfied with their current doctor and insurance coverage they have now could keep them.

These requirements ought to reassure Americans who already have coverage that their lives would not be upended by reform. Obama also has called for providing coverage to the 47 million uninsured who often seek treatment in hospital emergency rooms — a cost that is largely shifted to paying patients. He insists that the costs of extending this coverage, roughly $1 trillion over 10 years, be paid through spending cuts and targeted tax increases and not be added to the deficit. And he wants to drive down the explosive growth of health care costs. These are all laudable goals, and more Republicans should be working with Democrats to reach them.

Yet none of the health care bills passed by four House and Senate committees garnered a single Republican vote. That needs to change as both chambers pass their bills, negotiate a final version and come to an agreement on how to finance the reforms. To be as successful as Social Security and Medicare, health care reform should be widely embraced by members of both parties.

How to pay for it

Right now, the measures call for creating a government-sponsored health plan to compete with private insurers, require employers to cover their workers, and provide subsidies to help low- and middle-income families afford insurance premiums. But the real focus needs to be on the toughest challenge: financing the reforms. The House proposal would roughly split the costs between cuts in Medicare and Medicaid and new taxes on the highest-earning households. The Senate Finance Committee is trying to find a compromise between House Democrats and Senate leaders, who prefer taxing some health benefits to imposing a new surcharge on the wealthiest Americans. It makes more sense to tax some generous health benefits than to impose a general tax increase that may be needed later to reduce the federal deficit.

There are other fiscal decisions: How needy should a family be to receive government insurance subsidies? How much relief should small businesses receive from the mandate to cover their employees? What can the government strip away from hospitals, health providers, entitlement programs and the pharmaceutical industry? How will the reforms achieve a primary purpose — to structurally reduce the skyrocketing costs of medicine and make smarter use of America's health care dollars?

The scare tactics

Key to understanding these reforms is understanding what they are not:

• This is not socialized medicine.

• This is not a single-payer system.

• This is not an attempt to force elderly citizens on Medicare to give up care and die sooner.

• This is not a government-sponsored health insurance option aimed at forcing private insurers out of business.

So tune out the scare tactics. These poisonous attacks are to be expected from the insurance lobby and conservative commentators such as Glenn Beck. But they should not disrupt the dialogue between elected representatives and their constituents. It is time for congressional delegations in Florida and elsewhere to hear their constituents' concerns — and for constituents to listen to the facts.

Do not let the angry protesters popping up on YouTube, the hysterical television ads or the dire warnings about socialized medicine drown out reasonable discussion. Progress is being made, and maintaining the status quo is not a viable option.

On reform, move past fears 08/08/09 [Last modified: Saturday, August 8, 2009 4:31am]
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