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Nick Anderson | Houston Chronicle

What health reform must do

This is a defining moment for the future of health care in America. President Barack Obama and Congress are poised to focus on comprehensive reform this summer, and the outcome will affect every family and the long-term financial health of the country. It is an opportunity that the nation cannot afford to squander. The United States spends far more on health care than other developed countries, yet the health of Americans by many measures is not as good. The current system is not sustainable, and the public conversation about how to change it cannot be allowed to degenerate into a series of scare tactics and partisan attacks. As the details and the cost of potential changes will evolve in the coming weeks, the focus should remain on these guiding principles:

Cover everyone

One of every three people under 65 years old, about 87 million Americans, were uninsured in 2007 or 2008. In this state, the numbers were even worse — about two out of five Floridians under 65, or about 5.8 million residents, had no health insurance. For both economic and moral reasons, any reform should feature universal coverage.

The financial cost of treating the uninsured is borne by everyone through higher health care costs for business, higher premiums for workers and more public money for costly charity care in hospital emergency rooms. Universal coverage would result in more preventive care for more people, which means treating medical issues before they grow more serious and more expensive.

One of the fights will be over how to get everyone insured. Obama and congressional Democrats envision new national or state insurance plans that would offer coverage to those who could not afford or obtain coverage through their employer. That would be a similar concept to Cover Florida, the initiative Republican Gov. Charlie Crist pushed through the Legislature that provides bare-bones, low-cost private coverage.

The lightning rod, of course, is the prospect of creating a government-sponsored health insurance option. Critics label it socialized medicine and contend it is the forerunner of a single-payer system. Those are false charges designed to scare away voters. A public option may be the only means of ensuring there is a viable coverage plan for everyone, and it already has brought private insurers to the negotiating table. So a public option should remain in the mix until there is another way of guaranteeing universal coverage.

Meeting that goal is already proving even more difficult than anticipated. Last week, the nonpartisan Congressional Budget Office unexpectedly concluded that a Senate plan would cost at least $1 trillion over 10 years and still leave 36 million uninsured by 2017. That is too much money for too little, and neither Congress nor the American people should accept anything less than coverage for all.

Cover the cost

Obama has pledged that health care reform will not add to the soaring federal deficit and eventually will help reduce it. That is a pledge that has to be kept, and it is going to take some creativity to make the numbers work.

Using the president's math, roughly half of the $1 trillion cost over the next decade — $635 billion — would come from spending cuts and tax increases. But he would generate $326 billion of that amount by tax changes such as limiting income tax deductions for the wealthiest taxpayers. Congress has not embraced that, and it should reconsider. The rest of that $635 billion would come from reasonable cuts to programs such as Medicare Advantage, which is run by private insurers. The Medicare Payment Advisory Commission said last week that Medicare will pay about $12 billion more for seniors enrolled in those plans this year than it would have under traditional Medicare. Who can argue that resulted in better care for seniors?

The president would raise an additional $313 billion through other cuts to Medicare and Medicaid. Those would include cuts in payments to providers because of increased efficiencies, subsidies to hospitals that treat large numbers of uninsured patients, and payments for prescription drugs. Pinning down the true value of those changes, though, could be difficult.

Other options also should be on the table. That includes taxing health care benefits for some of the highest wage earners with the most expensive policies. This editorial page opposed Sen. John McCain's campaign pitch last year to tax health plans offered by employers and use the money for a refundable tax credit that could be used by Americans to buy their own insurance. But this idea is a significant alteration from McCain's plan, and it would tax only a portion of the richest health benefits. It is not easy to raise more than $1 trillion, and the money has to come from somewhere. Obama should reconsider his opposition.

Build on what works

Practically and politically, a new health care system that covers everyone cannot be designed from scratch. As Obama said in his speech to the American Medical Association last week, patients who are happy with their doctors should keep them. Families who are satisfied with their health insurance plans should stay on them. Do not believe the baseless charges that Americans will be forced to give up their doctors and forced into a government-run health plan. Those accusations are designed to instill fear and protect the status quo for the powerful health care special interests that are part of a $2.5 trillion industry.

Yes, there are going to have to be significant changes. Medical records have to be made electronic to save time and money, reduce errors and improve efficiency. Treatments have to be based on outcomes, not on how much Medicare or private insurance will pay. Something is wrong with a Medicare system where the average cost per patient is some $9,000 in St. Petersburg but more than $16,000 in Miami. Something is wrong with a private health care system where costs vary widely because of local attitudes in the medical community about generating revenue by performing more procedures — with little variance in the health of the patients. This debate is not about rationing care. It is about emphasizing best practices to get the best outcomes.

This president and this Congress probably only have one shot at comprehensive health care reform. The Clinton administration failed in the 1990s, and the Bush administration never tried. The Obama administration needs to get it right for the physical health of all Americans and the fiscal health of the country.

What health reform must do 06/20/09 [Last modified: Saturday, June 20, 2009 10:12pm]
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