Incremental steps better than monster health bill

Among the most recent dust-ups regarding the massive health care reform bill awaiting action in the Senate was a demand late last week by labor leaders that Democrtas eliminate the tax on so-called “Cadillac” health insurance plans. The tax wouldn’t affect only corporate fat cats, the labor leaders rightly proclaimed, but would tag many middle-class Americans who traded higher wages in favor of better health plans through their employers.

That issue followed a variety of disputes — from abortion to expanded Medicare coverage to pay caps for insurance executives to the multiple permutations of the public option — that have dogged health care bills.

At more than 2,000 pages and growing, the bill has become too large to fail. The legislation has so many moving parts that it’s impossible to keep track of all of them or know with any certainty what their consequences will be. When it affects 16 percent of our national economy and likely will increase our rapidly mounting national debt, the consequences for all of us could be unimaginable.

Frankly, we believe it’s time for Congress to drop this Rube Goldberg approach to health care reform — in which new sections are continually being added to the battered legislative contraption while members hope they can still make it function.

A better approach is to attack health care reform incrementally, focusing first on cost containment. Keep costs from continuing on their skyrocketing trajectory and you will prevent families and businesses from dropping health insurance. You also will make it more feasible to provide coverage to those who are now uninsured.

We don’t claim to have a simple idea to accomplish cost containment. Indeed, we don’t believe there are any simple solutions. But there are measures that have been suggested which can begin to make a dent.

One such measure, discussed by many people but absent from both the House and Senate versions of the health care bill, is to abolish the ban on buying insurance across state lines. The ban was created because individual states wanted to regulate insurance within their boundaries. But it has proved costly and inefficient, while in today’s world offering no great protection to consumers.

Especially in states where very few insurers operate, eliminating the ban would spark competition and help stabilize, if not reduce, insurance prices.

Additionally, we think the government should expand the availability of HSAs — health savings accounts — that allow individuals to set aside a portion of their pre-tax pay into a savings account they can use to pay health care bills and purchase insurance. Any money left over at the end of the year can be rolled into the following year and, eventually put toward retirement.

HSAs provide incentives for individuals to spend their health care dollars carefully and to shop for the best insurance deals. They won’t work for everyone, but they make sense for many people and will help contain costs, especially if they’re linked to high-deductible, catastrophic health insurance plans.

One of the serious problems related to health care costs stems from the fact that medicine has evolved in recent decades in such a way that it rewards doctors, hospitals and clinics based on the number of patients they see or the procedures they perform, rather than on the overall quality of care.

Several measures aimed at addressing that issue are included in the Senate bill now. And they would be expanded upon by amendments offered last week by Senate Democratic freshmen, including Colorado’s Michael Bennet and Mark Udall.

For example, one of the freshmen amendments would expand a proposed pilot program on what’s called “bundling” of payments — offering a single comprehensive fee for treatment of certain medical conditions such as diabetes instead of charging separate fees for each doctor visit or each procedure performed.

There is also a pay-for-performance pilot program for Medicare that would be expanded under the freshmen amendments.

These are among several good ideas that could be implemented through individual legislation. They don’t have to be part of a huge health care bill, nor do they require the massive new bureaucracy that the bill would create.

We also think there should be tougher rules to limit physicians’ financial entanglement in surgical hospitals or ownership in costly diagnostic equipment. That sort of financial linkage creates incentives for doctors to perform more costly procedures than they might otherwise recommend.

There are no doubt many other ideas being developed to curb costs by people with substantial expertise in health care. Those that have merit should muster enough votes in Congress to be implemented.

The notion that we have to fix health care with one massive, many-faceted bill — which will have thousands of unforeseen consequences and whose impact on our national economy is far from predictable — should be as obsolete as a 1940s x-ray machine.


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