We need to reform the reform
The president, Republicans and Democrats in Congress and millions of Americans all agree — our health-care system is broken and must be fixed. We also agree that we must reform how we pay for this system, and, at the same time, reduce the number of people who lack coverage without disrupting the coverage that insured people already have.
However, in Washington it is always easier to talk about reform than it is to make the tough decisions necessary for change. The Kennedy-Dodd health bill put forward by the Democratic Senate has turned the basic goals of reform upside down. Instead of expanding coverage to the uninsured, the legislation upends the current employer-sponsored insurance system, ends patients’ choices and puts a bureaucrat between you and your doctor.
Instead of reforming our insurance payment system, the legislation would allow continuation of flawed policies that incentivize quantity over quality.
More than 160 million Americans are covered by health insurance made available from employers, and more important, most like the coverage they have. But according to testimony by the Congressional Budget Office this past month, millions may lose access to their current employer-sponsored health plan under the Kennedy-Dodd bill.
Health reform, for many Americans, means enacting policy changes that will result in covering the 47 million people nationwide who lack any health insurance. Yet rather than concentrating aid to those who need it most by offering subsidies to low-income families to make health insurance affordable, this bill subsidizes health insurance for those with an income up to 400 percent of the federal poverty level, or $88,200 for a family of four.
Due to such misdirected policy proposals, the current Kennedy-Dodd plan for “reform” still leaves 34 million in our country without health insurance. This is unacceptable, and many are right to wonder, “Where, exactly, is the reform?”
Unfortunately, you won’t find reform in how we pay for health care. Medicare currently pays doctors and other providers based on the volume of care, such as the number of tests performed or the number of office visits a patient has. As one would expect, this encourages more prescriptions, more tests and more surgeries than might otherwise be necessary.
More care, however, doesn’t always mean better outcomes. Yet unfortunately Medicare’s current structure encourages more by paying for more, which increases costs but doesn’t necessarily improve health. It’s the worst of both worlds.
To reduce costs and improve quality, we need to uproot this broken system. As a nation, we spend more than 17 percent of our gross domestic product on health care — in 2009, it is estimated this spending will amount to more than $2.5 trillion. We don’t need to spend more, we need to spend better.
There is a lot agreement on where health-care reform should end up. Unfortunately, the policymakers steering the effort are reading the map upside down. Instead of providing needed coverage to the uninsured, reducing costs and improving quality, we are going to tear down an employer-sponsored insurance system that most Americans believe works for them, begin to establish a single-payer system that eliminates choice, and increase costs without improving quality.
It’s not too late to get this right, but it will require setting aside partisan politics and working together to find the right solutions for our nation.
U.S. Sen. Gregg, a New Hampshire Republican, is ranking member on the Senate Budget Committee and the former chairman of the Health, Education, Labor and Pensions Committee.