Cut costs to expand care

November 11, 2003

PRESSURE ON the General Assembly to address Maryland's growing health insurance crisis is coming from all directions.

Employers moan that they can't afford to keep up with double-digit increases on premiums for their workers. Advocates for the growing ranks of jobless and others without health insurance warn that cutting off access to primary and preventive care is also expensive.

And screeching in protest from the top of its lungs is the state budget - nearly one-sixth of which is consumed by Medicaid, the health care program for the poor and disabled that tries in vain to fill in the coverage gaps.

Gov. Robert L. Ehrlich Jr. and legislative leaders agree that they have to move quickly on corrective action, and are holding a summit tomorrow with industry and advocacy groups to start crafting their approach.

The place to begin is with controlling costs, particularly on pharmaceuticals - a principal contributor to the rise in health insurance premiums. Allowing for broader use of generic drugs, bulk purchasing and similar tactics would relieve some of that pressure.

Early steps should also include a revamping of the medical liability system to weed out bad doctors but spare the good ones from unbearably burdensome malpractice insurance premiums.

Savings in these and other areas would make it easier to expand state help to Marylanders most urgently in need, which includes nearly all low-income adults except the poorest of the poor. Medicaid in Maryland offers generous benefits, but is among the stingiest in the nation in determining who is poor enough to qualify for coverage.

The ultimate goal is sometimes described as universal health care, but that already exists in Maryland because no one is turned away from an emergency room. For those with ailments that could be treated elsewhere or avoided altogether, though, such high-priced service is inefficient and a drain on the system.

Doing the job right would probably require a complete overhaul of the national health care system at the federal level that addresses issues such as the future of health insurance as an employer-paid benefit and the financing of long-term care.

But Congress - currently struggling just to modernize Medicare - is not yet up to the broader task. So it falls to the states, which often serve as laboratories for potential national solutions.

Even at the state level, the issues are dicey. Should employers be induced to offer health insurance through tax credits, or forced into it through a play-or-pay approach? Should the Medicaid benefit package be trimmed so more people can be covered? Should health insurance coverage be better managed so benefits are not wasted?

Resolving such questions may be too big a task for one General Assembly session. It is encouraging, though, that a consensus for at least a phased-in approach appears to have developed.

If lawmakers can lock arms to fend off the drug industry lobbyists and malpractice lawyers and shrink the costs of pharmaceuticals and legal fees, they will be off to a good start.

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