Unhealthy Compromise

Our View: Conservative Democrats Are Forcing Changes That Weaken The Health Care Reform Legislation, But It Would Still Represent An Improvement Over The Status Quo

August 03, 2009

The Democrats trying to reform the nation's health care system have met the enemy, and it is them.

With few, if any, Republican votes up for grabs, leaders in the House and Senate have been forced to accept a series of compromises that weaken some of the bill's key attributes. The public health care option to compete with private insurers is in danger; subsidies to help the poor afford health care are being slashed; and, at the same time, provisions to control the rates at which medical procedures are reimbursed are being softened.

In the House, the conservative Blue Dog Democrats - a group that includes Maryland's Frank Kratovil Jr. - has been the driving force in making changes in recent days. Their efforts shaved off $100 billion in costs over 10 years by reducing the value of insurance subsidies, and a compromise late Friday only partially restored them. But amid intense lobbying - and political contributions - by the health industry, they have scuttled a proposal to tie reimbursements under the public health insurance option to those offered by Medicare, which would reduce costs and offer strong competition to private insurers.

The Blue Dogs have wrapped their concerns in the mantle of fiscal responsibility. Mr. Kratovil, for one, wrote on op-ed for The Baltimore Sun last week urging changes to the plan to make sure it doesn't increase the federal deficit. It's hard not to see that worry as political posturing; after all, it didn't extend to their votes on this week's bacon-stuffed pork roast of a defense authorization bill, which included hundreds of earmarks representing billions in spending the White House and Pentagon do not want. Blue Dogs voted en masse for the bill and against amendments offered by GOP Congressmen Jeff Flake of Arizona and John Campbell of California to strip out the earmarks. Mr. Kratovil issued a news release trumpeting his support for the bill, and one of the targeted earmarks, $2 million for missile defense shield components to be produced in Maryland.

If Congress is serious about controlling health care costs in the reform legislation, reducing the value of subsidies for the poor is not the way to go. In Howard County, where the Healthy Howard Initiative is providing a dry run for universal health care, officials have found that even the low-cost plans they have devised for the uninsured are proving too expensive. Dr. Peter Beilenson, Howard's health director, says about 10 percent of the credit and debit cards the uninsured used when they signed up for the program are bouncing for insufficient funds or maxed-out credit limits every month. And that's with a plan that offers subsidies two to three times as generous as the most liberal plans being considered in Congress. Reducing subsidies is no bargain if it means the whole program doesn't work.

The better way to control costs is to change the way we pay for medical care. The current fee-for-service model provides incentives to make sure we get more medical care - but not necessarily better care or better outcomes. Too little discussed in the health debate has been the idea of modeling our health care system on places like the Mayo Clinic and Cleveland Clinic, which provide some of the best care in the world at substantially lower cost than other American hospitals by placing doctors on salaries rather than paying them per procedure.

However, despite their failings, the bills being debated would offer substantial advances over the status quo. Even the watered-down plans accomplish important things: They provide subsidies to significantly expand health coverage; help make health insurance portable so people don't lose coverage when they're between jobs; and prohibit insurance companies from rejecting people for pre-existing conditions.

If Congress enacts a bill that's less than perfect, it will have plenty of opportunities in the next few years to tweak it so that it meets our needs. But if health care reform fails, no politician will even consider the issue for a decade or more. There are still major fights to come - not least, over how to pay for the plan - but we shouldn't let the perfect be the enemy of the good.

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