March 17, 2010

Cost control essential if health care reform is to succeed

WASHINGTON — A recent column challenged me to put forth my ideas on controlling health care costs and said that the "debate (on cost) should start after the establishment of universal health care."

Contrary to the columnist's view, I believe that cost control is essential for reform.

I am disappointed that the Senate bill did not do enough to rein in costs and to provide consumers with more affordable choices. Unless costs are brought under control, an expansion of coverage will be unsustainable in the long run.

Throughout Maine, families and small businesses are struggling with the soaring costs of health insurance. Yet, the Senate bill would increase health care costs and impose billions of dollars in new taxes, fees and penalties. Many of these new taxes and fees would be passed on to consumers.

According to the government's own actuary, America would actually spend $234 billion more on health care if this legislation were to become law. I could not support such a bill.

The good news is that some areas of the country, including Portland, are leading the way in developing models that provide excellent health care at a lower cost. Studies show that other areas, however, such as Louisiana, provide lower-quality care at a much higher cost.

There is potential for tremendous savings if reforms are implemented. A Dartmouth study found that, if all health care providers were able to achieve the same level of efficiency as the famed Mayo Clinic, U.S. health care spending could be cut by almost 30 percent.

We should enact delivery system reforms that reward value rather than volume and quality over quantity. For example, paying physicians, hospitals and post-acute care providers separately for each service is inefficient and costly. Bundling these payments will save money and improve patient care.

The Senate bill did call for a pilot program on bundling. To strengthen this, I offered an amendment to start the pilot sooner and to give the secretary of Health and Human Services authority to expand the program if it reduces spending without compromising quality.

During the debate, I offered several bipartisan amendments to reduce costs, increase transparency, and improve quality. One addressed the inexcusably high rate of hospital-acquired infections. An estimated 1.7 million Americans acquire one of these infections each year, with 99,000 dying. These infections extend hospital stays and increase costs by $30 billion annually.

The Senate bill would begin penalizing hospitals with high infection rates, but not until 2015. Our amendment would have increased the penalty and implemented it sooner, saving more than $8 billion over 10 years and improving the quality of care. Unfortunately, we were denied a vote on it.

Another source of savings is liability reform to reduce frivolous lawsuits and lessen the costly practice of defensive medicine. The Congressional Budget Office estimates this could save $54 billion in health costs over the next decade.

The Senate bill would lead to fewer choices for many middle-income Americans and small businesses. Under the bill, all individual and small group policies sold in the United States must fit into one of four categories. But I am concerned that one size simply does not fit all. In Maine, 87 percent of those purchasing coverage in the individual market have a policy that does not meet the standards in the bill.

Americans should have the choice to purchase more affordable coverage. Therefore, I joined two Democratic senators in authoring amendments to advance the goal of more affordable insurance and more choices. One amendment would have allowed individuals who do not qualify for subsidies to purchase lower-cost plans.

We also included health insurance vouchers that would have provided more options for employers and employees, and we proposed incentives for insurers that keep rates low while penalizing inefficient, high-cost insurers. Unfortunately, once again, we were prevented from getting votes on these ideas.

As our inability to have the Senate vote on our bipartisan amendments demonstrates, the process for considering this important bill was fundamentally flawed. The bill was largely written behind closed doors and riddled with special deals to garner votes.

These include hundreds of millions of extra Medicaid dollars for Louisiana and Nebraska. That is unfair to other states, and that these favors had to be included to win enough votes tells you a lot about the merits of the bill.

Our health care system needs fundamental reform. But central to reform is the imperative to find ways to control the costs that have driven up the cost of coverage for families, employers, and governments alike.

The challenge now before the Senate is to work together, in a transparent manner, to develop a new, bipartisan proposal that can accomplish these goals.

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