HEALTH CARE

Accessibility Through Affordability

We all agree that individuals and families need access to health care.  The only question is how to expand that access.  Is it through a combination of government support and incentives aimed at helping families purchase private insurance, or by expanding government-delivered health care and moving our nation toward a nationalized system?  My position is based on one simple fact: The United States has the best health care in the world; it’s just that the costs are making it unaffordable for too many Americans.

Based on the results of government-run health care in other countries, I cannot support a drift toward that type of system.  While these systems profess universal coverage, the question is “what kind of coverage?”  If care is rationed to the point where certain procedures are not covered or waiting periods are measured in months not days, one has to wonder whether they truly have coverage at all.

I regret many aspects of the new health care law championed by President Obama and pushed through a partisan Congress.  For one, while the new law may appear to increase access, it actually does nothing to lower costs.  Hence, the system is unsustainable.  Meanwhile, as Americans learn that they aren’t getting what was promised (like so many government services), our nation’s health care system will cease to be the finest in the world and will sink into mediocrity.

Here are some of the reasons we need to start immediately to make necessary fixes to the Patient Protection and Affordable Care Act.

Too many Oregonians will lose their existing coverage: The law provides an incentive for businesses to drop employer-provided coverage and dump their employees into a government-run regional exchange.  According to a study published by McKinsey Quarterly in June of this year, 30% of private employers will shift their employees from their company plan into the government health care exchange plan.  That is a staggering number.  Hundreds of thousands of Oregonians would be forced to change their health care plan once the law goes into effect in 2014.  Their government-run plan will be managed through the principle of cost control (fewer covered medical procedures), not quality of care.

Tax increases: The law raises taxes by $400 billion and directs every penny of that tax increase into a new health care entitlement program.  With all the talk about reducing the deficit and debt, why are we raising taxes to fund new entitlement programs that are sure to cost more than originally estimated?

Medicare cuts: The new law cuts Medicare by $500 billion and directs every penny of that savings to the new health care entitlement program.  Again, with the Medicare system going bankrupt and the explosion of deficits and debt, why are we taking money from Medicare to give to a new, controversial entitlement program?  Please find my views on preserving Medicare by clicking here.

BETTER SOLUTIONS

So how would I expand access to health care as an alternative to the Obama health care plan?  I support proposals that retain the current private health care system, with all of the quality that it can provide, but makes that system accessible to more Oregonians.

Small employer insurance: One of the biggest obstacles to health care coverage for Oregonians is that they work for a small business that can’t afford to offer health care to its workers.  At a time when we are trying to encourage small business growth – and thus jobs – why should employees of big corporations get better coverage just because they can leverage their massive “buying power?”   I support the expansion of purchasing pools, which allow small businesses to band together to purchase insurance as a group.  This would reduce their premiums and expand their insurance options so that they are on par with larger businesses.

Support community health centers: As a board member of the Virginia Garcia Memorial Foundation which assists in funding the Virgina Garcia Community Health Centers in Washington and Yamhill Counties, I am well aware of how community health centers (CHC’s) can provide essential care to low-income Oregonians who may not otherwise have access to health care.  As New Jersey Governor Chris Christie recently stated, “Community health centers are an essential part of our health safety net for those who otherwise would not have a medical home.”

CHC’s are cost-effective, locally-governed clinics that require each patient to pay for care based on their income. In fact, nearly half of the operating budget of Virginia Garcia comes from the patients themselves.  Whether patients contribute a lot or a little, CHC’s promote responsibility and preventive care, thereby reducing the overall financial burden all Americans must carry for the underserved.  On average, a single emergency room visit in Oregon costs the health care system an estimated $1,900. Contrast that to an entire year of preventive care at a community health center, where the system cost averages $765 per patient.

Wyden plan: While the existing employer-based insurance model served a valuable role for a time in our country, it’s time to look at different models that can place coverage at the individual level, where it ultimately belongs.  Sen. Ron Wyden (OR) has proposed the Healthy Americans Act and deserves credit for starting this discussion.

Under his bi-partisan plan, an employee would have their employer-provided insurance converted into salary so they can go into the private market and purchase a health plan that best suits their situation.  Most importantly, if the employee ever had to change jobs, lost his or her job, or became too sick to work, the health plan would follow the individual.  While I disagree with the proposal’s mandate that individuals buy insurance – we will soon find out if the so-called “individual mandate” violates the U.S. Constitution – making the health plan an individual plan, rather than an employer-provided plan will help ensure that people don’t lose their insurance.  By creating a large private market for individuals to buy health insurance, insurance companies will have to compete for that business, much like car insurance.  Market competition will lower rates and increase customization and customer service.

Allow consumers more choice:  Another sensible way to increase market competition and lower the overall costs of health insurance is to allow consumers to purchase coverage across state lines.  Some states have placed onerous and costly requirements onto insurers in an effort to require “Cadillac” plans for all state residents.  But, if you live in a state that requires all insurers to cover services you have no interest in (plastic surgery, fertility, toupees) you are prohibited from purchasing cheaper coverage from another state.  This artificially increases the cost of insurance.  We must encourage a broadening of the insurance marketplace by allowing consumers to purchase their coverage across state lines, and to take their coverage with them if they move from state to state.

Tort reform:  One of the leading drivers of the extraordinary growth in the costs of health care is our overly litigious society.  Many Oregon doctors tell me they can diagnose a patient with nearly complete certainty by only running one or two relatively inexpensive tests.  Yet, the fear of litigation and the need to practice “defensive medicine” means doctors feel compelled to order a battery of up to a dozen highly expensive and usually unnecessary tests.  This defensive medicine raises the cost of care, increases everybody’s insurance premiums and wastes valuable resources.

One of the main challenges we face in delivering health care to all Americans is how to expand the number of healthcare providers like doctors so as to serve more patients as we expand access.  Unfortunately, many doctors, especially those in specialties like anesthesiology and obstetrics are leaving their practices because they can no longer afford the exorbitant cost of malpractice insurance.  These good physicians are forced out of medicine because of the explosion of frivolous lawsuits and unreasonable jury awards that have become a cottage industry for some lawyers.  We cannot afford to lose good doctors because some lawyers like to use the medical tort lawsuit as if it were a roulette game.

While patients and their families should always be entitled to actual damages caused by a careless medical provider, we must look at capping the punitive damage awards as well as considering a loser pays system to dissuade shady lawyers from filing nuisance suits.  Some states have already successfully instituted common-sense tort reform that is working.  We need this reform on a national level.  Even a progressive think-tank estimates that such national reform could save $207 billion a year just by reducing defensive medicine!

Individual responsibility: Universal access to the world’s best health care system is a great aspiration. But, even if it is achieved there can be no substitute for individuals taking control and responsibility over their own health. Many look to government programs as the answer to all things that ail our citizens, but in many cases that just shifts responsibility. While we need to care for the poor and disabled among us, Individuals living healthy lifestyles and teaching their children to do the same will do wonders for the health of our communities — and drive down the costs of this escalating problem.

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