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Healthcare's hurdles

Democrats in the House get their way, but what we need is real debate. If only the Republicans would oblige.

November 09, 2009

The House passed a sweeping healthcare reform bill Saturday despite the opposition of virtually every Republican in the chamber as well as 39 mainly centrist Democrats. This illustrates both the success and the failure of the Obama administration and House Democratic leaders on this issue. On the one hand, they've sold lawmakers in both parties on the need to rein in rising healthcare costs. But on the other, a significant minority on Capitol Hill -- and a sizable portion of the public -- don't see the connection between controlling costs and extending affordable insurance to all Americans.

Nothing illustrates this disconnect better than the House Republicans' proposed substitute for the Democrats' bill. The GOP proposal is devoted mainly to curbing the growth in healthcare spending by reducing state mandates on insurance providers, restricting damages in medical malpractice cases and rewarding states for keeping rates down. It also would reward states if they reduced the number of uninsured residents, but, according to the Congressional Budget Office, the proposal would leave the same percentage of Americans uninsured a decade from now as are uninsured today.

The GOP's ideas aren't bad, exactly. It's just that they don't tackle the systemic problems in the healthcare system. Those problems -- including uncoordinated care, misplaced incentives, overconsumption of services and widespread cost-shifting -- won't be solved without dramatic changes in the way healthcare services are sought, delivered and paid for. And a fundamental part of the solution is bringing as many people as possible into a new system that pays for results, not procedures, and provides powerful incentives for prevention and wellness. That means insuring them. Such an approach would be far less costly and inefficient than the current one, which leaves the uninsured to be treated in emergency rooms and recoups their unpaid bills from patients with insurance.

We'd all benefit from a vigorous debate between Republicans and Democrats over the best way to do that. Unfortunately, the GOP is posturing rather than offering meaningful alternatives. Even its cost-control proposals aren't as effective as the ones in the House Democrats' bill. Republicans can do this with little political risk because their constituents don't understand how much the insured stand to gain from overhauling the system and covering the uninsured. That perception is a critical hurdle to healthcare legislation. As Senate Democratic leaders scramble for enough votes to overcome a filibuster, supporters of comprehensive reform need to make a far better case for why half-measures like the House GOP proposal won't do.

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