First, Quit Feeding the Monster : Insurance: Only with effective cost control can other changes work. The Democratic plan has it; Bush's doesn't.

Just this month, President Bush became aware of technology familiar to most Americans who use supermarkets, the checkout scanner. Soon afterward, he unveiled his health-care reform package. It is a program as out of touch with modern American life as the President is with a supermarket.

We have some of the world's most advanced health-care resources, the world's best-equipped hospitals and some of its best-trained health professionals. When the American health-care system operates at its peak, nothing can match the care that it delivers.

At the same time, only in America, among the most developed Western nations, do working citizens risk personal financial ruin through illness or accident. Our infant mortality rate ranks 19th among industrialized nations. We have more people without ready access to the simplest care than all but one developed society, South Africa.

Our challenge is to build on the best in our system and correct what's worst about it. The health-care reform plan that I and other Democratic senators have proposed responds to American needs. When it's fully phased in, no family need fear that a child's illness or a spouse's accident will leave the family bankrupt. It is designed to provide insurance for all and to control costs.

This plan, called HealthAmerica, would assure every American of basic coverage, either through employer-provided insurance or a federal-state insurance program. An independent agency, the Federal Health Expenditure Board, would negotiate with providers and purchasers of health care to determine an overall national health spending target and payment rates to providers. Reform would ensure coverage of pre-existing conditions and place limits on annual increases in premium costs. The bill would also reduce the paperwork costs associated with the duplicative insurance system in place today.

Our plan's goal is to expand access to health care for all Americans while controlling the overall cost of the system. The plan emphasizes preventive and primary care. It calls for research into the effectiveness of medical treatments and technologies so that health-care dollars are spent wisely on appropriate treatment.

The President's health-care proposal, in contrast, does virtually nothing to control costs--the single greatest problem in the system. His plan would subsidize, not cure, what's worst in our system.

Health-care reform must do three things: control costs, insure everyone and emphasize preventive care. Unless we address all of these elements, we won't have reform. And of the three elements, cost is the single most important limit on care. Unless we address cost control, we will never get insurance for all or increased preventive care.

Cost considerations today make too many families put off the annual checkup or the pediatrician's visit. As a result, care is too often provided in the most-expensive places: hospital emergency rooms. Too many health conditions become acute before they're treated.

The President says costs can be controlled through the use of managed care systems and reform of medical malpractice insurance. They're steps in the right direction. But virtually no one familiar with the American health care system agrees that this is all that's needed to control costs.

Health maintenance organizations and preferred-provider plans offer a one-time saving, but have not reduced health-care cost inflation overall. Our largest corporate employers, the organizations most effective at negotiating the most cost-effective health insurance, agree that managed care alone does not control rising costs.

Liability insurance premiums equal less than 2% of health spending. Reform will be a modest step but not nearly enough.

The President also proposes vouchers to let the poorest Americans buy basic coverage, and tax deductions for working families. But his plan gives only 15% of $3,750--the maximum deduction--to middle-income families taxed at the 15% rate. That's $563 a year. Higher-income families taxed at 28% would get $1,050 a year. In Augusta, Me., the price last month for a basic benefit plan for a family of four was $4,242 a year. In Los Angeles, it was $7,296 a year. Those are premiums for the healthy family. Children with diabetes or severe asthma or allergies mean far higher family costs. The pooled risks of insurance are being less and less equitably shared. We shouldn't be subsidizing this sort of restriction. But that's what the President's plan would do.

Anxiety about health costs isn't just a problem for the uninsured. Some of the most anxious families in America have health insurance. They worry that one illness will lead to the loss of insurance, or that a job change will eliminate their coverage.

Our plan addresses those fears. Contrary to the President's claims, HealthAmerica preserves the right to choose a personal physician. It's a plan to buy more care with the $800-billion plus dollars we now pour into the health system. It preserves and builds on the best in American care, responding realistically to a critical problem.

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