Laying the foundation

The campaign for comprehensive healthcare reform reaches its make-or-break point Sunday, when the House could vote to send the Senate’s proposal to the president’s desk -- or to kill it. Although the vote will be shrouded in a procedural controversy, the bottom line is clear. We urge representatives to approve both the Senate-passed legislation and the reconciliation bill that would improve it. The measures won’t solve all the problems in the healthcare system, but they would make significant progress toward that goal.

The Senate bill, HR 3590, is a multifaceted effort to deter insurers from cherry-picking policyholders, spread the risk and cost of illnesses more broadly and promote more efficient and effective treatment. Instead of throwing out the current system, which relies on employers, private insurers and government programs to pay for care, it works within it to try to change the way healthcare is delivered and paid for over the long term. Its boldest features are a controversial mandate that all Americans buy insurance and federal subsidies to make the coverage affordable to the working class.

Some critics argue that the country can’t afford a new healthcare entitlement. Others resent the idea of using their tax dollars to pay for other people’s insurance, even though that’s what Medicare and Medicaid do today. And many say it’s un-American, even unconstitutional, to mandate coverage. Such every-man-for-himself thinking ignores how interconnected we are as a society, how important health is to productivity and how much of a drag healthcare costs are on economic growth.

Everyone has a stake in improving public health, just as we all have a responsibility to pay our share of the cost. In addition, the large and growing number of uninsured distorts the system, acting as a hidden tax on the insured. Many of the uninsured don’t get preventive care, and once they’re sick, they wind up in the most expensive place to get treatment -- the emergency room. Insuring them is vital to making the system more efficient and improving the quality of care, which are key to slowing runaway costs.

The Senate’s approach has its flaws, as this page has noted before. The reconciliation bill, HR 4872, would fix some of them; among other things, it would eliminate the special treatment the Senate granted Nebraska’s Medicaid program and Florida’s Medicare Advantage recipients. On some issues, though, the bill moves in the wrong direction. In particular, it would delay until 2018 the onset of an excise tax on high-cost insurance plans. That tax was expected to trim demand for unnecessary medical services by raising the price of policies with low out-of-pocket costs. The bill also tosses in a wholly unrelated measure to eliminate the banking middlemen involved in federally subsidized student loans.

The national debate over the legislation, though, has been focused almost exclusively on the Democrats’ maneuvering and non- issues such as “death panels” and “government-run healthcare.” Republicans persuaded the public to fear “Obamacare,” even as pollsters found broad support for its key provisions. There was little substantive debate over risks that the overhaul might realistically pose, such as the chance that the influx of new patients could drive up prices and overwhelm state Medicaid budgets; that more people could opt to go uninsured until they need expensive care; that the inducements to spend too freely on care could be replaced by incentives to skimp on treatment; and that the public’s relentless demand for medical services could hinder any effort to parespending, even on ineffective tests and procedures.

Yet these concerns shouldn’t persuade lawmakers to cling to the status quo. The problems in the current system are so deeply ingrained and intertwined, they defy the incremental approach favored by the GOP. To be effective, the change has to be comprehensive, addressing cost, access and quality. And change on that scale inevitably brings new challenges.

The Democrats’ proposal is just the first iteration of a better system. The package before the House may not have all the right pieces, but it lays the foundation for more efficient, effective and humane healthcare. House members should not hesitate to vote for both bills in the package and make healthcare reform a reality.