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Mary Grealy, Washington, column: Time to hit 'reset' on health care reform

By Mary Grealy

WASHINGTON -- How did the drive to enact health reform veer off course? More important, how can it get back on track? Those are the critical questions facing American policymakers today.

The most recent Rasmussen poll shows only 45 percent of the public supporting current health reform legislation with 52 percent opposed, and majorities believing reform will raise the cost and lower the quality of their health care. Capitol Hill publications are reporting that it's increasingly likely no health reform bill will pass this year.

So what happened? It's become clear over these past few months that Congress has taken its eyes off the real health reform prize. We don't hear debate and discussion in Washington over how to improve health care delivery or reform our payment systems so that dollars are paying for quality and better patient outcomes. Rather, all discourse seems to be focused on the so-called public option, which has become nothing less than a holy crusade for those who want government more involved in healthcare.

It's not too late, though, to get this effort back on track. Here are some steps that congressional leaders should take to regain a health reform approach that can earn the public's confidence.

** Get serious about a fully insured America.

Right now, the Senate's health reform bills do one very good thing: They require that everyone have access to health insurance regardless of pre-existing medical health conditions. But the Senate doesn't take the next necessary step, which is requiring everyone to accept the responsibility to have coverage.

The bills' penalties for not having insurance are so minor that many healthy Americans will wait until they're injured or sick before buying coverage. That will drive costs higher for everyone who does have insurance.

Then, Congress needs to use tax incentives and subsidies to give low-income Americans a ticket into the system.

The House bill wants to accomplish this goal through an historic expansion of Medicaid. That's potential catastrophe for states already unable to afford coverage for their current Medicaid recipients, as well as for physicians and hospitals that are reimbursed by Medicaid at rates far below the actual cost of providing care.

** End the public option controversy once and for all.

For North Dakotans, a public option is particularly devastating. Blue Cross Blue Shield of North Dakota pays state doctors and hospitals significantly higher rates than Medicare, compensating for the public program paying less than the actual cost of care.

If even one-third of Blue Cross Blue Shield's current North Dakota members move to a public plan, it could cost state health providers more than $130 million a year.

And the cost shift to those North Dakotans still in private plans will cause annual family premiums to rise more than $3300 in the next five years after reform is enacted.

** Make payment and delivery reform visible priorities.

Too little attention has been devoted to these core issues of health reform. Yes, the current reform bills include important pilot programs and demonstration projects, but lawmakers need to spell out a vision of how we can make sure our health care dollars are paying for better health outcomes and not just greater volume of services.

** Stop ignoring the medical liability issue.

To make this bill truly bipartisan, medical liability reform needs to be more than just a passage in a presidential speech.

The Congressional Budget Office has found $50 billion in liability-related unnecessary spending in federal programs alone, because of doctors practicing defensive medicine to avoid litigation. It's a glaring omission to leave this out of health reform legislation.

Too much progress has been made to allow health reform to fail. At the same time, it would be a tragedy to squander this unique, once-in-a-generation opportunity on legislation that falls short of health reform's original objectives and may even do more harm than good.

It's not too late to get this job done right, but time is running short.

Grealy is president of the Healthcare Leadership Council, a coalition of chief executives of the nation's leading health care companies and organizations.