April 4, 2007 | Commentary on Health Care
Washington - Most Americans think that health care costs too much, too many people can't afford insurance and the entire system needs to be reformed.
Most Americans also say no to government bureaucrats interfering with doctor-patient relationships, taking away their existing health coverage, invading their privacy, limiting their right to seek better care or jacking up their taxes.
Can Congress address the first set of problems without causing the second set? Not if it heeds the stale and windy rhetoric about comprehensive health care reform being emitted by most of the current crop of presidential candidates and members of Congress.
But the answer changes to a resounding "Yes," if Congress takes the detailed legislative remedy prescribed by Sen. Tom Coburn, R-Okla., the Senate's only physician.
Coburn is sponsoring a big bill called "The Universal Health Care Choice and Access Act," or S.1019. The legislative equivalent of a Cecil B. DeMille production, it's a big picture rethinking of how the $2.2 trillion public-private conglomerate known as America's health care system should operate.
Coburn's remedy would consolidate existing federal efforts to focus on promoting wellness and preventing chronic diseases - concerns which account for three out of four dollars spent today on health care. It would also radically reform the $329 billion Medicaid program for the poor and indigent.
Traditional Medicare, the huge government program for retirees, would remain as it is today, unchanged for the millions already enrolled in it. But for the next generation of seniors, Coburn would expand and improve the Medicare Advantage program, which offers integrated care and already enrolls roughly one out of five seniors The idea is to help Medicare absorb the shock of the first wave of the 77 million baby boomers set to retire in just five years.
To help restrain spiraling medical malpractice insurance costs, Coburn would create specialized "health courts" to adjudicate legitimate medical issues at the state level. The goal: protect patients and reduce frivolous litigation.
Even more importantly, he would change the private health insurance market so that insurers would be forced to compete directly for consumers' dollars. How?
By giving individuals and families tax breaks to buy health insurance. This would let people choose their own health insurance directly, just like they do with auto or life insurance.
The tax break would put people on the same playing field as corporations - meaning workers would no longer have to pay 40 percent to 50 percent more for the same coverage provided through work, and could take their coverage with them if they decided to change jobs.
Research shows that the major problem facing the uninsured is not that they don't have access to coverage, but that they have trouble keeping it once they have it. Coburn's policy prescription is to tie health insurance to the person, not the job.
A second big change is the Coburn bill's provision giving individuals and families dissatisfied with their health coverage the legal right to shop for a better health plan anywhere they want, even if that plan is being sold in another state. In effect, Coburn's bill would allow interstate commerce in health insurance - a given in virtually every other area of the economy.
This right would create a national market for health insurance, which would lead to large national pools, an increase in the spreading of health risks, and lower administrative costs.
Today, the only class of Americans who enjoy the equivalent of a national market for private health plans, being able to choose among a variety of coverage options whether they reside in Seattle or Santa Fe, are members of Congress and federal employees enrolled in the consumer-driven Federal Employee Health Benefits Program (FEHBP).
If, like many members of Congress, you think seniors should be able to buy cheaper drugs in Canada, you can't have a logical objection to young working families in, for example, California buying a more affordable health plan in Iowa.
The supreme value of the Coburn proposal is that it preserves what is best in the American health care system: the provision of high quality specialized medical care, the comparatively quick and effective treatment of patients and a level of medical professionalism that is the envy of the world.
At the same time, it fixes what is clearly broken: slow and ponderous government bureaucracies, an excess of red tape and tax and regulatory barriers that keep individuals and families from getting and keeping insurance of their own choosing.
Coburn has written the right prescription. But do his congressional colleagues have the imagination to grasp its significance, and the courage to follow it?
Robert E. Moffit, Ph.D., is director of the Center for Health Policy Studies at The Heritage Foundation.
First appeared in The Examiner