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Sunday, June 21, 2009

Address Flaws in Health System

By U.S. Sen. Jeff Bingaman
New Mexico Democrat
      Health care costs in our country are out of control in large part because our system rewards more care, not better care. Americans spend $2.3 trillion per year on health care, yet nearly one-third — or $700 billion — is attributed to waste and does not improve the health of Americans.
       At the same time, nearly 50 million Americans lack health insurance, in many cases because it's too expensive and they can't afford it. Nationwide, an estimated 20,000 Americans die per year because they can't find affordable health insurance.
       In New Mexico, the problem is particularly acute; we have among the worst statistics in the country. About one in four New Mexicans is uninsured, and many of them actually have full-time employment.
       Having such a high uninsured rate makes the problem of costs worse. It's estimated that in 2008 our health care system provided $116 billion worth of health care to uninsured Americans. Of that amount, the uninsured paid about $43 billion out of their own pockets. Charities and government initiatives picked up about one-quarter of the total. But the remaining amount — $42 billion — was paid for by those of us with health insurance — in the form of higher charges for services and higher premiums. Families USA estimates the average American family paid about $1,000 in higher premiums to compensate for the care given to the uninsured.
       Equally problematic is the fact that 25 million Americans have health insurance that doesn't meet their needs. Problems of the underinsured can be anything from plans that don't pay for necessary treatments to prohibitively high co-pays for routine visits. According to a Harvard University/Ohio State University study released this month, more than 60 percent of all personal bankruptcies in 2007 were filed as the result of medical bills.
       Our health care system is clearly broken. The time has come to fix it.
       Last week, the Senate began developing legislation to reform health care in our country. I am fortunate to be on the two Senate committees that will be responsible for crafting the bill. Many months of Senate hearings helped prepare us for this debate. I came away from those hearings believing two things. First, we must find a way to make quality health care affordable for all Americans. And second, those Americans who like what they have must be able to keep it.
       Though it will not be easy to find agreement, I will be pushing hard for a bill that deals with three key areas: ensuring that every American has access to affordable health insurance, containing health care costs and improving the quality of care.
       The key to improving access is making sure health insurance works for everyone, that everyone is contributing to the system, and that everyone can afford insurance.
       To make sure health insurance works, we must clearly define what a basic insurance plan must cover. We must also end the practice of insurance companies denying coverage for pre-existing conditions, or preventing Americans from renewing an insurance policy. Insurance companies should also be prohibited from placing limits on annual or lifetime health care coverage.
       Everyone must pay into the system in order for insurance to be affordable and to work. This is because insurance companies must draw from a large pool of both healthy and sick people to cover their costs through reasonable premiums. Part of reform is making sure younger and healthier people are buying coverage now rather than only when they get older and sicker. For this reason, reform will likely include a requirement that all Americans pay into the health care system.
       But with this requirement we have an obligation to help ensure that lower-income Americans can afford insurance, and I support doing so through a substantial tax credit for individuals and for small businesses that offer employees coverage.
       For reform to succeed, we must go beyond expanding access. We also have to address the underlying flaws in our health care system that lead to unnecessarily high costs and poor quality.
       Health care costs are rising at nearly twice the rate of inflation. The bill we send to the president should shift us from a system that emphasizes “sick care” to one that emphasizes prevention. We can do this by minimizing co-pays for preventive medical visits that could help identify problems before they become serious.
       When problems do arise, we should be incentivizing the best and most efficient care. There are many reforms that we can adopt to do this, including embracing evidence-based medicine, reducing medical errors, preventing avoidable hospital readmissions, and better utilizing health information technology.
       Moreover, because there isn't an unbiased source of information for patients and doctors to rely upon, billions are spent annually on medical care that is unnecessary and sometimes even harmful. We should develop a resource for health care professionals and the public that provides information about which medical interventions are appropriate. For example, what medications work best for a given condition or if a surgery being considered is effective.
       Finally, I believe it is important that reform includes real competition between public and private insurance plans. The only way to do this is to make sure there is at least one plan whose focus is providing care — not simply making a profit. Such a plan could take many forms, ranging from a federal cooperative patterned on rural electric companies to a nonprofit insurance plan. But whatever form it takes, we must ensure there is fair competition and all plans are playing by the same rules.
       It has been clear for years that our health care system is broken. The burden of paying for health care continues to grow. Tens of millions of Americans lack coverage and tens of millions more live with financial insecurity because the coverage they have doesn't meet their needs.
       We must not miss this historic opportunity to rein in health care costs and to expand and improve health care for New Mexicans and all Americans.
       

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