Congress must do more to curb medical costs

Congress must do more to curb medical costs

Kansas City Star: The comprehensive health care bill passed by the U.S. House is momentous because it grants nearly all American citizens access to health care. About 96 percent under the age of 65 would have insurance, and insurers could not discriminate against policyholders who have the misfortune of becoming seriously ill.

But the House bill falls short of meeting a second essential goal of health reform — controlling the skyrocketing costs of medical care. Final legislation passed by Congress must do much more to move away from fee-for-services incentives to a system that rewards results rather than procedures.

The House bill pays for its reforms with a tax on the incomes of the very rich. That would do little, if anything, to encourage less use of unnecessary services.

The Senate Finance Committee has a better plan — a tax on the expensive “Cadillac” insurance plans that encourage overuse of medical care.

Important omissions

The House bill leaves out a crucial feature that the Senate is considering: creation of a commission empowered to enact measures that would save money and improve patient care in the Medicare program. That kind of panel, properly insulated from lobbyists and political pressures, could enact reforms worth copying in the private sector.

The House bill also proposes a public option to compete alongside private insurance plans, which is an essential safety net for patients. But House members rejected a plan to base reimbursements rates on the Medicare fee schedule. Without that advantage, costs of the public option could be equal to or greater than costs of private plans.

If final legislation includes a public option — and we hope it does — it must be empowered to negotiate rates that lower the costs of treatments, medications and premiums.

Many good ideas have been proposed for reducing waste, mistakes and inefficiencies in medical care.

Some of the most promising reforms: penalties for hospitals with high numbers of preventable errors and infections; more transparency about the true costs of treatments; rewards for doctors and hospitals achieving good results, disincentives for providers who over-treat; and “bundled” payments that provide doctors and hospitals with a fixed amount to care for acutely or chronically ill patients.