Will health care reform free us from China?

By William Mckenzie

For some time now, it has been frustrating watching the health care debate. The dizzying back-and-forth between President Barack Obama and town hall protesters has not helped.

The discussion still seems mostly about whether to insure more Americans, whether you favor a government plan or whether you believe reforms will force funding of abortions or create death panels.

What about the larger picture?

Think of how we approach the energy debate. It usually isn’t framed around whether we favor this alternative fuel over that one, this car over that one, or this emission control over that one. It often is framed as a way to make us independent of foreign sources of oil.

A similar question now needs posing in the health care debate: Will the reforms free us from the Chinese?

Yes, the Chinese.

They hold about $800 billion of our $11 trillion public debt. We — and our children — increasingly will answer to them if we don’t control that debt.

The Chinese already have started asking questions about our economic course. They even recently told U.S. officials that they hope to see our deficit reduced year to year.

Exorbitant debt

I can’t blame them. I would love to release our economy from their grip. I particularly would love to free our children and grandchildren from having to pay the Chinese and other creditors for the exorbitant debt we’re running up.

That’s why we need another way to view this health debate: Will the proposals put us further into the grips of the Chinese or make us more independent?

So far, the House bill places us more in their grip. The nonpartisan Congressional Budget Office estimates it will add $239 billion to the deficit.

The Senate’s plan remains in flux, so perhaps it will look better. But we still don’t know how we’ll pay for any final Senate bill and whether it will add to overall health costs.

The answer must be solid in both cases before anything reaches the president’s desk. And “solid” means being paid for through a reliable revenue stream and reducing national medical costs.

The best way to create that revenue stream is to cap the annual tax subsidies that employers get for providing employees health care. Washington could see a revenue flow of several hundred billion dollars, if not more. That could pay for a big chunk of the trillion dollars it will take (at least) to finance a health care overhaul.

If limiting subsidies won’t work, I would favor a tax hike, but I wouldn’t limit it to wealthy folks. Congress should extend it to the middle class.

One problem with health care is that we get a benefit for which we don’t pay most of the freight. Either government or employers pay it. We could rectify that by getting more Americans to finance the overhaul.

As far as saving medical costs, the best answer is to change the way Medicare and insurers pay doctors and hospitals. Instead of reimbursing them for each visit or procedure, reward them for the quality of their care.

Local component

Numerous people are talking about this, including Obama and former Medicare chief Mark McClellan. There’s also a strong local component to this. For it to work, local medical providers must change their ways. Think of it this way: We could save a bunch of money if patients weren’t so routinely given costly tests.

It’s harder to put a human face to this part of the debate. It’s much easier to talk about a friend gaining health insurance, or more vivid to talk about Grandma facing a death panel.

But anything that is not solidly financed and does not control health costs will only worsen our debt. And that will make us less free of the Chinese. That’s the issue we need to start considering.

X William McKenzie is an editorial columnist for The Dallas Morning News. Distributed by McClatchy-Tribune Information Services.