In assessing the predictable political firestorm in the wake of the U.S. Supreme Court’s decision that largely upheld the Affordable Care Act, it’s hard to believe that a mere five years ago senators from both parties urged President George W. Bush to work with them on universal health care coverage.
Signatories to the Nov. 13, 2007, letter included U.S. Sens. Maria Cantwell and Ron Wyden, Democrats from Washington and Oregon, respectively, and Mike Crapo, a Republican from Idaho. U.S. Sen. Jim DeMint, R-S.C., one of the most conservative members of the Senate, also concurred, along with Republicans John Thune of S.D.; Bob Bennett, a senator from Utah who has since been ousted; and Trent Lott, the former majority leader from Mississippi.
The letter states, in part: “Each of us believes our current health system needs to be fixed now. Further delay is unacceptable as costs continue to skyrocket, our population ages, and chronic illness increases.”
That was true five years ago, and it’s true now that health care reform has been affirmed by the highest court. It would’ve been true had the court overturned the law. The difference now is that members of Congress refuse to reach across the aisle. Indeed, only Democrats voted for the Affordable Care Act, and only Republican attorneys general chose to challenge it.
Chief Justice John Roberts surprised many court watchers when he chose to uphold a law that probably offended his political sensibilities. But now, as it is the law of the land, Congress should focus on the many changes that will address its flaws. Revision, not repeal, is the best way forward. After a year and a half of debate and two years of litigation, we need to accept this as the foundation of reform and begin repairing Obamacare’s weaknesses.
Most importantly, the law does not do enough to control health care costs, which will continue to crowd out other spending, to the detriment of other vital services. Massachusetts has passed a law that mandates insurance coverage, and it has been successful in covering the uninsured. But it has not succeeded in tamping down costs.
This is where the focus must be now, and it will take the kind of bipartisanship reflected in that letter from five years ago. This means paying close attention to paying for effective health care, rather than all treatments. This holds true for Medicare, too.
The letter provides an example that has since become politicized: “Encourage more cost-effective chronic and compassionate end-of-life care. Studies show that an increase in health care spending does not always mean an increase in quality of outcomes.”
This sensible approach has been demagogued as “death panels” and “an unwelcomed government intrusion.” In fact, about one-third of health care spending is wasted on unnecessary tests and ineffective treatments, yet Congress has failed to approve even small reforms.
The nation can’t contain costs without getting more surgical about spending. And we can’t do that if all political energy is expended on fighting and defending the first step.
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