It All Boils Down To Cost Control

Do you feel dumb as a Q-tip when listening to debates over national health care reform?

I do. In the last few days I count myself among the millions of Americans who have been swabbed into a stupor as politicians and analysts first whipped up a big fog about health care reform and then tried to drive through it.

This last week of discussions would tempt almost anyone to say, “Forget it. Let’s junk the whole idea.”

Instead, just forget most of what you have heard.

The entire debate at the national level has been swept over the waterfall of “universal coverage” when that’s not really the major problem nor the reason for changing our health care system.

The key issue is cost control.

This country has the most expensive health care service in the world and we can’t afford it.

So, turn down the volume on the TV and get worked up over the aspirin that cost a dollar when you go to the hospital.

Instead of worrying about someone who doesn’t have insurance, worry about your own last few weeks of life and consider whether your children or relatives should press the system for tens of thousands of dollars of treatments that might keep you kicking for a few more days.

“President Clinton made a big mistake by saying universal coverage was his bottom line,” suggested Spokane Rep. Dennis Dellwo, the 3rd district Democrat who engineered Washington state’s own health care reform legislation last year. “The key to this thing is cost control, but that has been lost politically because it’s easier to talk about universal coverage.”

Universal coverage is the easy part, the Christmas morning aspect of all of this.

The tough nut to crack, but the one that needs the leverage, is getting a grip on the costs of getting sick.

Businesses - those that insure their workers - already devote 25 percent of their total payroll costs to health care.

Young people are outraged every time they are reminded that onethird of all the billions spent on health care essentially is wasted on old people in their last days of life. Example: a Rand study found that 32 percent of elderly people who received $25,000 heart bypass surgeries in this country didn’t need it and didn’t benefit from it.

In Washington state, it’s particularly important to stay focused on the key issues of true health care reform. This state is now in the final stages of developing a plan that could turn out to be a model for the nation on true cost control, true universal coverage and true health care reform.

“I really think what Washington state is doing is as good as can be done in this country,” said Henry Berman, president and Chief Executive Office of Group Health Northwest in Spokane. “I think it is clear that we will be the first state to have health care reform that actually makes sense.”

That is, unless the bungling hands of a failing federal government effort end up sinking the state’s effort.

The federal debacle could hobble Washington state’s pioneering efforts in at least three crucial ways:

No ERISA Exemption. This isn’t complicated. Very simply, provisions of the National Employee Retirement Income Security Act (ERISA) now allow workers employed by big companies that are self-insured (Boeing, for example) to be exempt from the Washington state reform plan. Congress needs to change the ERISA law so that these exempt workers, who represent 50 percent of the state workforce, can be part of the plan.

Outlaw employer mandates. Washington state says at least 50 percent of a worker’s insurance premium must be paid by an employer, with breaks for small businesses. Congress could pass a plan with no employer mandate, putting the funding mechanism for the state plan in jeopardy.

Insist on an “any willing provider” clause. The state of Washington decided health cooperatives should be able to select the doctors who provide care under their plan. If Congress says all doctors must be part of all reform plans, the state’s ability to control costs by focusing on the use of the most efficient doctors could be eroded.

The state already has jumped off a bridge from the old system. Supporters of reform say it’s essential the key elements of the reform effort stay in place.

“Partial reform just doesn’t work,” said Don Brennan, a State Health Services commissioner. The pieces of the reform puzzle all have to fit together.

To provide universal coverage everyone with a job must pay into the system.

To keep costs down, health cooperatives must be able to choose the most efficient doctors and services.

To provide both a floor and a ceiling on services, the state must be able to mandate an affordable basic health benefits package and also insist on a cap for insurance premiums.

As the white water of the national debate threatens to sink Clinton’s reforms, residents of Washington state would do well to hold on tight and not bail out of their state effort.

This state appears poised to accomplish something the federal government hasn’t - figure out health care reform and make it work.