Editorial: Health care cost-cutting still possible for Congress

The Massachusetts election to replace U.S. Sen. Edward Kennedy unleashed a torrent of angst about health care reform, and an obscure state senator rode that to victory. With 41 senators, Republican filibusters can now block legislation.

Democrats are now talking about a scaled-back plan that focuses on insurance reform. We don’t see a realistic path to near-universal coverage, but Congress does not need to widen access to health care to salvage many of the cost-cutting ideas that have emerged. At the same time, mere insurance reform doesn’t get at some of the biggest cost drivers. Some ideas that ought to survive a recalibration are:

Reining in Medicare costs. The Dartmouth Health Atlas shows that about one-third of Medicare spending is on unnecessary tests and procedures. This amounts to hundreds of billions of dollars annually. Medicare Advantage is reimbursed at a higher rate than regular Medicare. Congress should decide whether the nation can afford this extra coverage when so many people have none.

Tempering malpractice lawsuits. If Democrats truly want to reach across the aisle, then changing tort laws would be smart. Whether it’s pursuing medical courts to adjudicate malpractice cases or other ideas, Congress can cut down on “defensive medicine” practices that arise from the fear of malpractice lawsuits.

Changing fee-for-service. The traditional practice of reimbursing providers for every test and procedure is too expensive and it doesn’t reward positive outcomes. Congress should consider bundling payments to hospitals and clinics for particular procedures and allow them to keep some of the savings. This would reward coordinated care, which is more cost-efficient.

With some of the overall savings, Congress could finally fix the Medicare reimbursement system that is causing more and more doctors to reject new patients. This is particularly true in areas such as Spokane, which don’t get their fair share because of a funding formula that rewards waste. With the rest of the savings, Congress can pursue a long-term fix for Medicare or apply it toward deficit reduction.

The opportunities are still there. Congress should not walk away from them.