Health Care

Rationing
Government health care rationing would be a catastrophe for the quality of health care in the United States.  Such a change in health care policy would involve an unacceptable intrusion into the doctor-patient relationship.  For example, in 1999 the British created their comparative effectiveness organization called the National Institute of Health and Clinical Excellence (NICE).  This entity has routinely denied patients access to care.  Similarly, it is instructive to observe that Canadian cancer patients regularly wait months for treatment and diagnostic scans.  It is a common occurrence for Canadians to come to the United States and pay out of pocket for care in the United States.  A recent report in the Wall Street Journal indicated that a number of Quebeckers even sued their government for violating their "right to life and security" under the Quebec Charter of Rights and Freedoms.  Canada's Supreme Court has acknowledged the pervasive rationing that occurs.  In the 2005 case of Chaoulli v. Quebec the majority opinion stated: "the evidence in this case shows that delays in the public health care system are widespread and that, in some serious cases, patients die as a result of waiting lists for public health care."

The decision concerning treatment is one that should be determined by doctors in consultation with their patients.  It is not the proper role of government to interfere with that relationship. 

Preexisting Conditions
The need to cover pre-existing conditions is something which everyone in the health care debate should be able to reach a consensus.  Exchanges would offer a diverse assortment of insurance plans, with each plan meeting minimum coverage requirements, similar to those available through the Federal Employee Health Plan. In order to adjust risk and ensure that no one may be denied coverage on the basis of age or preexisting conditions, such a system would necessitate rewarding insurers who provide coverage for high-risk subscribers. This would provide both access and portability, while giving Americans the opportunity to choose their own healthcare coverage.

Tort Reform
It is my view that any serious health care reform legislation must also include litigation reform.  Excessive lawsuits have contributed to the rising cost of medical care.  This comes about as a result of the reaction of those in the medical profession in the form of "defensive medicine."  The argument has been made by the President and others that we need to reduce the number of unnecessary tests.  One of the primary reasons this occurs is that if all of the standard tests are not done and the outcome for the patient is not successful, physicians are more vulnerable to lawsuits.  Thus, legal reform must be an integral part of healthcare reform. 

Flexible Spending Accounts
Flexible spending accounts can play an important role in providing individuals and American families with the ability to offset the impact of rising medical costs.  The Congress should be looking at policy options which expand choice in the health care marketplace.  Flexible spending accounts should be looked upon as one element of a multi-faceted approach to health care reform.

Single-Payer
A so-called single payer option for the delivery of health care services would be nothing more than a government monopoly which would have the same adverse consequences that monopolies do in other contexts.  The reform of our health care system should maximize choice and empower health care consumers.  A government health care monopoly would undermine both of these objectives.

One need only look across the border to Canada to observe the evidence relating to government run health care.  In fact, the President of the Canadian Medical Association recently stated that: "We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize."

Similarly, it is instructive to observe that Canadian cancer patients regularly wait months for treatment and diagnostic scans.  It is a common occurrence for Canadians to come to the United States and pay out of pocket for care in the United States.  A recent report in the Wall Street Journal indicated that a number of Quebeckers even sued their government for violating their "right to life and security" under the Quebec Charter of Rights and Freedoms.  Canada's Supreme Court has acknowledged the pervasive rationing that occurs.  In the 2005 case of Chaoulli v. Quebec the majority opinion stated: "the evidence in this case shows that delays in the public health care system are widespread and that, in some serious cases, patients die as a result of waiting lists for public health care."

Finally, it is encouraging that the Obama Administration itself has abandoned the idea of a government health care monopoly. 

Coverage of Illegal Immigrants
Regarding extending the federally-funded "public option" to illegal aliens, Section 246 of H.R. 3200 specifically states that there will be "no federal payment for undocumented aliens."  I believe that the bill should be amended to include provisions to facilitate implementation and enforcement of this section.

Coverage for Members of Congress
Members of Congress should be willing to stand by their vote on a comprehensive health care reform bill.  To this end, Congressman John Fleming recently introduced a Resolution (H.Res. 615) to express "the sense of the House of Representatives that Members who vote in favor of the establishment of a public, Federal Government run health insurance option are urged to forgo their right to participate in the Federal Employees Health Benefits Program and agree to enroll under that public option." 

Employer Mandates
Employers with an annual payroll above $100,000 would be required to provide basic coverage to all employees, or pay a payroll tax.  Under this plan, the payroll tax would vary, depending on employee payroll, as follows:

Employee Payroll	Payroll Tax
$250,000 to $300,000	2 percent
$300,000 to $350,000	4 percent
$350,000 to $400,000	6 percent
Above $400,000	8 percent

 

 

 

 

 

 

 

Very small businesses would be eligible for a permanent tax credit.  Businesses whose employees earn below $20,000 would receive a credit equal to 50 percent of the employer's share of premiums.  The tax credit would be phased out for businesses with between 10 and 25 employees and average wages between $20,000 and $40,000.  It would not be available for employees whose wages exceed $80,000. The non-partisan Congressional Budget Office (CBO) prepared a preliminary analysis of the legislation and found that the cost of subsidizing health insurance once the plan is fully implemented would increase from an average of $4600 to $6000 per person in just five years.

I am very concerned about the impact a "pay or play" provision would have on small businesses, particularly given our current economic crisis.  The unemployment rate in California is already a staggering 11.6 percent, the highest level since World War II.  The Congressional Research Service, in its June 30, 2009 report on health care reform noted, "Most economists argue that employer payments for health insurance are actually borne by workers through reduced wages and other forms of compensation."  Forcing "pay or play" on the business community during these perilous economic times will likely result in lower wages and higher unemployment, further eroding our economy.

Many of my colleagues on both sides of the aisle are troubled by the employer mandate.  On July 16, 2009, 22 Members of the Majority signed a letter to House Speaker Nancy Pelosi expressing concerns "that the proposed method of paying for healthcare reform within this legislation will negatively impact small businesses."

Health Information Technology
A RAND Corporation study found that if most doctors and hospitals adopted health IT, potential efficiency savings for inpatient and outpatient care could average over $77 billion per year.  The net potential savings over 15 years, taking into account the initial cost of health IT, could reach $400 billion in efficiency saving alone; health and safety benefits could double the savings.  According to the RAND study, "the largest savings come from reduced hospital stays (a result of increased safety and better scheduling and coordination), reduced nurses' administrative time, and more efficient drug utilization."  Moreover, implementation of health IT would result in increased safety and health benefits for patients.  For example, if all hospitals adopted a health IT system, the RAND Corporation found that "around 200,000 adverse drug events could be eliminated each year, at an annual savings of about $1 billion."

With that said, health IT is expensive for physicians, especially those in private practice, to implement.  Because net savings are initially low, some physicians are reluctant to incur the high cost of adopting health IT systems.  As I review healthcare reform legislation, I will be looking for provisions that facilitate the adoption of health IT, especially for physicians who may not otherwise be able to install such systems.

At this time, there is no single standardized system of electronic medical records.  As recently reported by the American Medical Association, 37 percent of the nation's hospitals have adopted electronic medical records for clinical documentation; however, only .3 percent are entirely paperless, meaning they have fully integrated healthcare IT.  Because of the tremendous efficiency savings associated with the implementation of health IT, it is likely that we will see proposals to incentivize IT adoption in healthcare reform legislation.

Public Option
In regard to the public plan proposed under the "Affordable Health Choices Act of 2009" (H.R. 3200), I have concerns because the nonpartisan Congressional Budget Office (CBO) recently estimated that the Act "would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period."  Moreover, as CBO Director Douglas Elmendorf recently testified, "Debt is projected to soon grow to unsustainable levels even under [a scenario] which assumes that spending on programs other than Medicare, Medicaid, and Social Security will decline substantially (relative to GDP) over the next 10 years and that revenues will increase...Under current law, the federal budget is on an unsustainable path - meaning that the federal debt will continue to grow much faster than the economy over the long run."

I believe Congress can do better than this.  I believe we can look to proposals that would create healthcare exchanges administered on a statewide, or even regional, basis that will offer insurance plans tailored to the needs of Americans, rather than imposing a government-run option that reads like a one-size-fits-all approach.