A so-so health bill goes to the
Senate and louder debate

A health care bill chock full of compromises passed the House of Representatives Saturday night by a scant five-vote margin. It will take all of the president’s political skills and a willingness to be tough as nails to get it past the Senate in recognizable shape.
What passed isn’t what the nation needs. It still leaves millions uninsured. It doesn’t do enough to reduce health care costs. Abortion rights supporters had to agree to onerous amendments to get it passed. But it did provide funding by raising taxes on the rich and super rich and other modest steps. It did provide coverage for those with pre-existing conditions and does prevent insurance companies from canceling policies on those who become ill and it does extend overage to 36 million of the 48 million now uninsured.
Republicans voted against the bill unanimously, with warnings that “this government takeover has got a long way to go before it gets to the president’s desk, and I’ll continue to fight it tooth and nail at every turn,” in the words of Representative Kevin Brady, Republican of Texas.
The volume of this overblown rhetoric will be turned up to the max when the Senate debate begins.
But the truth of the matter is that the Republicans have offered nothing but the status quo as an alternative. Their bill would extend coverage only to an additional 3 million people — about 7 percent of those now without coverage — and would not even put an end to denying coverage to those with pre-existing conditions, which is where health care reform should start. More to the point, it would do nothing to reduce health care costs.
As the national health care debate moves to the Senate, these fundamentals should be kept in sight:
— The United States is the only rich, industrialized nation in the world that does not provide health care to all of its citizens. Health care is considered as basic to the people’s welfare in other countries as police and fire protection, protection against foreign invasion, education and food and shelter. Publicly assured quality health care is considered by our competitors abroad to be as important to economic growth as are good public schools. Like education, it is considered an investment rather than welfare.
— The Medicare program, which has provided quality health care to Americans over 65 for the past four decades, is a model for universal health care.
— While the United States does not provide health care for all, it spends far more on health care than any other nation both in dollars and as a percentage of its annual gross national product. By bringing U.S. health care costs in line with those of other nations with similar wealth and demographics, every U.S. citizen could be covered for far less than is now being spent.
Can medical costs be brought down to rest-of-the-world levels without “a government take-over?”
That’s a question opponents of reform answer with a resounding no.
They are right to say that costs can’t be reduced without causing a lot of pain to the current providers. Every one of those dollars finds its way into someone’s pocket.
Health insurance companies now add billions to annual costs with their administrative costs and profits which can only come from premiums charged and profits made. There is no way to reduce national health care costs without hitting that industry hard.
Pharmaceutical companies charge more, much more, for prescription drugs in the U.S. than they do in other countries because other countries bargain at the national level for lower prices. The U.S. is a sucker for allowing its Medicare program to pay premium prices for drugs and for trying to keep citizens from buying from abroad at much lower prices. (Prices which would soon come down to world levels if those trade barriers were removed.)
Careful studies have revealed that health care costs vary enormously from one U.S. area to another and that low-cost providers — a category that includes such world-renown health centers as the Cleveland Clinic and the Mayo Clinic in Rochester, Minn. — can provide superior health care at low costs by paying physicians salaries rather than fees for each service provided; by practicing in teams rather than sending patients from specialist, to specialist, to specialist; by limiting the use of expensive laboratory and imagining tests and by eliminating duplicate testing.
These same studies seem to prove that U.S. health care costs would drop to an acceptable level if all providers followed these examples.
Is it reasonable to expect today’s high-cost providers to follow these examples and bring down their costs — and their incomes — on their own initiative? Maybe not.
On the other hand, the bill the House passed will cost an estimated $1 trillion over the next 10 years. Those are dollars that would go to the health care industry to take care of an additional 36 million customers. Somehow, they ought to be able to manage.

— Emerson Lynn, jr.