The country's health care system is in crisis. The number of uninsured Americans is at an all-time high, health insurance premiums are rising, health disparities plague our nation's medically underserved populations, and Medicaid is under major strain. While I wholeheartedly support broad health reform, we'll never get there if policymakers can't even implement incremental reforms that have broad-based support. A centrist approach to health care reform is possible—if the American people insist that their representatives in Congress pursue bipartisan efforts. It's time for Republicans and Democrats to stop blaming each other for what Congress has not accomplished, and instead share credit for enacting measures that will improve access to and quality of health care in this country.
We all remember the television program, Crossfire, on which the moderator's goal was to encourage heated debate between people on opposing sides of an issue. While Crossfire has been canceled, I have come up with an alternative: the "Ceasefire on Health Care: Finding Common Ground for the Uninsured" series is an effort to stimulate dialogue among leading Republican and Democratic policymakers, as well as advocates. I have now moderated several events in which Republican and Democratic participants are encouraged to come to a consensus on public policies to address health care issues. For too long there has been only crossfire on health care issues; I want to cease fire and develop thoughtful, meaningful reforms.
After eight months of "Ceasefire" events, I can report that there are indeed practical solutions to the nation's health care problems that have bipartisan support. But in order to be legislated and implemented, members of Congress will have to put aside their differences and focus on these areas of agreement.
Here are a few ideas that have emanated from the "Ceasefire" series that could form the basis of a bipartisan package of health care reforms to be legislated by Congress this year:
- Offer health insurance tax credits: Most people in this country have access to some health care. The problem is that, for the uninsured, the emergency room serves as their primary care provider—the most expensive care out there. The costs of treating the uninsured are shifted to other payers in the form of increased premiums. These higher premiums, in turn, make health insurance less affordable for individuals and families. According to a survey by the Henry J. Kaiser Family Foundation, in 2003, eight of 10 uninsured individuals came from working families. These working adults and families often do not have access to affordable health coverage due to their low incomes (two-thirds of the total uninsured earn less than 200 percent of the federal poverty level). Tax credits would provide incentives for working adults and families to purchase health insurance in the private market, potentially resulting in fewer uninsured patients, less cost shifting, and lower premiums.
- Consider long-term care tax credits: When I was chairman of the Senate Aging Committee, I often said that the good news is that people are living longer and the bad news is… that people are living longer and straining our country's health care resources. Long-term care continues to be an important issue for us to address, as 77 million baby boomers will retire in 2012 (just five years away). The Deficit Reduction Act of 2005 tightened the asset transfer rules for individuals qualifying for Medicaid assistance with nursing home bills, which will make it harder for some people to pay for their long-term care. Additional incentives for people to purchase long-term care insurance, such as tax credits, would be a sound policy for Congress to consider.
- Cover the kids: Despite recent upswings in Medicaid and State Children's Health Insurance Program coverage for the youngest and most vulnerable Americans, there are still huge numbers of eligible children who remain unenrolled in these programs. These children are not getting the basic medical treatment and preventive care they need. In 2005, the president proposed the Cover the Kids program, which would award grants to eligible entities to conduct innovative outreach and enrollment efforts and give states the option of simplifying children's eligibility determinations for medical assistance. Senate Majority Leader Bill Frist and House Ways and Means Health Subcommittee Chairwoman Nancy Johnson introduced the bill with bipartisan support, giving it credibility as a reform that Congress could accomplish in the near future.
- Expand community health centers (CHCs): CHCs are the primary source of health care for many impoverished and uninsured Americans. Funded through federal grants, CHCs provide primary and preventive health care services in underserved rural and urban communities, and have received widespread support among policymakers.
- Improve access to health insurance for small businesses: The number of uninsured under age 65 increased by nearly 6 million between 2000 and 2004, primarily due to a decline in employer-sponsored coverage. Many jobs shifted from larger firms to businesses with fewer than 25 employees and many people became self-employed. Thus, although employment began to pick up in 2003, the number of uninsured still grew. Although some proposals to expand access to health care for small businesses have been controversial, I believe there could be bipartisan support for a plan modeled after the Federal Employees Health Benefits Program. The idea would be to create large insurance pools for small businesses, which could then deliver benefits to their employees at affordable group-rate premiums.
- Implement health information technology: The Institute of Medicine says that about 98,000 people a year die from preventable medical errors, many of which are related to drugs that are contraindicated for certain conditions, or misreading of handwritten prescriptions. The adoption of a nationwide interoperable health information technology system and widespread use of electronic prescribing technology would improve the quality of health care, reduce medical errors, and lower health care costs. With a strong bipartisan push from Senator Hillary Clinton and former Speaker Newt Gingrich, the Senate last year approved legislation to implement such a system. A separate proposal has been introduced in the House. Although the two measures take decidedly different approaches, bipartisan support exists to pass this legislation. A negotiated bill between the House and Senate is likely this year, and should result in tangible improvements in the quality and safety of care.
I have often said that health care reform should combine the best of what the government can do with the best of what the private sector can do—allowing the government to provide oversight and management, while enabling the private sector to infuse competition and innovation into the system. I continue to believe that broad-based health reform must follow this path. In the meantime, Congress will have to cease fire on health care to keep the existing system sustainable and set the stage for broader reforms in the future.
Senator John Breaux, senior counsel at the law firm Patton Boggs, retired from the United States Senate in 2005.
The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.
