Change in health care system? It is necessary

This editorial appears in the Yakima Herald-Republic on July 12, 2009.

Our elected representative from the 4th District has a word of advice to share with everyone living in Central Washington: Our national health care system is good.

Rep. Doc Hastings, R-Pasco, said health care in America doesn't require government intervention that would only upset the beneficial doctor-patient relationships that private insurers have fostered. What certainly isn't needed is a government-backed, public option for insurance, the eight-term congressman recently told the Yakima Herald-Republic's editorial board.

Let's be clear on this issue. We disagree with Hastings' assessment of our nation's health care system. It may be a good system, but only if you can access it. And that's the problem. How can health care delivery in the world's most advanced nation be considered good if 46 million Americans are going without any kind of medical insurance?

Our health care system is bloated with extra costs and underachieving with respect to producing better outcomes. Some analysts claim as much as 30 percent of all health care spending in this nation -- about $700 billion a year -- may be wasted on high-cost, high-tech tests and treatments that do not appreciably improve the health of the patient.

For employers, health insurance expenses are the fastest-growing cost component. For families, health costs spell bankruptcy and foreclosure. Even before the recent downturn in the economy, about 1.5 million families were losing their homes to foreclosure every year due to unaffordable medical costs, according to Health Matrix, a publication of Case Western Reserve University.

We are not alone in this assessment that our nation's health care system requires a re-invention, possibly even a public insurance option.

A recent New York Times/CBS poll showed 72 percent of those questioned favored a government-run insurance plan -- similar to a Medicare plan for those under 65 -- that would compete with private insurers. Among these supporters, half of those who called themselves Republicans said they supported the public plan, while three-fourths of independents and nearly 90 percent of Democrats voiced support.

Hastings argues there's no need for the public option. He says we already have an option that is both portable and affordable. It's called the health savings account, which was established under the 2003 law that set up the prescription drug benefit plan for Medicare.

Indeed, the health savings account provides another option that private insurers have embraced. But it also carries potential drawbacks.

A health savings account must be tied to a health plan that meets certain criteria including deductibles of at least $1,000 for an individual and $2,000 for families. Individuals, as well as employers, can deposit money into these accounts to cover the deductibles and other medical expenses. And if an employee leaves a job, the account stays with the employee, unlike employer-backed insurance plans.

However, several studies by nonprofit research centers have shown there are hidden costs to manage these accounts that eat away at any potential earnings through interest or investments. Furthermore, some critics argue the accounts amount to nothing more than tax shelters for wealthy and healthy individuals -- in other words, for those who don't need the accounts to cover health care costs.

We don't see health savings accounts representing a sustainable solution to this nation's flawed delivery of health care. A systemic reform is needed.

Momentum for this change has been increasing. That's why the pharmaceutical industry recently agreed to spend $80 billion over the next decade to improve drug benefits for seniors on Medicare and why the nation's hospital industry on Wednesday made a preliminary agreement with the Obama administration to accept $150 billion in cuts if the nation extends health insurance to those Americans now without coverage.

What we don't want to see in our future health care system is the federal government as the lone insurer. It should only be positioned as the insurer of last resort.

But any reform, no matter how much compassion and compromise it embraces, must be tempered with fiscal restraint. We agree with President Barack Obama that health care reform must be expense-neutral, that its costs cannot obligate this nation to additional indebtedness. And if that means the process to reach reform requires more time, that's fine.

What we cannot countenance is the specter of millions more going without health insurance. Nothing good comes from that.

* Members of the Yakima Herald-Republic editorial board are Michael Shepard, Bob Crider, Spencer Hatton and Karen Troianello.