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The Honolulu Advertiser
Posted on: Monday, November 2, 2009

It's time for the final health reform push

The sausage-making exercise America has witnessed for several months — the drafting of legislation to reform its inefficient health-care delivery system — is drawing to a close. It now seems likely each chamber of Congress will deliver its own version of a bill that achieves a measure of the primary aims: extending access to health care to more people and making service fairer to those who already have access — all without compounding the national debt.

The hope is that the final product includes the better parts of each proposal, because there are strengths and weaknesses in each version.

The House is ready to endorse a bill that includes a public option — a government-run health insurance program. It's not the only important element in the plan, but it is critical. In many parts of the nation, the private sector has not produced the level of competition needed to give consumers a real choice. And it's unlikely that simply allowing carriers to sell across state lines would entice enough to fill that void, as Republicans suggest, with most consumers preferring to deal with a carrier closer to home.

The Senate seems to be teetering on this point. Hawaii's delegation rightly has supported the public option. Even if passed in one of the current, weakened variations, allowing states to opt-in or opt-out, that would be preferable to Sen. Olympia Snowe's "trigger," authorizing the government insurance program if private efforts to lower costs and provide coverage fall below set standards. Unfortunately, policymaking history has shown triggers never drive the desired result. The federal government typically has treated them as mandates to be ignored, like giant IOUs that never get paid.

Some form of government option should be passed. But that's not the only knotty issue.

In terms of driving down costs through financing the system, the Senate has the better approach by taxing the "Cadillac" health plans, which would both raise money and discourage plans enabling excessive use of procedures and tests.

A more modest form of the House mechanism, a tax on the upper income brackets, could be part of the solution but does not help "bend the cost curve," as President Obama seeks. However, the House plan does include a reform in the delivery system that rewards results, edging away from the fee-for-service model that drives up costs.

Congress has come a long way toward a goal that once seemed unreachable — bringing affordable health care within the grasp of most Americans. Hurdles remain, but leaders on Capitol Hill must not stall out now. The final bill will not be ideal by anyone's standards, but a starting point toward a more accessible health care system is better than standing pat on a system that is being crushed by costs and is not fulfilling the basic mission. The status quo is unacceptable.