Wednesday, May 23, 2018
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David Kushma

Don't kill health reform - fix it

IT'S 1936: Republican presidential nominee Alf Landon vows to repeal the Social Security Act passed the previous year, which he calls "stupidly drafted and wastefully financed. If the present compulsory insurance plan remains in force, our old people are only too apt to find the cupboard bare."

It's 1961: TV pitchman - and, more and more, political activist - Ronald Reagan calls on Americans to reject what four years later would become Medicare: "If you don't [stop Medicare] and I don't do it, one of these days you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."

It's last week: Sen. Jim DeMint (R., S.C.) demands repeal of the health-care reform legislation the House - more precisely, House Democrats - just passed, denouncing it as a "government health-care takeover [a] trillion-dollar assault on our freedoms."

You'll hear a lot between now and November about the need to repeal the health-care legislation. Republicans have made clear that they will exploit their absolute opposition to the new measures as a campaign issue against Democrats.

They might want to think again. Governor Landon campaigned so successfully against Social Security and its prime mover, President Franklin D. Roosevelt, that he suffered one of the most humiliating losses in political history.

Today, even though the solvency of Social Security and Medicare is hardly assured, you don't hear many calls for the repeal of these safety-net programs. President George W. Bush failed in his bid for partial privatization of Social Security, even when he had a Republican Congress to work with.

But Mr. Bush did add a prescription drug benefit to Medicare. And remember the emotional, if somewhat confused, gentleman who warned a Republican lawmaker at a health-care town meeting last summer: "Keep your government hands off my Medicare."

So maybe repeal of health-care reform won't seem like such a can't-miss issue to voters in seven months. Maybe providing tax breaks to small businesses to help them insure their employees, and prohibiting insurers from refusing to cover children with pre-existing conditions - elements of the legislation that take effect within months - won't appear to be such outrageous ideas.

The better course is to improve the reform legislation, not to wage yet another futile effort to kill it. There is plenty of work for both Republicans and Democrats to do along those lines, if prospects for bipartisanship in Washington haven't been destroyed.

That might be a forlorn hope, given last week's vow by 2008 GOP presidential nominee John McCain - who faces a re-election challenge from the right this year - that "there will be no cooperation for the rest of the year." If you forgot, Mr. McCain's campaign slogan two years ago was "Country First."

It's not just Republicans: A fund-raising letter sent by Sen. Robert Menendez (D., N.J.) after the President signed the Senate health-reform bill sought money to "help us push back against the right-wing liars."

When you look at the merits rather than the toxic rhetoric, the legislation's biggest deficiency remains the inadequacy of its cost-control measures. Unless we can finally limit the growth of health-care costs, bringing the rate of "medical inflation" closer to that of general inflation, none of the reform legislation's appealing features ultimately can be sustained.

These include the package's extension of health coverage to 32 million Americans, and the subsidies that accompany the new mandate for buying health insurance. If those goals are to be assured, there can be no backsliding on the reform package's tax on high-cost "Cadillac" insurance plans, despite complaints by unions and insurers.

Cost containment works best when it is approached in tandem with access to, and quality of, health care. There must be meaningful incentives for doctors and hospitals to emphasize wellness and prevention rather than endless series of tests and procedures, many of them unnecessary.

Other incentives should discourage duplication of service. They should link medical providers' compensation to an objective, data-driven determination of the quality of care they provide.

The new legislation calls for review panels that would use Medicare and Medicaid as laboratories for initiatives along these lines. I hope no one - not even Sarah Palin - still subscribes to the absurd notion that these are "death panels."

The provision hasn't gotten a lot of attention, but it's one of the most important elements of the reform package. The White House needs to take full advantage of it, quickly.

And yes, Republican ideas such as malpractice reform that enables doctors to avoid practicing costly defensive medicine, and enabling consumers to buy insurance across state lines, belong in the mix, too.

Let's be realistic. Health reform is becoming the law. Don't expect it to be repealed, any more than Social Security and Medicare were.

So it's in the interest of both parties - and all of us - that the legislation is made as strong as it can be. If Republicans or Democrats show no interest in working toward that end, that's where the voter pushback should come in November.

David Kushma is editor of The Blade.

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