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Published: Thursday, 3/18/2010

Do health reform right

THE health-care reform legislation before the House is good law. It would provide affordable coverage to 31 million uninsured Americans, enhance competition among health insurers while curbing abuses, and start to control medical spending and insurance costs without widening the federal deficit. However good these ends, though, the means House leaders are proposing to enact the legislation are disturbing.

It's understandable that after more than a year of debate, President Obama and House Democratic leaders want finally to cross the goal line with a successful vote this week. Further discussion with the Republican minority in either house of Congress would be a waste of time given its unanimous, intransigent opposition to the proposal.

But urgency is no excuse for permitting secrecy, corner-cutting, and artificial deadlines to dominate the process. House Speaker Nancy Pelosi suggested that House members could vote on proposed changes to the health care bill the Senate approved late last year without voting on the Senate bill itself. If they approve those corrections, House leaders simply would "deem" the underlying Senate measure passed and send it to the President.

House Democrats of various political persuasions don't like the Senate bill, because they object to its removal of the public option or believe that it would enable insurers to approve subsidized abortions. But the Senate bill is the only realistic vehicle for health-care reform this year. If House Democrats can't support it, they should cast a public vote to that effect rather than hide behind parliamentary tricks.

It's troubling that House leaders seem prepared to hold a vote on the amendments they seek to the Senate bill before Americans or even their own members can review them fully. The use of the reconciliation process in the Senate to pass the House-approved fixes to the bill - assuming they get that far - is an appropriate, if controversial, strategy to prevent the obstructionist Republican minority from filibustering them to death.

Yet that's all the more reason for the House to consider the amendments completely before enacting them. That process should include, before the final vote, an authoritative estimate of their costs by the nonpartisan Congressional Budget Office.

The public debate can and should proceed in the meantime. Speaker Pelosi's assertion last week that "we have to pass the bill so that you can find out what is in it" is hardly reassuring.

The type of corrections the House makes to the Senate bill are crucial. They must remove the "Cornhusker kickback" and other noxious special-interest favors extorted by several Senate Democrats for their votes for the bill. They should rule out special deals for unions in the proposed tax on high-cost "Cadillac" health insurance plans.

Lawmakers should resist the urge to expand Medicare coverage beyond what the legislation can afford. They could start to do more to reward medical providers for successful outcomes and an emphasis on preventing illness, rather than simply reimbursing them for the number of procedures they perform, although that's a long-term process.

During his visit to suburban Cleveland this week to promote the health-care package, President Obama adopted the slogan of a spectator at the rally:

"We need courage!" That includes the courage for advocates to do the right thing the right way, both fiscally and procedurally.

A sense of urgency to pass a reform bill is appropriate, given its importance to the national agenda. Doing nothing while the health-care system continues to deteriorate is not a good option.

But neither is a fatally flawed process that causes Americans to question its legitimacy, even to achieve an appealing outcome.



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