Do It Right, Not Just Fast

Published in the Milwaukee Journal Sentinel on September 5, 2009

At the 12 town meetings I held last month, large numbers made it clear that they resent being given the bum's rush on health care. Democratic leaders put the emphasis on doing reform fast rather than right, compressing the schedule in order to avoid tough questions and to present the country with a done deal.

People noticed and were deeply offended. "Slow down," they said. With recent reports that the current proposals are going to be scaled back and simplified, I'm hopeful that President Obama has been listening.

Health care is a life and death matter, and about 17 percent of our economy is devoted to it. Reform in this crucial area requires an extensive national debate on the substance of the proposals. We need to develop a broad consensus by answering key questions.

For instance:

* What can we afford? This year's deficit is expected to be $1.6 trillion, and projected future deficits are unsustainable.

President Obama says reform is necessary to slow the growth of health care costs. But the Congressional Budget Office has said that the House leadership's plan will not do this. Instead, according to the CBO, that plan would result in over $1 trillion in new spending over 10 years.

The House plan would help fund the reforms by cutting $500 billion from Medicare. But, does anybody really think that such cuts are politically possible?

Another $800 billion would come from new taxes, including hikes on small businesses - the engine of job creation.

* Should there be a government-run plan? The President says we need a public option to provide competition with private insurers. But, there's no plausible way to make it a fair fight, and local medical administrators throughout east-central Wisconsin have warned me that it would be a disaster for our state because of the way the government would likely reimburse health care providers in different parts of the country. Our region's providers are among the most efficient nationally, and have less room to improve than others.

As a states' rights issue, I am open to government plans, and even single payer, on the state level. Let the different states figure out what works and what doesn't.

* Should insurance companies be forced to accept all comers? There is a lot of common ground in favor of this. But are we clear that this means that everybody will be required to get coverage whether they want it or not? The system won't work if people are able to avoid paying premiums, waiting until they get sick before signing up.

* How do we propose to reduce costs?

We can't afford to cover every health care cost without limit. The President wants government panels to decide what's cost-effective and what's not.

But, rather than a top-down approach, I prefer to empower the patient. Part of the health care solution should be wider tax incentives and, where appropriate, subsidies for consumer-driven initiatives such as Health Savings Accounts which patients can tap to help pay for routine services out-of-pocket. If a patient saves money by comparison shopping and avoiding optional care, the savings are combined with future deposits and subsidies to provide a bigger cushion against future expenses. If serious illness strikes, required catastrophic insurance kicks in.

Surely, we can find common approaches to health care if we are willing to confront the outstanding questions seriously. Right now, there are more questions than answers, and if we decide that the time for discussion is past and that smaller, targeted reforms just won't do, we may find that a huge reform comes with huge risks which will not be easy to fix.