A foundation for better American health care

December 29, 2009

More than 60 years ago, President Harry S. Truman said: "Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection."

The economic realities of the American health care system as acknowledged by President Truman and so many past Presidents -- Republicans and Democrats alike -- still exist today. For decades, health care costs have threatened the stability of our nation's middle class, small businesses and economy.

Last week, the Senate passed a health care reform bill that, though not a perfect fix to our health care problems, is a solid first step toward a stable and secure health care system.

Much of the public focus on the Patient Protection and Affordable Care Act has been on insurance reforms and consumer benefits, with good reason. This bill will provide affordable health insurance to more than 30 million uninsured Americans, including tens of thousands in New Hampshire. It will prevent insurance companies from denying coverage to patients who have pre-existing conditions and will eliminate lifetime limits on coverage. This bill will stop insurance companies from dropping their customers if they get sick, and it makes prescription drugs more affordable.

Holding insurance companies accountable is the right thing to do, but it is not the only benefit of this bill. Perhaps the most important aspect of this bill can be summed up in two words: cost control.

Years of perverse incentives have encouraged health care professionals to practice more medicine rather than better medicine. Under our current system, providers are paid based on the number of patients they treat and the number of procedures they perform.

Research conducted at Dartmouth College shows us that a high quantity of care does not mean a high quality of care and that we can save billions of dollars by reforming our health delivery system.

The Patient Protection and Affordable Care Act encourages health care providers to better coordinate care through the expansion of Accountable Care Organizations (ACOs), a concept championed by Dartmouth's Dr. Elliot Fisher. ACOs encourage primary care doctors and specialists to work together and share information to develop the best treatment plan for the patient. And ACOs will reward doctors not based on how many procedures they perform, but instead based on the health outcomes of each patient. I wrote a provision in the Senate bill to expand ACOs to cover all patients regardless of their insurance plan.

We also save money by cutting Medicare waste. Medicare has served our seniors well. This bill will ensure we continue to serve our seniors long into the future by strengthening the program and extending its solvency. But in even the best systems, there is always room for improvement.

A New England Journal of Medicine study conducted earlier this year found that almost one-third of Medicare patients who were discharged from a hospital were rehospitalized within 90 days, mainly due to lack of follow-up care. This problem costs Medicare an estimated $17 billion per year and is frustrating to our seniors. We can do better.

Sen. Susan Collins, R-Maine, and I worked on a measure, included in the Senate bill, to provide better transitional care following hospitalization. This could save approximately $5,000 per Medicare beneficiary while improving the quality of care he or she receives.

These reforms and the many others in this legislation will not only cut costs to make the health care system run better, but also they will make our nation's economy run better.

Health care costs have been rising three times faster than wages, and two-thirds of bankruptcies in America are caused by medical expenses. Health care costs make up a staggering 18 percent of our economy. That path is not sustainable, and this bill puts us on a different path. This bill is fully paid for -- it will not add one dime to our already too-high national deficit. In fact, the nonpartisan Congressional Budget Office states that this legislation will reduce the deficit by $132 billion over 10 years. The bill also provides significant tax credits to small businesses to help them cover health insurance for their employees.

Today, we are closer than ever to ensuring that health care is within reach of all Americans. There is a lot of hard work ahead of us, but the foundation we have laid -- one that values efficient and effective health care -- will ensure a healthier America for future generations.


By:  Jeanne Shaheen
Source: Union Leader