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Commentary: A proposal to restart the discussion on health-care reform

This article first appeared in the St. Louis Beacon, Sept. 9, 2009 - HR 3200 - the health-care proposal that has been voted out of a House committee - will not fix health care in the United States. It tries to do too much, too quickly. It has become a huge unwieldy piece of legislation that will cost an enormous amount of money. It will lead to escalating costs. The belief that it will fix the problem while saving money is based on inaccurate assumptions.

The Republican Party has as yet not presented a workable alternative plan.

Nonetheless, there are serious issues that need to be fixed as soon as possible. These will be enumerated below. Any bill designed to address the urgent and essential factors in the near future must have a sunset provision that would require a more complete proposal by no later than 2014.

The overall long term plan must:

1. Examine a thoughtful, well-researched approach that has been tested or proven in an existing U.S. market.

2. Allow insurance companies to sell and to compete nationally.

3. Provide insurance for pre-existing conditions.

4. Insure that costs will not add ANY increase to federal spending and must reduce overall health-care costs.

5. Provide access to preventive care as well as medical care to those currently not insured.

6. Determine a fair and equitable strategy for dealing with the health-care needs of illegal immigrants.

7. Assure that benefits currently offered by Medicare/Medicaid cannot be reduced.

8. Insist that Medicare Part D become a negotiated rate for the drugs, NOT retail.

9. Recognize the necessity of healthy lifestyle approaches to care and treatment.

Here are suggested areas of study and action:

Expert Study Groups

Create a regional system throughout the country with study groups of experts in all aspects of the health-care system. Their task would be to study existing health care to find out what works and what doesn't work, and why (for examples, Massachusetts and Oregon), to establish pilot projects and to monitor them as they succeed or fail, with the goal that by 2014, the administration could then propose to the Congress a sane, workable plan that would not bankrupt the nation and future generations of citizens.

All parties of the current health care system -- doctors, nurses, other health-care professionals, insurance and pharmaceutical companies, hospitals, long-term care facilities -- would agree to participate in these studies. No members of the administration or the House or Senate would be deemed experts in this area, and they would be excluded from participation in these study panels. These panels must be limited in size to be effective and could operate in ways similar to National Institutes of Health study sections.

Best Practices

Create panels of physicians from all specialties who would have access to insurance and Medicare records, with names protected, to analyze what the true "best practices" are based on patient outcome, type of treatment and cost for at least the top 10 medical diagnoses.

Uniform Reporting

Use one uniform reporting form for all insurers, including Medicare and Medicaid, to reduce the time and labor needed to file patient data. Have insurance companies collaborate to produce the one electronic-only form that would be used by all.

Tort Reform

Establish tort reform to eliminate frivolous malpractice lawsuits that add significantly to the nation's health-care cost burden. Frivolous would be defined as an award in excess of the true cost of the medical care needed.

Drug Regulation

Restore former provisions regarding pharmaceutical companies' advertising practices, and ensure that any new drug has studies that show it to be BETTER than currently used drugs, not just simply more expensive.

Physician Fees

Restructure physician fee schedules to recognize outcomes, in addition to paying simply for providing care. Review the payment structure for home health care based on three key outcomes: level of hospitalization, level of emergency room visits, at or above national scores in 10 functional areas.

As noted previously, the GOP has not put forth a viable or serious alternative to HR 3200. However, serious-minded people such as Steven A. Burd, chief executive officer of Safeway Inc., have written persuasively about workable options that could form the basis for larger-scale regional pilot projects.

(In addition to the Beacon, this proposal was sent to members of the Missouri and Illinois congressional delegations.)

About the authors

Virginia Weldon, M.D., St. Louis, is a former professor of pediatrics and deputy vice chancellor for medical affairs at Washington University School of Medicine, and retired senior vice president public policy at Monsanto Co. She was chairman of the board of trustees of the St. Louis Symphony Society and the first woman to chair the Association of American Medical Colleges.

Melissa Adams, Melbourne, Fla., has combined a background in physical therapy with an MBA. She has held senior and executive level positions in start up pre-IPO health-care companies and in not-for-profit health-care systems. She is working with a new start-up company, RediLearning, focused on reducing costs in the senior health industry by using technology and innovation for the regulatory training requirements. Adams is a 5-year survivor of a second bout with breast cancer, and is very active one-on-one with women going through breast cancer all over the country, most of whom she never meets.