Andy Harris On Health Care

Reform, not overreach
Changes such as market-based 'exchanges' can improve our health system without upending it


By Andy Harris October 6, 2009

If there is any message that has come from this summer's town hall meetings throughout the country, it is that the American public is unhappy with how health care reform is being approached by Congress. As the only physician in the Maryland Senate, I know how legislatures approach health care issues. Politicians are usually tone-deaf to those who know the most about the issue - patients and their health care providers.

We all want reform - but not the over-reaching measures promoted in the current bills. We have to strengthen and broaden individual decision-making. Serious efforts to bring down the cost to families while preserving patient choice should include several elements.

There are things we can all agree on: covering those who can't afford insurance, lowering costs, making insurance portable, and covering pre-existing conditions. In addition, in areas like Maryland's Eastern Shore, any reform plan must address the need to attract physicians to smaller towns and rural areas in order to increase health care quality and access everywhere. These are common sense goals that offer real reform and don't require a government takeover of our health care and medical decisions.

Perhaps the most significant element of reform involves bringing market forces to bear on health care insurers. Creating a health care "exchange" allows for affordable, accessible and portable insurance for millions of Americans. An "exchange" would let everyone choose their health care insurance from a broad range of options and allow their employer to help pay for it. Competition among insurers would bring down the cost of health care insurance, just as it brings down the cost of car or homeowners insurance.

Under this system, people could choose an insurance policy that exactly fits their families' needs and their budgets, be able to take that coverage with them from job to job, and be able to "fire" their insurance company if it doesn't treat them well. Our current system, which locks most people into the insurance their employer offers, doesn't do this. An exchange would also offer competitively priced insurance to millions who are unemployed, self-employed, or who work for an employer who can't afford to offer insurance. But including a government ("public option") insurance plan or even a "co-op" option is not the solution. Finally, insurance should also be made available across state lines.

Other changes are also needed. They include:

· Tort reform. Obstetricians and neurosurgeons in some states pay malpractice insurance premiums in the hundreds of thousands of dollars, costs that are passed on to the patient and insurers - and limit access to those physicians.

· Bringing market forces to bear on health care purchases. Americans are used to making price/value judgments in their purchases. Health care purchases shouldn't be treated any differently. Patients should know the cost of services. (How many people know what an MRI actually costs?) Provider quality information should be made readily available to patients (consumers). Any reform should encourage price and quality transparency.

· Providing tax deductibility for all health insurance purchased, not just that provided by employers. This, combined with health care exchanges, will bring down the out-of-pocket cost to those who have to buy their own insurance, such as farmers, sole proprietors and small businesses. For those who still couldn't afford even the most basic plans, tax credit subsidies can be made available.

· Expanding the availability of high-deductible ("catastrophic") plans combined with roll-over health savings accounts. These products could substantially reduce the cost of everyday health care expenses, with those savings passed on to patients. They could be designed to encourage wellness programs that could save even more in the long run.

· Encouraging use of technology to provide higher quality with lower cost. Everyone should have an electronic copy of their entire medical record. That would not only save costs of duplication when going from one physician to the next, but it would avoid errors in hand-written records and prescriptions.

· Denying any new health care entitlements to illegal immigrants. The costs of providing care to needy Americans through Medicaid is already threatening to bankrupt state governments as well as the federal government. We have to provide everyone care in true emergencies, but that's where we should draw the line.

These reforms would address the demand for portability, personal ownership, affordability and accessibility. They protect patients' rights, preserve the doctor-patient relationship and focus on putting patients and their families first. Our nation still enjoys the finest health care in the world. Let's make necessary changes, but let's take the time to get it right.

Dr. Andy Harris, a Republican, represents District 7 in the Maryland state Senate. His e-mail is andrew.harris@senate.state.md.us.