Our views: A long battle on health bills

• Advocate Opinion page staff
• Published: Nov 30, 2009

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Had our expectations in the health-care debate been higher, maybe we’d be more disappointed in the current state of “reform” legislation.

All along, our concern was that enforcing fiscal discipline on America’s sprawling, expensive and inefficient health system would be so politically difficult that neither party would realistically tackle that job, at least not in one bill.

Neither has.

However, there’s still the possibility of some constructive results in the upcoming Senate debate on health care, and the eventual reconciliation of the House-passed bill with Senate ideas. The real battle over the details, though, is going to occur in the next few years as the consequences, intended and unforeseen, work through the system.

We are unwilling to join with the Republicans hyperventilating about what’s in the bill, and the liberals hyperventilating about what’s not in the bill. At the risk of sounding like the ivory-tower idealists disparaged by President Barack Obama’s top aide recently, there is some hope for a middle ground that preserves the private insurance system but reforms its abuses, and that ensures that people have access to affordable insurance, whatever their income or health or employment situation.

The battles in the Senate, and then in an inevitable House-Senate conference committee, will tackle some of the tough issues, including efficiency in Medicare and the insurance reforms. At the same time, the real gains for many people will be found in two areas: making insurance more widely available and sharply limiting exclusions, and putting in place mechanisms — “bureaucracies,” to the Republican critics — that will have the thankless job of improving delivery of health care and improving its efficiency.

The Holy Grail of cost containment is not going to be achieved in this legislation but in the new bureaucracies and in Medicare administration. And that will take time.

We need more research into what works in medicine, and what are less costly ways of doing the things that run up the tab. Physicians and other providers shouldn’t be forced to practice “defensive” medicine, but neither should patients have unlimited leeway to demand expensive scans and otherwise run up the bill when it’s medically unnecessary.

Reforming the practice of medicine is more than just one bill realistically can achieve. But we hope that a process will begin that doesn’t foreclose in the name of political compromise now some tough decisions about cost-containment down the road.

Nor should a final bill omit constructive Republican ideas about health savings accounts — pushed by U.S. Rep. Bill Cassidy, R-Baton Rouge, among others — and other mechanisms to make consumers more conscious of the dollar cost of medical care. U.S. Rep. Charles Boustany, R-Lafayette, is a key player in these issues as well, because of his post on the Ways and Means Committee.

Still, in the final bill, the costs are going to be up front. The hope for savings is down the road.

That’s just a fact. A political fact, but one that must be recognized.

Every American ought to be able to get affordable health insurance. In fact, just as auto liability insurance is required for Louisiana drivers, insurance ought to be mandated — somehow. How that is managed is difficult, but we hope the eventual bill will come out with ways to make that happen. The whole concept of risk management involves spreading premiums around.