Saturday, November 14, 2009

Reforming health care

insurance company

MASSACHUSETTS HAS some of the best doctors, nurses, and other caregivers in the world. Yet our national health care system costs too much and covers too few. Climbing costs put basic coverage beyond the reach of millions. This is economically unaffordable and a moral disgrace.

Promoting affordable, quality health care has been one of my top priorities as attorney general, and it will be a top priority if I serve in the Senate. National efforts should draw on lessons that we have learned in Massachusetts.

The good news is that our reforms here show that it is possible to provide insurance to almost everyone. We have done so by building consensus with the business community, doctors and hospitals, insurers, and most of all, consumers.

Our state’s experience also raises warning signs. While costs for individuals, employers, and the state spiral upward, cost often does not correlate to quality. National reform must tackle the cost crisis up front. The most effective way to lower costs is through competition that a strong public option will provide.

My office has been involved in health care issues - and we’ve gotten results. We reached a historic $17 million settlement with an insurance company that misled consumers and unfairly denied coverage. We have achieved several record national settlements with drug companies for deceptive marketing and sales, recovering tens of millions for individuals and the state. And we have promoted greater transparency regarding quality, costs, and executive compensation.

Here are the key elements on which I’ll focus as a senator:

Strong public option. A strong public insurance plan would provide choice to individuals, expand access, and lower costs by promoting competition.

Preserving women’s rights. The Stupak/Pitts amendment included in the House health care bill represents an unnecessary, significant step back in women’s rights. It violates the very intent of health care reform by severely restricting access to reproductive health services, especially for low-income women. This amendment represents a false choice. We can and must pass meaningful health reform without compromising women’s access to reproductive care.

Consumer protections. With a requirement that all people obtain insurance, federal and state government must enforce strong consumer protection measures. Insurers must not be allowed to deny coverage based on preexisting conditions or make false marketing promises. Being a woman should never be a preexisting condition. In some states, victims of domestic violence are denied coverage, which is reprehensible.

Cost control. Immediate steps to curb costs include reducing preventable hospitalizations, readmissions, and hospital-acquired infections. We should also encourage standardized billing and claims processing to reduce administrative overhead. We need to focus on prevention and develop better models for primary care. We should close the Medicare Part D coverage gap, and help seniors afford the drugs they need.

Payment reform. Federal reform should look aggressively at ways to reshape the incentives that providers face. Our current fee-for-service models reward hospitals for performing more procedures and tests, not for quality. In contrast, models such as global, bundled, or episodic payments encourage integrated care management and reward providers for better outcomes. That said, I will oppose federal funding cuts aimed at our state’s health care providers, which would jeopardize the progress we have made in covering the uninsured.

Protecting Social Security and Medicare. Health care reform will improve the quality of care in Medicare, reduce costs for seniors, and preserve Medicare for future generations. In the Senate, I will support reform that eliminates excessive government subsidies and results in lower out-of-pocket costs on prescription drugs.

Achieving real health reform will take a different kind of leadership than the old partisan fighting we’ve seen in Congress. Massachusetts showed a different kind of leadership in passing health reform three years ago. Senator Ted Kennedy himself was a different kind of leader, and I hope to follow in his footsteps, and work to bring real reform to health care.

Martha Coakley is attorney general.