Fairness must be ensured
Published 3:36 pm Wednesday, July 15, 2009
Lost amid the dizzying details of health-care reform is a central point that Washington’s congressional delegation has been making for years: some states, including ours, get a raw deal on Medicare.
Here’s the problem: When the state-by-state formula for setting Medicare payment rates to providers was created, it was based on the state-by-state cost of providing care. Seems fair, but it’s not. See, Washington and other states that have historically delivered high-quality, cost-effective care get lower reimbursement rates than states where care costs more, but doesn’t deliver better results.
The inequity plays out in discouraging providers from offering services to Medicare patients, which decreases access to quality care for seniors here — the opposite of one of the key goals of health-care reform.
Despite a lot of squawking, and legislation introduced annually by Washington Sen. Patty Murray, members of Congress from the unfairly treated states were outnumbered, and thus plumb out of luck. The “haves” had no incentive to give up their advantages to the “have nots.”
Now a band of about two dozen House members, including Rep. Rick Larsen of Everett, are working to fix the problem as part of comprehensive health-care reform. And this time, they appear to have political leverage: their votes on the overarching bill, President Obama’s No. 1 legislative priority. If no Republican votes emerge for the House bill, Larsen and the others reason, Democratic leaders will be counting on their own members to toe the line.
If the House bill includes a government-backed insurance option, as expected, Larsen says he won’t support it if public-plan payments are based on the current, unfair Medicare formula.
The group of which Larsen is part will soon meet with House Speaker Nancy Pelosi and other key leaders to make their case.
They have a compelling one, especially in the context of achieving reform that lowers costs by rewarding good outcomes and high-value care.
Research overwhelmingly shows that paying more for care doesn’t necessarily yield better results. In fact, outcomes from pricier care are often worse. A reformed health-care system should reward quality and cost-effectiveness, not penalize it. Spreading that principle to all states, equally and fairly, is an essential step toward controlling costs, which in turn is essential to ensuring health coverage for all Americans.
Reform that doesn’t treat each state fairly isn’t the reform our nation needs. Larsen and the others are right to use all the leverage they have to push for fairness.
