If their critics were looking for an easy target, Senate Democrats gave them a nice holiday gift when they passed their version of health-care reform on Christmas Eve.
Let us be clear: We find more to like than dislike in this imperfect bill. Besides achieving the basic goals of covering most of the uninsured and eliminating pre-existing conditions as a barrier to coverage, the final Senate bill carries key cost-cutting provisions won by Washington Sen. Maria Cantwell. If those survive final negotiations between the House, Senate and White House, they’ll mark a critical first step toward creating new, much more efficient and cost-effective ways of delivering care — the other fundamental tenet of reform.
All that was overshadowed, though, by the unabashed payoff given to the state of Nebraska in exchange for the crucial vote of its Democratic senator, Ben Nelson. Nelson, who supposedly was holding back his deciding 60th vote to get language restricting coverage for elective abortions, got his state exempted from payments for an expanded Medicaid system that taxpayers in every other state will have to cough up.
The deal, corrupt as it is on its face, was notable for its transparency. Democrats didn’t even try to deny that this was legislative sausage-making at its worst. Their basic argument: It was worth it to get health-care reform on its way.
A group of Republican state attorneys general, including Washington’s Rob McKenna, are looking into a possible constitutional challenge of the “Cornhusker Kickback,” which would seem to have merit. Even if much of the AGs’ motivation is political, we hope such an effort eventually gets Nelson’s deal thrown out.
We don’t think, however, that it should hold up passage of a final bill — if that version retains cost-containment measures like those won by Cantwell.
The most important may be the establishment of a “value-based index” within Medicare that would reward physicians for providing quality, coordinated care rather than for ordering tests and procedures that often are redundant and don’t improve outcomes. Such an index will go a long way toward fixing a perverse payment system in Medicare, in which Washington doctors have been punished for their efficiency by receiving relatively low government reimbursements, which has limited some patients’ access to care.
Cantwell also won a provision to offer incentives to medical students who pursue a career in primary care, where there’s an alarming shortage. Having more dedicated, highly skilled primary physicians will help lower costs by increasing access to well-coordinated care.
Enacting these improvements in the shadow of political payoffs leaves a bitter taste, to be sure. Better to move forward with the good, however, and try to rectify the bad in court.
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