Compromise is essential

Health-care reform that covers all Americans and addresses runaway costs is much more likely to last with at least some bipartisan support.

If majority Democrats in Congress force through an overhaul with little or no Republican backing, it will worsen the very polarization that candidate Barack Obama spoke against so frequently and eloquently. Count on the GOP to make the unraveling of a strictly partisan health-care bill its mission for years to come. And since no reform plan is likely to work perfectly, the votes needed to chip away at it over time may not be hard to find.

A strong, bipartisan bill will require compromise. If the president wants a bill this year, it’s time to give some ground. We suggest Democrats, including the president, start by dropping their insistence on creating a government-sponsored plan to compete with private insurance. Obama says it’s intended to keep commercial insurance companies “honest” by offering a low-cost alternative. Opponents say it would be inherently unfair, given the government’s power to dictate reimbursement rates.

Undermining commercial insurance runs the risk of making health-care reform cost-prohibitive. Payments to physicians and hospitals under current government programs, Medicare and Medicaid, are already too low to cover costs, and those underpayments are made up by commercially insured patients.

It’s an annual cost shift of $88.8 billion — essentially a hidden tax on privately insured patients and employers that increases their premiums by about 15 percent a year, according to a nationwide study last year by Milliman, Inc.

If a government insurance plan were to draw millions of customers away from private insurance, as is widely projected, who’s going to pay for the cost shift? Bet on even greater underpayments to providers, which isn’t a prescription for greater access or better care.

And it should be noted that recent double-digit hikes in health-insurance premiums in our state aren’t lining insurance executives’ pockets. Hikes at Regence BlueShield and Group Health (both are not-for-profit, as is Premera Blue Cross) were deemed justified by state insurance regulators.

Another place Democrats should give ground is in taxing “Cadillac” health-insurance plans offered by some employers — plans that cost $15,000 or more a year — to help pay for covering the uninsured. For their part, Republicans should agree to requiring employers to offer coverage to their employees, or paying a commensurate tax instead. Even Wal-Mart has come out in favor of that idea.

The central focus of this reform effort, aside from expanding access to quality care, must be on curbing skyrocketing costs of care. That’s where the biggest overhaul is needed, and the rest of the nation would do well to learn from cost and quality innovations being made in our corner of the country. Prevention must be emphasized, and financial incentives geared toward healthy outcomes rather than the number of procedures performed.

The opportunity for meaningful reform is at hand. Meaningful give and take can make it happen.