Health care will continue to be my top legislative priority in 1991, driven by growing concerns nationally about both cost and access to quality care.  I am well-positioned to address these concerns via my memberships on both Senate committees that address health care issues – Finance and Labor and Human Resources.

Unlike many countries I’ve visited in the past two years, availability of health care isn’t a problem for most Americans.  Without question, we have the most doctors, the most specialists, and most hospital beds per capita of any nation on earth.  We also have the most innovation – new technology and new procedures – even when compared to those nations who have become our peers in other fields of economic or technological competition.

But for millions of Americans, health care costs too much and delivers too little.  With its high and rising cost, widespread availability of health care does not translate into universal access.  The best evidence for this conclusion lies in the more than 30 million Americans who don’t have the basic tickets into this system – either health insurance or income or age qualifications for a public program like Medicare or Medicaid.

The culprits in this crisis are many.  But, at its heart is a system of health care financing that often ignores sound insurance principles, that fails to reward individual health and wellness, and that provides serious disincentives to hold down costs.

In response, many politicians and consumer groups are urging either a requirement that all employers provide health insurance to their workers or a government take-over of health care financing through a “single payer” system like that now in effect in Canada.

These failings in America’s health care system won’t recede, however, without more fundamental, system-wide reform.  Merely shifting costs to employers (mandated benefits) or government (single payer system) just won’t do the job.

A“Third Course for Reform”

My response to this dilemma has been to chart a “third course” – premised on accepting the reality that we have a diverse and partly privately-financed health care system, but with a personal determination to incite fundamental changes in the way it performs.  This “third course” must not be viewed as a defense of the status quo.  And, it must not be viewed as being deferential to any of the principal actors in our current health care system – consumers, providers, employers, insurers, or government.

This “third course” for reform envisions much greater consumer, provider and employer responsibility.  It assumes fundamental reforms in governmental programs like Medicare and Medicaid.  And, it assumes a vastly different role for the federal tax code – to reverse incentives and create a truer and more properly functioning market.

To achieve these goals for reform, I intend to introduce legislative initiatives over the next several years in all the following areas: private health insurance reform, Medicare reform, Medicaid reform, long term care financing reform, and tax reform.

Enhanced role for

third-party payers

At the heart of this “third course” I have chosen in health care reform is an improved and more socially responsible role for “third party payers.”  They include insurance companies, HMOs, and others who administer self-insurance programs, manage care and perform other intermediary functions linking consumers and providers of health care.

Small group reform is first step

Total reform of our health care financing system will take time and involve a number of separate initiatives.  The first is my “Small Employer Health Benefit Reform Act” which is designed to make private health insurance more affordable and accessible to smaller employers.  Past studies indicate that more than half of America’s uninsured workers and dependents are employed by firms that have fewer that 25 employees.

Under my proposal, insurance companies would face a federal tax penalty if their policies sold to smaller employers did not meet certain requirements.  they are designed to limit restrictions on coverage due to pre-existing conditions, guaranteed issue and renewability of policies to all employees, stabilize rate increases, and restrict variances in rates among different categories of employees.

Medicare and Medicaid reform

Beyond private health insurance reform, I also intend to offer comprehensive Medicare and Medicaid reform proposals.  One objective of these proposals will be to put these two public programs on a firmer financial footing for the next several decades.  And, I also want to make sure that Medicare and Medicaid reflect changes in health care delivery we’ve experienced in recent years and the potential both programs have as models for needed reforms in the role of private health insurance and other third party payers in the private sector.

                – Dave Durenburger