Seeking Bipartisan Health Care Solutions

Weekly column by Senator Susan Collins

President Obama recently announced that he plans to convene a health care summit with the goal of crafting consensus health care reform legislation. The summit, entitled “Next Steps,” could indeed be a positive step forward.

Rather than rehash the arguments surrounding the health care bills considered last year, it is time to look forward. The bitter rhetoric and partisan gridlock of the past year on health care legislation obscured a very important fact: there are many health care reforms that have overwhelming support in both parties.

Here are some of my thoughts on the specifics for this discussion. It is my judgment that the following seven proposals would win bipartisan backing and make a real difference in our health care system.

First, to expand access to health care, we should recognize that 63 percent of uninsured workers are employed by small firms. Tax credits to help small businesses afford health insurance for their employees would, therefore, reduce the number of uninsured.

I have heard from so many Maine small business owners who want to provide coverage but who cannot bear the burden of health insurance premiums that continue to increase by double-digits year after year. And if they pass on a greater percentage of the cost to their employees, workers often decline coverage because they simply cannot afford the additional cost.

These tax credits also should help the self-employed. For the self-employed and their families, the problem of affordability can be insurmountable since they are paying the entire monthly premium which often exceeds their mortgage payment. A generous tax credit, made refundable for low-income individuals who are self-employed, would help them afford coverage.

Second, we need reforms of the insurance market. Consensus reforms would include:

·preventing insurance companies from denying coverage to children who have pre-existing conditions,

·permitting children to remain on their parents’ policies until age 26,

·requiring standardized claim forms to reduce costs,

·allowing interstate sales of insurance with appropriate consumer protections, and

·enabling small businesses to join together to purchase health insurance to have the kind of bargaining clout now available only to larger companies.


Third, cost containment must be a primary focus. The soaring cost of health care is the reason millions are uninsured and millions more are struggling to pay their premiums. We should enact reforms that reward value rather than volume and quality over quantity.

Dartmouth College has done extensive work in comparing health care costs and quality across the United States. Some areas of the country, like here in Maine, are known for high quality care at a lower cost. Others, like Louisiana, are known for the opposite: lower quality and higher costs. If all health care providers were able to achieve the same level of efficiency as the famed Mayo clinic, Dartmouth researchers estimate that overall health care spending in the U.S. could be reduced by as much as 30 percent!

Because of its impact on cost, I would like to this bill include medical liability reform. The Congressional Budget Office estimates that medical liability reform could save $54 billion over the next decade. Doctors should not be forced to practice defensive medicine and order unnecessary and expensive tests just to protect themselves from potential litigation. That does nothing to improve quality and exacerbates costs.

I understand, however, that these reforms may not enjoy bipartisan support. Perhaps more modest medical liability reforms modeled on Maine’s successful pre-litigation screening panels would garner support on both sides of the aisle.

Fourth, reforms must help improve the quality of care. Greater use of electronic records, for example, would reduce medical errors. Everyone likes to joke about physicians’ indecipherable hand-writing, but it is no laughing matter when it leads to serious medication errors. Repeating medical tests because a primary physician’s office cannot transmit the results electronically to the specialist not only increases costs, but also can expose patients to needless risk.

Improving quality also means cracking down on hospital-acquired infections. An estimated 1.7 million Americans acquire an infection during a hospital stay each year, resulting in 99,000 deaths. In addition to the terrible human toll, these infections extend hospital stays and increase costs by $30 billion annually.

Fifth, we need greater transparency throughout the health care system. It is now difficult, and in some cases impossible, for health care consumers to compare cost and measures of quality. In deciding where to have a colonoscopy, for example, shouldn’t a person be able to easily compare the cost of the procedure at all the area hospitals that would be logical choices?

Sixth, virtually everyone agrees that our health care system should focus more on wellness and disease prevention. Federal law, however, limits the ability of large employers who self-insure their employees to reward those who participate in smoking cessation programs, monitor their blood pressure, or take advantage of work-site exercise programs. We must not penalize workers for having health challenges, but we should provide incentives for them to improve their health through wellness programs offered by the employer.

Seventh, we must address the serious health care workforce shortages that plague rural and small-town Maine. Simply having an insurance card will do you no good if there is no one available to provide the care.

The problem of access to health care is not limited to the uninsured, but is shared by the millions of Americans living in areas like Aroostook County that have severe shortages of physicians, nurses, mental health professionals and other critically important health care providers. Moreover, a recent report released by Maine’s Office of Rural Health and Primary Care found that Maine’s rural residents tend to be older, poorer and sicker than residents of our more urban areas. While they suffer disproportionately from chronic illness, just 39 percent have a personal doctor. In terms of their medical care, they are hanging on by a thread.

These seven steps, I believe, could be the foundation for a health care bill that could pass with strong bipartisan support and demonstrate to the American people that their President and their representatives in Washington can work together to tackle a major problem.