Congress still can improve legislation
There's not much hope for major changes in Congress' health care bill as it moves toward final passage, but some incremental improvements surely can be made.
One is for the House to adopt the Senate's proposal to devote $500 million a year to bridge the "valley of death" that prevents medical-research discoveries from being translated into disease treatments and cures.
Another would be for House-Senate conferees to revive a Senate proposal -- rejected because it would cost $1 billion a year -- to increase America's supply of doctors, especially the primary-care physicians that will be needed to treat 30 million newly insured people.
The conferees also should pick up on a new proposal by the W.K. Kellogg Foundation to train a corps of dental therapists -- akin to nurse practitioners -- to provide basic service in rural and urban areas where dentists are unavailable.
And, if Congress really wants to take responsibility for what it is doing, it should give all states the same deal that Sen. Ben Nelson (D) gained for Nebraska -- pick up the full cost of expanding Medicaid instead of creating a giant unfunded mandate.
There's no time or appetite for huge conceptual changes in the bills the House and Senate have adopted.
President Barack Obama and congressional Democrats want to produce a bill that Obama can sign as soon as possible this election year to show that Democrats have achieved the president's signature policy goal.
To get a bill passed, it's clear that the House basically will have to adopt the bill the Senate passed with a bare 60 votes. That will mean foregoing a public insurance option to compete with private insurance and a tax on millionaires to pay for health reform.
Unless some other pay-for can be found that can attract 60 votes in the Senate, the House will also have to accept the idea -- stoutly opposed by organized labor -- to tax rich-benefit or "Cadillac" insurance plans.
If this weren't an election year, it might be possible to revisit the whole design of the package -- for instance, adopting proposals such as that of Sens. Ron Wyden, D-Ore., and Bob Bennett, R-Utah, to give Americans tax credits to buy their own private insurance, giving them maximum choice and portability.
But it's not going to happen. What conferees can do, however, is make sure that as many Americans as possible obtain insurance -- especially young people -- by increasing the penalties for not being insured.
The Senate bill contains a penalty starting at $95 but requires insurance companies to cover everyone regardless of pre-existing conditions. That's an invitation for young people to hold off buying insurance until they get sick or injured -- a recipe for increasing premiums on all those who are covered.
In addition, conferees should accept the Senate's "valley of death" proposal -- originally written by Sen. Arlen Specter, D-Pa. -- to increase "translational research" that will move scientific discoveries "from bench to bedside."
Basic research funded by the National Institutes of Health, nonprofit foundations and biotechnology and pharmaceutical companies has increased substantially over the past decade, but approvals of drugs and devices by the Food and Drug Administration have dropped.
Specter proposed, and the Senate adopted, an amendment to create a public-private "Cures Acceleration Network" to target "high need cures" and distribute matching grants to bring them closer to market.
Meantime, the president of the Association of American Medical Colleges, Darrell Kirch, recently wrote in the Wall Street Journal that the nation already faces a physician shortage that will be worse when 30 million uninsured people have coverage and are able to see doctors regularly.
He proposed that Congress lifts the cap it imposed on the number of medical residents Medicare would pay for by 15 percent. That idea had substantial Democratic support, but it was dropped as too expensive.
On Dec. 16, the Kellogg Foundation issued a report by Burton Edelstein of the Children's Dental Health Project showing that 48 million Americans live in areas without enough dentists to provide routine care.
The foundation proposed that the U.S. follow the example of countries such as England, Australia and the Netherlands in creating a dental therapist profession to provide such care under the supervision of dentists.
The idea, which has been resisted in the past by the American Dental Association, is not in either the House or Senate bill. But it should be.
And, finally, it's only fair that if Nebraska can be spared $100 million over 10 years in costs associated with Congress' mandate to expand Medicaid coverage, other states should be, too.
The House bill extends Medicaid coverage to people up to 150 percent of the federal poverty level and provides a 100 percent federal payment for two years, dropping to 91 percent thereafter.
The Senate bill goes to 133 percent of poverty and fully covers state costs for two years -- then drops to 82 percent to 95 percent for various states.
Governors of both parties have complained loudly that they are cash-strapped, yet Congress is requiring them to cover 11 million more people and insisting that they pay the freight. They're right. Congress should pay it all -- an estimated $30 billion -- and find the money to do so.
Democrats are pushing health-care reform even though it's unpopular in the country. They ought to make it as good a program as they possibly can.
(Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.)
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