Mike Enzi of Wyoming is the ranking member of the Health, Education, Labor, and Pensions Committee and the Senate's lone accountant.
I share the president's goal of helping all Americans get the healthcare they need. I agree with what the president has said over and over during the campaign and since taking office: We need reform that will bring down healthcare costs, help everyone get quality care, and allow Americans who like the care they have to keep it. Unfortunately, many of the ideas floating through Congress, like creating a government-run plan, would break the promises that the president has made. As we proceed with the healthcare reform debate, the Democrats in Congress must match their deeds with the president's words.
Before I was senator, and before that a mayor, I was a small-business owner in Gillette, Wyo. I saw firsthand how our nation's health insurance system doesn't work for many Americans. Too often, small businesses can't afford to purchase health insurance, and many insurers compete by selecting healthy individuals and not covering sicker ones. Premiums continue to spiral ever upward, while a small group of insurers dominates the market in many states. This denies consumers real choices and creates a situation where a single employee who develops cancer or a mother who has a premature baby can result in a small business seeing its health insurance become unaffordable. The current system also leaves many Americans trapped in jobs solely to preserve their current health benefits.
Our current system makes no sense. We need to make reforms to address problems, but I fundamentally disagree with advocates who argue that the way to fix healthcare is with a government-run health plan. A government-run plan will not meet the president's stated goals of bringing down costs and allowing people to keep the care they have now if they like it. Advocates of a government-run plan sometimes try to cloud its troubling aspects, but at its core, such a plan reflects the belief that government bureaucrats can effectively manage a marketplace. In a government plan, bureaucrats will determine how much every doctor, hospital, and healthcare provider is paid for services. They will also decide what items and services should be covered and whether patients should get access to newer, more expensive therapies.
Sixteen years ago, opponents of a similar approach described this structure as having all the efficiency of the Department of Motor Vehicles and providing all the customer service of the IRS. Little has changed. Government bureaucracies will always be nonresponsive to consumers' needs and waste huge sums of money by misallocating resources on politically powerful constituencies rather than investing in areas that drive down consumer costs.
When government-run plans confront the harsh reality of rising healthcare costs, they will respond as they always have, by lowering their reimbursement rates and by rationing care. This, in turn, will lead to shortages and patients being denied the ability to see the doctor of their choice. Anyone who wants to see a real-world example of this need only look to the government-run Medicaid program, with its woeful reimbursement rates and administrative hassles. Forty percent of all physicians refuse to see Medicaid patients, yet this is the model that advocates of a government-run plan are trying to force upon all of America.
Government needs to play a bigger role in regulating and policing the healthcare market. We need strong oversight to protect patients, but government needs to be the referee, not the biggest player. I support common-sense reforms that will force insurers to compete on a level playing field. We should prevent insurers from being able to cherry-pick only healthy patients and limit how much more an insurer can charge to individuals based on their previous health conditions. We also need to create ways to reward insurers who enroll sicker patients, which should be offset by payments from plans that disproportionately enroll healthier individuals.
I will push for reforms that could transform health insurance into a truly competitive marketplace, where insurers compete on the basis of the value they provide to their enrollees, rather than their ability to game the marketplace and gain unfair advantages. In a truly patient-focused healthcare system, insurers should have to work hard for your business. I believe that this type of model will really keep insurers honest, because it will allow consumers to call the shots and vote with their feet.
When individuals can choose among competing private plans, we will have a system that will far more effectively drive down costs and keep insurers honest than any government-run plan that sets prices and tries to manage the market. The new Medicare drug benefit provides a good example of what competitive markets can achieve. In Medicare Part D, consumers were given the choice of nongovernment plans, which were forced to compete in a system with clearly defined rules and consumer protections. As a result, seniors are getting the drugs they need, the program costs 37 percent less than expected, and it enjoys an 85 percent satisfaction rate.
Wyoming, even with its small population, went from just a few prescription drug plans for seniors before the program began to 48 different options today. That's the value of competition!
We all have the same goal—helping all Americans get healthcare coverage. We just disagree on how to get there. Winston Churchill once described democracy as "the worst form of government, except for all those other forms that have been tried from time to time." I feel the same way about competitive markets. In the long run, despite their occasional shortcomings, competitive markets are the most effective way to drive down costs and provide the greatest value for consumers. It's about time we tried them in healthcare.
- What do you think? Is a public option a good idea for healthcare reform?
- Read Health and Human Services Secretary Kathleen Sebelius' view, that a public option is necessary.
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