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Sunday, August 09, 2009

A Representative's Reply...

...to a health care query emailed to him in July.

Here's Representative Adam Smith's (D- Washington State) reply to an email to him addressing concerns regarding the government's proposed health care reforms. The letter was much like the open letter that I posted on this blog last month.


--- On Fri, 7/24/09, Representative Adam Smith wrote:

From: Representative Adam Smith
To: dher490@yahoo.com
Date: Friday, July 24, 2009, 8:12 AM

July 24, 2009

Dear ######,

The United States Congress is entering a critical stage in the effort to reform our country's health care system. I believe very strongly that, with the right legislation, we can provide quality, affordable care to all Americans while controlling costs and improving quality.

The House has now introduced, through a tri-committee process, its first bill aimed at substantially changing that system. I fear, however, that this bill doesn't recognize the need for reform that will not only create universal access for all Americans, but that also fundamentally changes our broken and inefficient health care system to control costs and improve quality. The cost of adding the nearly 50 million uninsured Americans into our current health care system without structural changes in health care delivery, as this bill does, could collapse the health system. And, by so doing, we will have missed a tremendous opportunity to change how all Americans receive health care in ways that will address the significant shortfalls that currently exist in the quality of that care.

The Tri-Committee legislation, while it makes great strides toward covering more Americans, is unsustainable. The draft is too expensive and misses the most fundamental problems with our current system. We will be unable to provide quality care for those Americans who would gain coverage under this legislation if we do not remedy the current wasteful spending and out of control costs in health care. Further, I am concerned that the Obama Administration has released several promising ideas but has not yet put forth a solid legislative proposal around which Congressional leaders can coalesce.

Achieving the essential goal of affordable health care and universal access to care can only be achieved and sustained through cost containment measures. In this country we do too many unnecessary tests, prescribe too many unnecessary drugs, perform too many unnecessary surgeries, and have too many unnecessary hospitalizations. With greater emphasis on primary care, prevention, and paying for quality outcomes instead the amount of services there is a way to reform health care that could not only rein in costs, but could also improve the quality of care dramatically.

If we are going to be able to provide universal coverage to all Americans without bankrupting our economy, we have to eliminate fee-for-service (FFS) medicine. It has led to massive overutilization of treatment and tests. The current FFS model, and basis of our health system, rewards the quantity of services provided rather than the quality of care. In this system, providers are overburdened and incentivized to fit in too many patients. Providers must rush through appointments, which means that they can often order treatments, tests, and specialists that they may have otherwise determined to be unnecessary if they were afforded more time with their patients.

Unfortunately, however, the debate on overhauling FFS medicine has taken a disappointing turn in Congress. The argument has been made that, if we move away from FFS, it will lead to rationing of necessary tests and treatments. Correcting the flawed FFS system is not about rationing medicine or valuing one kind of care over another. Rather, it is about more efficiently expending resources. There are studies that show that regions of the country that spend the most on health care and perform the most tests and procedures have a lower quality of care than those areas that have lower costs. The debate, then, should not be about denying care but about reducing overutilization of unnecessary services and promoting higher quality care, both of which save money.

The problem is particularly apparent in Medicare where the reimbursement rate formula fails to reward efficient health care regions at a fair rate and overutilization is rampant. As a result, Washington state and others like it with very efficient health systems, where providers order fewer unnecessary tests and treatments, have very low reimbursement rates compared to other regions of the country.

This system is not only unfair to states like Washington, it is incredibly wasteful and unsustainable for the entire health care system. Providers are paid for the amount of care whether or not it is of high quality and in the best interest of the patient. The Tri-Committee bill does nothing to reform this system, and also adds to the problem by basing the public option on this same failed fee-for-service reimbursement model.

If health care reform rewarded doctors for the quality of the care they provide, rather than the quantity of tests, referrals, and visits, we could greatly reduce the amount of services and provide better, more efficient care and cover more Americans in a sustainable way.

I believe a public plan option and broader health reform is our opportunity to get off of fee-for-service medicine. I am supportive of a public option that includes both a reformulated reimbursement system and a focus on preventative care with discounts for people that make progress on preventable and controllable heath conditions.

As you know, preventative care is about more than tests and taking medications, it is also about promoting healthy behaviors and individual engagement. Health care should be a shared responsibility between patients and providers and that should be reflected in how people pay for insurance. There are several common preventable, controllable, health conditions that can lead to larger problems such as high blood pressure, high cholesterol, obesity, and smoking. Pricing that rewards efforts to improve or control these problems is not only fair, but also incentivizes individuals to actively engage in their own health, ultimately driving down the cost of care.

Many companies that self-insure their employees have had great success with risk-based pricing. The system they uses gives discounts to people who make progress on or control the issues mentioned above and charges people who don't control them more. Using this model, these companies have had great success with not only improving the health of their employees, but also with keeping health care costs low while the rest of the country saw inflation in costs. There is no reason why this model could or should not be applied to all federal health care programs including the Federal Employees Health Benefits Program (FEHBP) in which Members of Congress participate.

The Tri-Committee bill makes great progress toward covering more Americans. But, the introduced legislation makes minimal progress toward containing costs which will mean that our health system will remain unsustainable, our federal debt will continue to grow, and the burden of an excessively expensive health care system will continue to be an impediment to economic growth.

It is also important for the White House to take a more active role in formulating health care reform legislation. To date, the Obama administration, while very supportive of Congressional efforts to reform health care, has not yet introduced its own legislative text. It is necessary for the White House to contribute concrete ideas to this debate so that Congress and the American people can know exactly where President Obama stands. I would encourage you to contact the White House and urge the President to present his own version of health care reform legislation.

Now is the time to fundamentally reform our health care system in a way that expands access while containing costs to instill efficiencies in the system that pay for the expansion. I am hopeful that these issues will be addressed as health care reform moves forward and I look forward to working with my colleagues and President Obama on these important issues.


Adam Smith

Member of Congress


If you'd like to receive occasional e-mail updates from my office, please visit my website to sign up - http://www.house.gov/adamsmith/IMA/newsletter.shtml.


Adam Smith
Member of Congress


Post comments:

Obviously, from the response given by Smith it's apparent the government has every intention of shoving this half baked plan down our throats! Smith discusses costs, preventive care, Fee For Service care, availability, etc. but fails to provide any real substance to the discussion. He does allude to expanding access while containing costs but has offered up no real ideas.

Bottom line, he's offering cool aid to us. He's lost my vote!

Here's the reply that was sent to Smith. Short and sweet. Let's see what Smith's reply will be to this query. I'll bet he won't reply.

August 09, 2009 10:43 a.m.

Adam Smith
Member of Congress


Does this mean you'll be taking the lead and abandoning your current health care plan(s) to participate in this one that is being advocated for all of us?

A taxpaying Washington State, USA Citizen

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