This article first appeared in the St. Louis Beacon, Aug. 7, 2009 - As the debate over health care heats up, the Beacon asked area members of the House and Senate where they stand at this time. Specifically, the Beacon asked:
Do you think a health-care bill is needed at all? If so, what specific provisions in the current House bill do you like? What don't you like? What three principles would you like to see guide health-care reform: universal coverage, single-payer, a self-sustaining system, government-run program? What specific provisions of a bill would ensure that those goals are accomplished? What would prevent your vision from becoming a reality and should not be included?
Here are the response to date:
Sen. Christopher Bond, R-Mo.:
I support reform that lowers health-care costs, increases access and improves quality, but I oppose the Democrats' proposal for a government takeover of health care that would drive health-care costs even higher for families, force millions of Americans off their current health-care plan, ration care, restrict access to the latest cures and treatments, and put health-care decisions in the hands of government bureaucrats rather than doctors and patients.
Among the reforms Bond supports:
- Helping small businesses find affordable health insurance options for their employees, who make up the largest percent of the uninsured, through small business health plans.
- Lowering the costs for people who buy health insurance on their own so they receive the same tax benefits as those who get insurance through their employers.
- Reforming medical malpractice laws to eliminate junk lawsuits so doctors can stop practicing defensive medicine, which can increase health-care cost as much as $120 billion a year.
- Encouraging wellness, prevention and disease-management programs that improve lives and reduce costs.
- Expanding the health-care safety net through community health centers
- Enrolling low-income Americans in the health-care programs they are already eligible for. Currently 11 million Americans are eligible but not enrolled in Medicaid and SCHIP.
- Reforming the Medicare and Medicaid programs to prevent these safety-net programs from going bankrupt. A grandmother living on a fixed income shouldn't pay the same for Medicare coverage as Bill Gates or George Soros.
- Cracking down on waste and fraud that drive up the costs of health care.
Sen. Claire McCaskill, D-Mo.
All of us are working on health care all the time. There is a great deal of political will to reform the system, across the aisle and across the political spectrum. We've got to focus on costs, both costs for the consumers of health care in this country and the costs for our government, and we have to evaluate whether or not the price of doing nothing is one that our country is willing to pay.
I just don't think it's completely sunk in with everyone what the consequences are of doing nothing. It puts us in a financial position that is just frankly not sustainable because of the rising costs of health care. I just don't want to have to acknowledge to people in Missouri that I realize that health-care costs could be half of everyone's income in a decade and not do anything about it.
There's so much misinformation out there. It is unbelievable to me the misinformation that people are grabbing onto and repeating as if it's the gospel. I think we've got to make sure that we stay on the facts and that we debate and that we find the right compromises that will reform health care for people in America who want to hold on to their current health care but don't want to have to continue to see the price go up double digit every year, like businesses that are paying for health-care have seen, and like most people who are contributing to the costs of their health care have seen, or those people who are buying health care on the open market. They certainly understand that these cost increases are something we just can't sustain.
Rep. William Lacy Clay, D-St. Louis:
This bill is not about creating a government-run health-care system, and anyone who tells you that either doesn't know what they're talking about, or they're trying to mislead you.
We are not going to create something like the British or Canadian system. We are going to create a uniquely American solution.
If you like your coverage, you will be able to keep it. If you can't afford any coverage, this bill will help you pay for it. If you want to change your coverage to a more affordable plan, you will have that choice. And we will do that without adding to the deficit.
I think that the most important change for most people is that if this bill becomes law, no one will be denied coverage because of a pre-existing condition. And no one will be penalized by outrageous premiums because of a pre-existing condition.
If we did nothing more than that, it would be a huge step forward. We are going to lower health-care costs for consumers and businesses who provide coverage for their employees.
And the public option is a key part of that.
We are going to put doctors in charge, not the clerks at the giant insurance companies.
We're going to build on what already works, and fix what doesn't work.
How are we going to pay for this? First, you need to understand that I will not support, and the president will not sign, any health-care reform bill that adds to the deficit. We have to pay as you go. One of the ways we do that is with a health-care surcharge.
I know there has been a lot of fear-mongering about this, so let me set you straight with the facts on this tax.
The surcharge that is part of the House plan would only apply a small tax to households who make more than $350,000 a year. In Missouri, that would apply to less than 1 percent of all taxpayers. And contrary to our critics, the surcharge would have absolutely no impact on 96 percent of small businesses. In fact, small businesses are going to be one of the biggest winners in this bill, because we are going to help them slash their health-care coverage costs.
We're also going to pay for this bill with significant savings that come from new health-care competition. That's why the insurance companies are fighting to kill the public option, because they know that it will force them to lower their costs, treat customers fairly and stop taking advantage of consumers with ridiculous premiums that are out of control.
Rep. Todd Akin, R-Town and Country:
He would like to see a bill contain these principles:
- Promotes the doctor-patient relationship and ensures that the patient has a medical advocate.
- Encourages medical decisions be made by the patient based on medical necessity rather than rationing by a bureaucrat.
- Encourages patients to practice healthy lifestyles. Such practices can be implemented through education and financial incentives.
- Encourages the implementation of electronic medical records that are interoperable and portable while ensuring that the patient's medical history is kept confidential and not released without the patient's consent.
- Encourages transparency of medical costs and quality so that patients have an incentive to "price shop" in the health-care market.
- Prohibits any particular entity, government or private, from obtaining a monopoly of medical services in any given market. Due to a lack of competition, monopolies have no incentives to be efficient, adapt new technology or restructure.
- If an individual is currently insured, they cannot be dropped by a health-insurance company due to a pre-existing condition.
- Rewards health-care providers based on the value of service, not the volume of procedures performed.
- Provides tax incentives to encourage patients to obtain catastrophic insurance.
- Encourages health insurance to be portable from job to job, and allow people to be able to get the same tax break when they buy insurance on their own as they do when they get coverage at work.
- Encourages preventive care through regular exams and check-ups.
- Turns illegal immigrants who have received free medical treatment over to the Department of Homeland Security.
Rep. Blaine Luetkemeyer, R-St. Elizabeth:
We have the highest-quality health-care system in the world, but most of us can agree that the cost of health care to the consumer is much too high and our system must be reformed. As the American people struggle to make ends meet, too many also live with the challenge of affording basic health care for themselves and their families. That is not acceptable. We must make quality health-care coverage affordable and accessible, and let those who like their current health care coverage keep it.
I don't think the Democrats' House bill truly achieves the goal of making health care more affordable and accessible. During the worst recession in a generation, the bill would add to our country's deficit, drive millions off their current plan, lead to fewer jobs, higher taxes and less health coverage.
With that said, I do support better utilizing health-care information technology and improving Americans' lives through effective prevention, wellness and disease management programs, while developing new treatments and cures for life-threatening diseases. I support making it easier to transfer health benefits from one job to the next and requiring health insurers to cover pre-existing conditions.
The majority's legislation exempts employer coverage from the additional federal mandates included in the bill, but only for a five-year "grace period" -- after which all of the bill's mandates would apply. This provision, by applying new federal mandates and regulations, would increase health costs for businesses and their workers and, by tying employers' hands, would have the effect of encouraging firms to drop existing coverage, leaving their employees to join the government-run health plan.
The legislation also has provisions requiring the new health choices commissioner to conduct audits of health benefits plans in conjunction with states, and further authorizes the commissioner to "recoup from qualified health benefits plans reimbursement for the costs of such examinations." These provisions likely would lead to overlapping and duplicative requirements on private businesses -- as well as higher costs due to inspections by the "health care police," which businesses themselves would have to finance.
Many Democrats argue that you will be able to keep your doctor and health insurance if you want. But that defies logic. If you put the government in charge of health care and create a system where providers are forced to suffer huge financial losses due to the government price-controlled Medicare and Medicaid payment systems, providers will reach a point where they cannot afford to provide care to patients with government-sponsored insurance. At a time when there are health-care shortages throughout the country, including many parts of our district, it makes no sense to create a system where fewer providers would be able to afford to accept Medicare and Medicaid, thus threatening patients' access to care.
Additionally, I will not support any plan that allows for the potential rationing of care or leaves life-and-death decisions up to government bureaucrats because of my belief in the absolute right of patients to make medical decisions with their doctors. I also believe that cuts to Medicare and Medicaid should be off-limits. The president has called for cuts in funding for Medicare and Medicaid to help pay for health-care reform. I do not believe limiting medical tests and treatments for the elderly and the poor is a proper way of "reforming" our health care system.
To lower health care costs, we must eliminate waste and fraud and crack down on abusive lawsuits that force doctors to practice defensive medicine or go out of business. Unfortunately, the Democrats' House bill does nothing to address the increasing cost of medical malpractice claims. I also want to ensure that health-care reform doesn't mean forcing folks into a new government-run health-care plan that would limit their choice of doctors and medical treatment options. We must give all Americans the freedom to choose the health plan that best meets their needs.
While I support health-care reform, I cannot and will not support a public health-care system that rations health care and allows a government bureaucrat to make life-and-death decisions when it comes to people's health.
Sen. Roland Burris, D-Ill.:
Our nation faces a health-care crisis. Over the past nine years, insurance premiums have more than doubled, increasing at a rate four times faster than wages. We must cut costs or more people will go without needed care.
I like the idea of state-based "exchanges." For individuals and some small businesses, these will act as regulated marketplaces, where Illinoisans can compare costs and coverage, then make the choice of insurance that is right for them. This system builds on what works in our system, because employer provided insurance will stay the same. Insurance reform is all about giving people options.
I am disappointed by the partisan nature of the health-care debate. Negotiations between all factions should lead to compromise and consensus and ultimately to a stronger, better bill.
The principles I would like to see are stability in insurance costs, quality coverage for all Americans and increasing prevention services.
To achieve these, I would like to see a public insurance option to compete with private insurers that will discourage excessive administrative costs and high profits from insurance companies; banning discrimination based on pre-existing conditions that will allow the people who need insurance the most to get the care they need; and minimal cost sharing for preventative services so people will be more likely to go to the doctor before a health issue becomes an emergency.
I am skeptical of the insurance "co-op" idea. Right now, large insurers dominate the market. They are able to use their monopoly power to negotiate low compensation rates with doctors and hospitals. A national public plan option would have the clout to negotiate fair rates, but state or regional co-ops may not enjoy that same power.
Rep. Jerry Costello, D-Belleville:
Rep. Costello continues to evaluate the bill and is withholding judgment until he sees the final bill and the various amendments.
Rep. John Shimkus, R-Collinsville:
The issue of the millions of Americans without health insurance does need to be addressed.
The three principles that I see as necessary to health-care reform are affordability, accessibility and portability. - What I believe needs to happen is for everyone to be required to have catastrophic health insurance coverage. We should allow 100 percent tax deductibility, allow for groups to pool membership in order to negotiate better rates, and assist those who cannot afford this coverage.
The insistence of a public option by some is a stumbling block to real, bipartisan reform.