Now's the time to debate health care like adults

Posted: Wednesday, January 19, 2011

The U.S. House of Representatives honored wounded Congresswoman Gabrielle Giffords last week by postponing what promises to be a rancorous debate on repeal of the Affordable Care Act.

Make no mistake, the House will have that debate, and the Republican majority will repeal the new law. Then the repeal will die in the Democratic-controlled Senate. Politicians will do what politicians think they have to do.

But what if ...

We hear much talk now about a watershed moment, about tamping down the rhetoric, about making government something other than a zero-sum competition.

So what if, after they go through the obligatory repeal and stop-the-repeal exercise, our elected leaders would begin negotiating a health care detente.

Because no one has any intention of going back to square one on health care, they would have to use the Affordable Care Act as the vehicle. That would be painful for politicians who campaigned on the erroneous premise that the law is, as newly elected U.S. Rep. Vicky Hartzler from Missouri put it in a tweet last week, a “job-killing, deficit-increasing, unconstitutional government takeover.”

But what if they actually tried?

Start with the biggest sticking point: the mandate everyone must purchase insurance.

This is being challenged by the attorneys general of half the states.

But instead of waiting for the U.S. Supreme Court to decide whether the mandate is within Congress’s power to regulate commerce, what if Congress came up with a better idea?

The goal, after all, is to get healthy people in the pool so insurance carriers can pay for the treatment of sick people.

Some smart people have proposed ways to do that. One is to raise everyone’s taxes, then give hefty refunds to people who purchase insurance. But given our tax-averse nature, a more feasible approach centers on establishing an enrollment period in which people can purchase affordable insurance regardless of their health status. Those who fail to enroll during that period would encounter steeper rates and consideration of pre-existing conditions if they wanted to purchase a policy later.

Like the mandate, the options aren’t perfect. But everybody seems to like the part about banning insurers from rejecting people or hiking their rates because they’re sick. If folks are in a compromising mood, that’d be a ripe field.

Likewise, the medical malpractice conundrum.

Doctors shouldn’t have to worry about their practices being destroyed by a false or exaggerated claim. On the other hand, the health care system is rife with errors. And the two major parties are basically deadlocked with Republicans calling for limits on malpractice awards and Democrats balking.

What if politicians looked for a third way — perhaps special courts, with expert judges, with the goal not only to compensate patients who have been truly injured but also to recommend systemic changes to reduce future errors?

And what if elected leaders from both parties rallied around the parts of the law that could transform the way we practice medicine in this nation — like reducing hospital readmissions with better coordinated care; or treating chronic diseases holistically, rather than symptom by symptom?

Is this pie in the sky? Probably. So much political currency is invested in the health care debate.

But what if ... politicians at least resolved to debate responsibly? No more talk of “pulling the plug on grandma,” or accusation that opponents of the Affordable Care Act want sick people to “die quickly.” How about a moratorium on shouting “rationing” every time someone takes up the issue of cost control?

We are fated to debate health care in this nation for a long time, perhaps indefinitely. But if Congress could lead the way in making the debate civil, maybe we’d end up feeling better.

• Barbara Shelly is a member of the Kansas City Star editorial board. Readers may write to her at: Kansas City Star, 1729 Grand Blvd., Kansas City, Mo. 64108-1413, or by e-mail at

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