Editorial: Health reform's fate hangs in balance

Bear with me a moment, said Park Nicollet's President Dr. David Abelson as he launched a recent health care reform presentation in an unexpected way. On the screen behind him flashed images of "Baby Jessica," the Texas toddler whose fall down a well in 1987 sparked a massive, expensive and heavily televised rescue effort. Abelson's point: The rescue didn't depend on whether the tiny girl's parents could pay for it or pass a credit check. So why does the dynamic change so radically if Baby Jessica -- or anyone else, for that matter --is sitting in an exam room with a treatable disease?

"In terms of the moral imperative, there is no difference," said Abelson, an internist and incoming chief executive officer of the St. Louis Park-based medical system.

If only the nation's political leaders could frame the health care issue as accurately and elegantly as Abelson. As the U.S. Senate pushes to pass a health care bill before Christmas, there is an underlying moral question sadly missing from this acrimonious debate: Should your chances of being cured or avoiding a disease depend on what's in your bank account?

The answer is a resounding no. And that's the fundamental reason why the Senate must pass its health care bill in the floor vote expected this week. A vote for the bill is a vote to begin the arduous process of fixing a national disgrace: a health system with soaring costs that covers fewer and fewer people. A vote against the bill is head-in-the-sand obstructionism, and opposition cloaked as "fiscal responsibility" is the absolute height of hypocrisy.

Letting the Medicare program for seniors careen toward insolvency while abandoning 47 million uninsured Americans to a threadbare patchwork of charity care and public programs is the most irresponsible, inefficient management possible of the nation's finite health care resources. It also does nothing to address skyrocketing health care premiums -- expected to hit $26,000 for an annual family plan in Minnesota by 2020 -- that will price the middle class out of health coverage.

No one piece of legislation could be a cure-all for the moribund American health care system. The Senate bill, while imperfect, nevertheless represents a solid start toward expanding coverage and reining in the world's most expensive annual medical tab: $2.4 trillion.

First and foremost, it addresses Abelson's moral imperative in several key ways. Coverage would be expanded to an estimated 31 million people. Overdue reforms would also prevent shameful insurance abuses -- denying coverage to those with preexisting conditions or cutting off coverage upon diagnosis of a serious illness. The legislation is also projected to save the nation billions over the next 10 years compared to the status quo, according to the Congressional Budget Office.

Critics justifiably point out that far more is needed to truly "bend the cost curve" -- to squeeze savings out of what will remain an expensive health care system. What the Senate bill does is lay the groundwork to accomplish this. Within it are a number of innovative pilot programs that begin the tricky process of payment reform -- financially rewarding providers for quality, efficient care instead of paying them for the number of procedures they do. An independent Medicare advisory commission, strengthened over time, could also find ways to improve that program's quality while heading off its looming insolvency. The exchanges that would allow some consumers to shop and compare different coverage plans are also a promising cost-control development. Over time, if they prove effective and are expanded, they could help harness the power of marketplace competition to make insurance more affordable for many more people.

Health care reform is one of the most complex undertakings the nation has ever tackled. But the bottom line is that it's the right thing to do. This will be a long, trying process to figure out what works and straighten out what doesn't. The question is not whether to plunge forward on reform, but whether policymakers and the public approach this massive undertaking with a gotcha attitude or pragmatic patience. We hope it's the latter.