Health care needs fixing, but fed plan is wrong way to do it

America needs health care reform to cover the uninsured and those who can't get health insurance for medical reasons, as well as to reduce the cost. But it does not need the federal government in charge of our health care or health care benefits.

Under the proposed legislation, House Resolution 3200, a government-run public health insurance option will be created and receive $2 billion for start-up costs (Sections 221-223) and compete against private insurance and HMO plans. Since the government will use a version of Medicare-allowable reimbursements to doctors and hospitals, the premiums for the government-run public option will be lower than the premiums in the private insurance market.

The Medicare-allowable reimbursements will not support the actual cost of providing services by the hospitals and providers, and this will create financial shortfalls for the providers. These losses will then be shifted to the private insurance market. This will cause the cost of private coverage to escalate and eventually destroy the private market.

The consulting group Milliman Inc. estimated that Medicare and Medicaid offloaded $88 billion in cost to commercial payers in 2007. That $88 billion came directly out of the consumers' pockets. In fact, the average family of four saw its insurance premiums increase $1,500 as a result of the public programs' systematic underpaying.

Under the proposed legislation, the Health Benefits Advisory Board will be established to decide the types of policies and coverage that will be deemed allowable (Section123 (a)).

Under the proposed legislations, employers will be required to pay most of the cost of the private or the government-run public option (Section 312) and will be exposed to a significant increase in taxes (Section 313). Neither of these will reduce the cost of health care or health insurance.

Under the proposed legislation, premiums for the public health insurance option will not be taxed at the state level. Now federal insurance programs don't pay state taxes. If patients leave private insurance companies in droves, those firms' revenues will decrease significantly. And that will yield an equally severe dip in tax revenue for the states. This could mean a loss of more than $300 million in premium taxes to the state of Georgia.

These are just a few of the highlights in the 1,017-page proposed legislation, and the Senate has not introduced their legislation. Therefore, the final design is yet to be determined and the current proposal is not the tool that will reduce costs or make coverage available to everyone.

So what will work to reduce the cost of health care and insurance? Meaningful, thoughtful and sustainable reforms will accomplish the task of controlling cost and improving access to the health care system.

Here are a few ideas:

· Guaranteed issued individual coverage with an enforceable individual mandate for health insurance coverage, along with tax subsidies for the low-income earner and small business owners who cannot afford to offer health insurance to their employees.

· Use of wellness factors in premium pricing that will require individuals who do not practice healthy lifestyles to pay higher premiums. Individuals who smoke, drink excessively and those who are obese should pay higher premiums because eventually they will incur higher heath care costs.

· A high risk pool is one of the best ways a state can ensure individuals suffering from catastrophic medical conditions have access to high-quality, affordable private health insurance coverage, while ensuring stability in state-level individual and small group health insurance markets. Thirty-four states have already implemented high-risk pools, which have provided affordable health care choices for hundreds of thousands of individuals who would otherwise be uninsured.

· Regulatory authority of insurance/HMO plans needs to remain at the state level. This is important because there is not a "one size fits all" federal solution to health care costs or access to health care coverage.

We have a long way to go in the debate, so do not let down your guard and keep reminding the members of the Senate and the House of Representatives about your concerns.

You can review additional information and ideas on Health Care Reform at www.nahu.org, www.uschamber.com or www.gwinnettchamber.org.

Raymer Sale is a Gwinnett resident, member of the Chamber of Commerce board of directors and the owner of E2E Benefits Services Inc.