comm_grassley Sen. Chuck Grassley

The American healthcare system needs reform.

We spend twice as much on health care as other developed countries. Yet despite all this spending, our health outcomes are often only half as good. Millions of people live in fear of losing coverage; 45 million Americans have none. The president and Congress want to fix what's wrong, but if we're not careful, we could make things worse.

As Congress considers health reform, I hope Republicans and Democrats can agree to four key principles.

First, health reform should be developed through a bipartisan process that leads to a bill with broad support. Health reform affects more than 17 percent of the economy. It affects everyone. So it should be subject to full, open debate-not jammed through Congress before anyone can figure out what's been proposed.

Second, we must also uphold the promise that if you like the coverage you have, you can keep it. President Obama's campaign promise was, "If you've got a healthcare plan you like, you can keep it." But he also wants to create a government-run health plan. In this plan, the government would set the prices, determine which treatments are covered, and control costs by offering a one-size-fits-all package. It would cause 119 million Americans to shift from private coverage to the government plan, according to the consulting firm The Lewin Group, and put America on the path toward a completely government-run healthcare system.

Cost shifting already happens in Medicare and Medicaid. Doctors and hospitals are already paid less by public programs. They make up the difference by passing the cost onto their other patients. If more people entered public plans, even more doctors would stop seeing Medicare, Medicaid, and public plan patients. Employers-especially small businesses-would stop offering coverage because they would be able to tell employees to get their coverage from the government plan. Eventually, the government plan would overtake the entire market.

Also, private health plans should not drop out of Medicare. Your healthcare options should not depend on your zip code. In 2003, I worked to bring private health plans to Medicare beneficiaries in Iowa and other rural states. Today, Medicare Advantage offers more choices and better benefits than traditional Medicare. Plans are widely available. More than 10 million people have enrolled. Drastic cuts could force plans to cut benefits and drop coverage in rural areas.

Third, healthcare costs need to be brought under control in a fiscally responsible way. We must provide affordable coverage to the millions of uninsured. But we shouldn't pat each other on the back if we provide access to unaffordable coverage in an unsustainable system.

Americans should be able to secure affordable, accessible insurance, regardless of pre-existing conditions. Many people who apply for insurance are able to enroll without problems, but even healthy individuals and families worry that at some point-probably when they need it the most-they'll be unable to get coverage. We need stronger rules on insurers, such as requiring them to cover people with pre-existing conditions and stopping them from charging higher premiums on those in poorer health. The system should treat everyone fairly.

But having coverage is not enough. As we get more people insured, we must make sure they also have access to providers.The Massachusetts experience shows that we have our work cut out for us to ensure that those who become covered through health reform have access to primary care providers.

Entitlement reform is also a key element of healthcare reform because the costs of the Medicare and Medicaid programs are growing at a rate that is unsustainable. Spiraling increases in healthcare spending overall increasingly burden family, employer, state, and federal budgets.

Healthcare reform has to be accomplished in a fiscally responsible way that includes reining in spending by Medicare and Medicaid and increasing access to affordable comprehensive coverage for everyone. Commercial health plans in the private market tend to follow Medicare's example by modeling Medicare's payment systems. That is why it's so important to fix the inefficient ways in which Medicare pays healthcare providers. The way Medicare reimburses for healthcare services today results in a lack of coordination among providers and, in turn, a lack of coordination in the care that is provided. As a result, the healthcare system isn't working to deliver the highest quality care possible. The saying that you get what you pay for applies.

When healthcare providers work out ways to deliver care in a more efficient, higher quality way, Medicare often pays less as a result. This lower payment discourages providers from innovating and working to deliver higher quality care at a lower cost. It doesn't make sense. One of my goals in healthcare reform is to realign the payment incentives in Medicare to reward quality and value rather than the volume of services provided.

Congress took steps to focus incentives on quality care in 2005, when it passed legislation that established a link between quality of services provided to beneficiaries and payment for those services for inpatient hospitals. Congress has also laid the foundation for value-based purchasing by establishing pay-for-reporting for physicians and other providers, and those programs are continuing to evolve to more outcome-based measures. We must continue our efforts to change payment systems to promote high-quality, efficient care. We must also put more emphasis on primary care and chronic care management. We must provide more incentives for physicians to choose and remain in primary care and for physicians to utilize better care management strategies for patients with high-cost, chronic conditions-an area where the greatest percentage of Medicare money is spent on a small percentage of Medicare beneficiaries. And we must provide incentives for providers across the entire episode of care to actually coordinate the care of the patient.

The Senate Finance Committee's policy options paper on delivery system reform proposes a number of options that would achieve these goals. If implemented, these proposals would begin to transform how health care is delivered in our country. It is clear that providers across the country vary in terms of their readiness to implement these major changes. That is why whatever reforms Congress enacts must ensure that providers of all levels of readiness are able to make changes in the least disruptive manner possible.

Fourth, whatever changes Congress makes to the healthcare system, we must ensure that healthcare decisions are made by two people-the patient and the doctor. I support making sure patients and doctors have the most up-to-date and accurate information. But I can't support reforms that allow the government to interfere with a doctor's ability to practice medicine. We also shouldn't put the government in charge of deciding which doctors patients can see and what treatments they can have.

I'm concerned about what Congress passed in the economic stimulus bill on comparative effectiveness. I'll continue to raise concerns about any national health board or other federal body that directs health dollars.

With all of these challenges, some people might question whether we can get significant healthcare reform done this year. There's good momentum now. If Republicans and Democrats agree to work together through the entire process, it can be done. As long as we stay focused on the problems we seek to solve, it can be done. As long as we don't try to bite off more than we can chew or create new problems where none really existed before, it can be done.

The possibilities to improve health care in a significant and substantive way are before us.


Sen. Chuck Grassley (R-Iowa) is the senior Republican and ranking member of the Senate Committee on Finance. He also serves on the Senate Committee on the Judiciary; Committee on Agriculture, Nutrition, and Forestry; Committee on the Budget; and Joint Committee on Taxation. Grassley uses his leadership position on the Senate Finance Committee to expand health insurance coverage; investigate drug safety issues; and build bipartisan consensus to address looming shortfalls in the public health systems. Grassley was elected to the Iowa legislature in 1958, to the U.S. House of Representatives in 1974, and to the U.S. Senate in 1980.

Publication Date: Wednesday, July 01, 2009

Login Required

If you are an existing member, please log in below. Username and password are required.



Forgot User Name?
Forgot Password?

If you are not an HFMA member and would like to access portions of our content for 30 days, please fill out the following.

First Name:

Last Name:


   Become an HFMA member instead