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Kohl: Controlling Costs Won’t Limit Care

We all agree that reforming our health care system is a necessity, and that we cannot afford to wait another 10 or 20 years until health care costs have become uncontrollable. Even waiting a year to tackle health reform would be devastating, when the politics of an election year could prevent us from getting anything done. However, as urgent as the issue is, we must approach every aspect of health reform thoughtfully.

I believe we absolutely cannot consider a proposal that does not control costs. Controlling costs must be our No. 1 priority. I believe it is just as important as achieving universal coverage — because if we provide universal coverage without controlling costs, the result would be a financial catastrophe that cripples our nation.

I want to be clear that lowering costs has nothing to do with limiting access to care, though opponents of health care reform will try to convince America otherwise. The idea of “rationing” is a myth, and anything resembling it will not be a part of health care reform. No American should ever be kept from a treatment they need. But if we can cut back on unnecessary testing and over-treatment, then our health care system — and America’s patients — will be in better shape.

However, it is crucial that the federal government starts paying for value of care, not volume. As it stands, the Medicare reimbursement system provides perverse incentives. In other words, geographic areas that spend more money are rewarded for providing inefficient care. We must ensure that all health care systems provide better care in a more efficient way and reward those systems that already do so. Otherwise, we’ll never get costs under control.

As chairman of the Aging Committee, I have gained a familiarity with many of the pressing health care issues that affect seniors and all Americans. In this capacity, I have been pushing for health reform to include improvements to our long-term care system. Our nation’s population is aging at an unprecedented rate, and with every passing year, more elderly Americans find themselves in need of long-term care. Most of us will, at some point, struggle to face the high and rising costs of caring for a loved one.

These, too, are costs we must get under control as part of health care reform. We can do this by promoting a move toward Medicaid-reimbursed home and community-based long-term care services. These programs break away from a one-size-fits-all approach, offering flexibility and choices tailored to an individual’s needs. And, even better, they save a lot of money that would otherwise be spent on institutional care, the crushing costs of which are eating up more and more of states’ budgets.

We must also protect those consumers who are making an effort to plan for the costs of their own care in advance. In recent years, long-term care insurance products have gained popularity. In fact, some consider LTCI to be a “silver bullet” for addressing the high and rising costs of long-term care in America. More than 40 states have initiated programs to encourage residents to purchase LTCI plans in an attempt to lessen the burden of Medicaid costs on state budgets. Sen. Edward Kennedy’s (D-Mass.) Community Living Assistance Services and Supports Act envisions a whole new market of supplemental LTCI policies that consumers would be urged to buy in order to complement the bill’s coverage.

We have a duty to make sure these policies, which may span several decades, are financially viable. Many insurance companies have been raising their policyholders’ monthly premiums, which can be devastating for older persons who are living on a fixed income. Until we can guarantee that consumers have adequate protections, that carriers will not arbitrarily deny legitimate claims and that premiums will not skyrocket down the road, long-term care insurance is not ready to be a major part of the health care reform solution.

The funding of care is not our only concern. It’s been 22 years since we raised the standard of care in nursing homes — significant quality improvements are long overdue. As part of our Medicare and Medicaid reimbursement system, our government collects information annually about all 16,000 nursing homes across the country. We should make this information available to consumers so they can judge a home’s track record of care for themselves before deciding where to place a loved one. If consumers can easily tell which nursing homes are providing excellent services — and which homes are not — then this will be a powerful motivation for facilities to provide the best possible care, to hire and keep the most dedicated staff, and to always prioritize the interests of residents.

And finally, we must bolster the ranks of those who provide care. As America faces a severe shortage of workers who are equipped to manage seniors’ unique health needs, comprehensive health reform efforts must address this critical shortfall. We can do this by offering training and education for the licensed health professionals, direct care workers and family caregivers who care for seniors every day.

The truth is, while there are some hot-button issues that divide us, and while there is seemingly endless ground to cover, there is a lot about improving health care that we can agree on. For example, we all agree on the need to better coordinate care, to expand the use of health information technology, to remove fraud, waste and abuse from the system, and to provide the right kind of care at the end of life. We agree that we must train and expand the health care work force, which faces a severe shortage of workers. And we agree that we have a lot to gain if we get this done right.

Sen. Herb Kohl (D-Wis.) is chairman of the Aging Committee.

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