All eyes will be on the U.S. Supreme Court when justices convene March 26 to hear arguments on President Barack Obama's health reform law and specifically the provision requiring everyone to have a health insurance policy.
Our hope is the justices will rule in favor of the mandate. It is a modest idea, first proposed by Republicans and based on the principle that healthy consumers need to be in the insurance pool so that companies can fully pay for the care of sick people.
The mandate would affect fewer than 10 percent of Americans — those who aren't insured by an employer or covered by a government program. We aren't losing sleep over the prospect that Washington will next require us to eat broccoli, as some opponents suggest.
It is past time for policymakers to ensure the health reform law works. The court's affirmation of the insurance mandate would be a significant step in that direction.
As the court date nears, it is helpful to remember why a Democratic Congress took up comprehensive health reform in 2009.
Exorbitant medical costs and lack of access to insurance were forcing families into bankruptcy and causing doctors, hospitals and state and federal governments to spend millions of dollars on uncompensated care. Abuses by insurance firms were commonplace. Experts of all political persuasions were sounding alarms about a system riddled with waste and inefficiency.
The Affordable Care Act has made headway in addressing those problems.
About 2.5 million young adults up to age 26 are insured on their parents' plans. Insurance companies can no longer deny coverage to children because of pre-existing medical conditions, or impose lifetime limits on essential benefits for people with chronic conditions. Annual dollar caps are being phased out.
If the court upholds the individual mandate, the next step will be state-based marketplaces in which consumers can shop for affordable insurance policies, with subsidies if their income is low enough.
Those and other measures will result in a fairer, more accessible health care system. A bigger hurdle is costs.
Some experts think the Affordable Care Act is beginning to change health care with rules and incentives shifting compensation for doctors and medical professionals from paying for procedures to rewarding positive patient outcomes. That trend must continue regardless of what happens in Washington.
"Staying on a fee-for-service system is killing us," said Tom Handley, a health care actuary with the firm Lewis & Ellis Inc., which has a firm in Overland Park, Kan.
Handley recently compiled a 50-year-look at health care costs, documenting skyrocketing increases in per capita expenses for hospital care, physicians' services and prescription drugs since 1960.
Out-of-pocket payments dropped precipitously over that period, with Medicare and Medicaid picking up the slack. Interestingly, the share of the U.S. health care tab being paid by insurers is about the same now as in 1990 — about 34 percent.
Health care in the United States now costs double or more what other industrialized nations pay per person.
Handley cited a few of the reasons: U.S. physicians prescribe nearly three times as many MRI exams as doctors elsewhere and more than twice as many angioplasty procedures. Americans are almost twice as likely to be obese.
The United States has fewer doctors and hospital beds in proportion to its population than other nations, resulting in higher rates for scarcer services.
These and other comparisons present significant challenges for the health care system. It has to do a better job of ensuring that patients not only get the care they need but that they need the care they get. Government will play a role in making that work — or not.
So the sooner leaders can find a way to cooperate on solutions, the better. And the first step is getting beyond the divisions manufactured over the insurance mandate.
Copyright Kansas City Star. Reprinted with permission.