World-Herald editorial: Just say ‘no’ to Reid health care plan

Sixty votes will be needed to send Sen. Harry Reid’s health care proposal to the Senate floor for debate. Sen. Ben Nelson, one of the most closely watched swing votes, should vote no.

Why? Because Reid’s proposal, like that approved in the U.S. House, would place immense burdens on small and medium-sized rural hospitals in the Midlands. It would not prevent further steep increases in health care costs.

It would, however, shunt billions in new costs onto state governments. And its budget savings at the federal level depend on empty, misleading promises of fiscal discipline that Congress has shown it’s utterly incapable of fulfilling.

If anyone doubts the threat to Nebraska, especially its rural areas, remember that it was Reid himself who tried to get a side deal to hold his own state of Nevada harmless from the increased Medicaid expenses that would raise costs steeply for state governments — and thus state taxpayers.

Those considerations need to occupy the very forefront of Sen. Nelson’s thinking as he ponders how to vote on the proposal. Is he more worried about making sure that the vital interests of Nebraska are protected, or about pleasing Reid and House Speaker Nancy Pelosi?

There ought be no question about what the proper answer should be. And that answer — making absolutely sure that health care legislation does not harm the interests of Nebraska — should lead the senator to vote “no” on sending the legislation to the floor.

If the legislation does win final passage in the Senate, it then would go to a conference committee with the House. The odds are that the conference committee would make the legislation even more heavy-handed and centralized, without proper consideration for the burdens placed on Nebraska. In the Senate, the conference committee’s proposal would need only 51 votes to win final approval. Nelson at that point could vote no and the legislation nonetheless would become law with the president’s signature.

No matter how much Nelson then said, “Look, everyone, I voted against it in the end,” the real-world harm to Nebraska would be gigantic and longlasting. The state’s smallest and most vulnerable medical facilities would face enormous pressure. Major new expenses would fall on the state government.

And judging from what Congress has decided so far, the legislation would do nothing serious to curb health care inflation.

Just this week, Jeffrey S. Flier, the dean of Harvard Medical School, wrote an opinion column on the nation’s health care debate, saying, “I’d give it a failing grade.” He added:

“Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that’s not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost — and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.”

If the Senate does take up the Reid proposal, Sen. Nelson’s fundamental obligation throughout the debate should be to focus on safeguarding Nebraska’s interests, particularly its rural areas. Nebraskans need to be watching and listening closely for the senator’s words and actions.

If Nelson can’t make the case right now that rural Nebraska would be safe under the Reid legislation, then he should not vote to allow it to go forward. Otherwise, congressional procedures would likely produce an ultimate result that — regardless of the senator’s possible “no” vote at the end — would deliver a terrible blow to Nebraska communities.

That is the kind of result from which a state finds it hard to recover. The same can be said of a lawmaker’s reputation.