Midlands Voices: Rural Nebraska urgently needs health care reform

The writer, of Lyons, Neb., is executive director of the Center for Rural Affairs.

The decision on health reform is one of the most important before Congress in the past 40 years. The World-Herald (Nov. 20 editorial) was wrong to urge a minority to block this historic legislation from even being debated and refined.

America needs a Congress that governs, not obstructs. The “do nothing” approach is unacceptable.

If recent trends continue, noted the New England Journal of Medicine, the Medicare Trust Fund will be broke by 2017. In 10 years, family insurance premiums will double and nearly one-third more families could lose insurance.

Action is needed to protect the American dream for working and self-employed families and to enhance American competitiveness.

It was particularly disconcerting for The World-Herald editorial to base its call for obstructionism on rural health care. The need for reform is most critical in rural America, where more of us go without the coverage we need because we depend so heavily on self-employment and small-business employment.

Insurance costs are undermining the foundation of the rural economy. With each increase in premiums, fewer rural Americans can take the risk of giving up a job with insurance to start a farm or business. And as rural entrepreneurship declines, so declines the rural economy.

Rural Nebraska is also at risk of losing access to care as providers reach retirement age and no one takes their place. “We face a looming crisis in the number of health care workers” says Dr. Keith Mueller of the University of Nebraska Medical Center and Nebraska Center for Rural Health Research.

The Senate bill would address that crisis by forgiving college loans to doctors who practice in rural areas and increasing support for rural students to become family physicians.

Furthermore, it “makes positive improvements in correcting systemic payment inequities that have plagued rural providers,” says the National Rural Health Association. The association and the Center for Rural Affairs will work to strengthen those provisions when the bill comes up for debate.

Of course, this is not just a rural bill. All Americans can benefit by preventing insurance companies from denying coverage of pre-existing conditions and dropping policy-holders for getting sick and needing care.

The financial assistance in the bill would help small businesses and families making up to $88,000 buy insurance, giving the most help to those with the most need. That assistance must not be shortchanged.

The legislation appropriately requires most Americans to have insurance. All should be covered, and all should contribute. But with that mandate must come sufficient help for working families.

The bill would lower premiums for individuals and small businesses by increasing competition through an insurance exchange. A small public insurance option would help keep private insurers honest, with individual states free to opt out and payment rates not tied to Medicare rates that discriminate against rural hospitals.

The bill would invest in preventive care and research to guide doctors toward treatments that work. It includes measures to discourage expensive but ineffective treatments.

Today, providers can make more money by using more expensive treatments — even treatments that don’t work. A pilot project would encourage cost-effective, proven treatments by paying fixed rates for fixing particular health problems.

We won’t tame skyrocketing health care costs until we eliminate the perverse incentives for unnecessary and expensive treatments.

America’s prosperity is on the line. And the economic imperative for reform is equaled by the moral imperative. Recent studies estimate that from 18,000 to 45,000 Americans die each year because they lack insurance and don’t get adequate care in time. Not only can health reform make America a more prosperous nation, but it also can make America a more perfect nation.

Most major Christian denominations agree. The Evangelical Lutheran Church says that “a just society is one that supports the health of all its members.” And the U.S. Conference of Catholic Bishops states flatly that, “Health care is a basic human right. Access to health care should not depend on where a person works, how much a family earns or where a person lives.”

The Catholic Conference has several concerns with the bill. But it is seeking to address those concerns through amendment, rather than obstruction, reflecting its moral commitment to extending insurance to all Americans.

That goal has defied American leaders since President Teddy Roosevelt first proposed health insurance coverage for all Americans in 1912. Presidents Harry Truman, Bill Clinton and Richard Nixon all tried, and all were blocked.

We’ve been talking about health reform for 100 years. More obstruction is not the solution. It is time to act.

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