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January 12, 2010 7:56 AM CST

Why I Voted ‘No’ on Health Care Reform


The need for health care reform is clear: The skyrocketing cost of health care threatens America’s financial future and our ability to effectively care for our citizens.

When Congress set out to accomplish health care reform earlier in 2009, I had two main goals in mind: slowing the growth of health care spending over the long term, and building a system that focuses on quality of care, rather than simply quantity of care. Achieving these goals would allow us to greatly reduce the number of Americans without health insurance coverage, and improve the quality and affordability of our health care system overall.

Unfortunately, the health care reform bill (H.R. 3962) that was passed in the House on Nov. 7 failed to include the reforms necessary to meet these goals. This is why I voted against it.

I support many aspects of the House bill, such as the insurance reforms prohibiting both lifetime health insurance caps and denial of coverage for pre-existing conditions. I also support the emphasis the bill places on wellness initiatives; its promotion of health information technology; its creation of a health insurance exchange; and its investment in research to better inform patients and doctors about the difference between the best treatments and the most profitable treatments.

Despite the bill’s strong points, it failed to address the one issue we cannot ignore in any truly effective health care reform bill: out-of-control health care spending. Until we tackle this core problem, we will simply be perpetuating an inefficient system that is unsustainable. This is the reason health insurance is so unaffordable to so many.

In recent months, politicians and analysts have discussed the need to “bend the health care cost curve.” The concept is simple: We must do something to make the system more efficient and slow the growth of health care spending that is increasing at an annual rate well above that of wages and inflation. Until we bring these costs under control, premiums will continue to rise faster than incomes, more small businesses will be unable to afford coverage for their employees, and government spending will escalate year after year.

The key to bending the cost curve and achieving true health care reform is changing the way we pay for health care. We must transform our current fee-for-service system, which pays providers primarily based on the quantity of care they provide, into a system that pays providers based on the quality of care they provide. This is crucial, because our current payment system incentivizes inefficiency and overutilization. This is because providers are paid for the number of times they see patients and the number of tests they run, rather than for how healthy they keep patients.

A number of academics, economists and health care experts from across the political spectrum, including the nonpartisan Congressional Budget Office and the Centers for Medicare and Medicaid Services, have documented that under the House bill, both federal and overall health care expenditures would increase in the long term compared to current law.

Instead of leaving the difficult decisions about systemic reform to future generations, I believe we must seize this historic opportunity and enact a health care bill that includes incentives for providers to keep their patients healthy and out of the health care system in the first place. The best way to contain costs and slow the growth of health care expenditures is to change behavior through reforming the way health care is delivered and paid for in this country.

Supporters of the House bill have argued that it is fiscally responsible, because it does not add to the federal deficit. While this is true, there is a big difference between not adding to the deficit and bringing down health care costs. The House bill pays for itself primarily by raising taxes, not by making the fundamental reforms necessary to bring down the cost of health care.

We cannot simply add tens of millions of uninsured people into today’s inefficient health care system and expect that it will yield different results. Absent the necessary systemic reforms, this approach would only compound our nation’s budgetary problems and do little to make health care more affordable for families and businesses.

The American people deserve better. I am hopeful that Congress ultimately will pass a bill that represents true health care reform: a bill that would both expand coverage and lower costs. The issue is too important for us to miss this opportunity.

About the Author

Congressman Jason Altmire is serving in the U.S. House of Representatives, where he represents all or parts of six counties in western Pennsylvania. He has quickly established himself as one of Congress' leading voices on health care, small business and veterans' issues.


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