Print  email 

tool name

close

tool goes here

Rep. Smith says House health-reform bill still 'deeply flawed'

• Published September 10, 2009

• Comments (0)

U.S. Rep.Adam Smith liked President Obama's pledge last night to cut spending if savings from health care reform don't materialize. He also liked that the president's speech emphasized those who have insurance and are at risk of losing coverage.

But the Tacoma-based Democrat, who serves Washington’s 9th Congressional District, said he thinks the House plan is a "failure" and "deeply flawed," and he expects a “Plan B” to emerge in the next couple of weeks. The plan, he said, should have more focus on cost savings.

As he's said before, Smith also wants to see Obama lay out his own plan, because he puts more faith in the White House than congressional leaders.

"The quibble I have is that, if you were listening to the president, you would get the distinct impression that the president has a plan …I thought gosh, they must finally be ready to write one. They are not," Smith said, adding that "what he was talking about was an amalgamation" of proposals in the House.

Smith spoke about last night's speech in a telephone interview this morning with The Olympian's editorial board. (I'm not on the board but sat in and listened as a reporter.)

Smith said the main measure, House Resolution 3200, "is one that troubles me greatly … It simply doesn't do enough on the cost-control side."’

The lawmaker echoed comments he made in town hall settings last month about wanting to rein in what he considers wasteful spending in Medicare and Medicaid, replacing fee-for-service payments with a system that rewards good medical outcomes. He reiterated his interest in seeing more of that in any reform.

Fellow Rep. Jay Inslee, D-Bainbridge Island, negotiated a side agreement (a potential amendment to H.R. 3200 or part of any Plan B) that would have the Institute of Medicine develop a different payment model, and Smith said that Inslee did a good job.

That Inslee agreement, which Inslee developed at the request of Speaker Nancy Pelosi, would send IOM recommendations to the secretary of human services. A second major piece is that it also would address the historic disparity in federal health-care payments to providers in low-cost states like Washington that get far less for the same medical work as in high cost states like Florida or New York.

But Smith said a flaw is that the Inslee agreement would not require the new payment system to take effect, but leaves it to the secretary of human services to advance it (with House and Senate action required to keep it from taking effect). Smith said this runs the risk of getting it dropped if the secretary finds the recommendations by the IOM’s stable of health-care experts are too politically hot to forward.

He also told a story about a man with breathing problems whose doctor referred him to specialists and for tests, which cost $35,000 by the end of the day. It later emerged that the man was volunteering at a thrift store where he was exposed to irritants – a fact that might have emerged sooner with cheaper costs if the first physician had been rewarded adequately to take more time with the patient.

Smith said that doesn’t happen enough, although Group Health and accountable-care groups are getting that kind of result. Higher reimbursements for primary-care physicians could be part of this shift in reimbursements and incentives, helping draw more medical providers into the primary care field, Smith said.

"We are not going to be able to provide universal access in any meaningful way unless we change those perverse incentives,"’ Smith said.

Smith also said people need to be able to buy insurance policies issued across state lines and he welcomes a look at medical malpractice, which he sees as a contributor to defensive medicine costs.