"Cantwell to Obama: Mr. President, heal thyself"

Joel Connelly (Seattle PI):

President Obama must "double up" in use of the presidency's bully pulpit to convince Americans their country's current health care system is unaffordable, or so argues Sen. Maria Cantwell, D-Wash.

"I think the president can help focus the country on controlling costs for the 80 percent of the country that IS insured," Cantwell, a member of the Senate Finance Committee, said in an interview.

"If the president gets back to this message, he will help secure the path for reform, whatever its eventual details," she added.

In short, recapture the argument -- on cost and care.

The two-term Washington senator represents a corner of the country lately getting praise on both fronts, for innovations that stress healthy patients rather than the amount of tests done on them.

Cantwell says she supports a "public option," but is vague on its definition. She is, however, on "pushing hard" that the final health care plan includes, in her words, innovations "on which the Northwest has led the way."

These include:

* Incentives to let persons needing long-term care stay in their homes, receiving help there rather than being forced by circumstances to move to a care facility.
* Provisions for providers and insurers to link up people with a personal physician and a "medical home," where access, early diagnosis and treatment cut down on costly acute care. A new partnership between Swedish Medical Center in Ballard and Premera Blue Cross --stressing preventive care, care coordination, and expanded interaction with medical staff -- is pilot project for a needed national reform..
* Reform of Medicare reimbursements, in a way that doesn't just reward the volume of services, but recognizes healthy patient outcomes.

"The Northwest subsidizes inefficient care in the rest of the country: I will put my foot down to change that," Cantwell said.

Low Medicare reimbursements are a critical issue. Not only are doctors being shortchanged, but costs are passed on to insurers and the insured. A recent (very good) Puget Sound Business Journal article reported:

"Without the larger private-insurer payments, The Everett Clinic could not stay open, its executives say. The clinic, one of Washington's largest, employs 320 doctors. Dr. Al Fisk, the clinic's chief medical officer, said that last year the clinic lost $11.7 million in serving its 28,000 Medicare patients.

"Fisk said the clinic has kept its doors open by charging more for patients covered by private insurance. This, he said, amounts to a hidden tax of about 10 percent that commercial carriers pay to subsidize Medicare patients."

The Mayo Clinic, the Everett Clinic, and 11 other Northwest and Midwest providers sent a recent letter to Congress, backing health care reform -- but saying it must reform costs.

"Our health care systems are among the most cost-efficient in the country in caring for Medicare patients," they wrote. "However, many of us operate in states with some of the lowest Medicare reimbursement rates in the nation."

The bottom line, they wrote: "The system must be reformed to compensate for value instead of volume."

Cantwell can't forecast the future, but sought to evaluate the political climate on three fronts:

* Prospects: "I'm still optimistic that reforms to the system that will lower costs and broaden coverage can be done (this year)," she said.The senator was pleased that a bipartisan group of six Senate Finance Committee members were still talking by phone on Thursday, despite partisan rancor of the past week.Two Republicans, Sens. Chuck Grassley, R-Idaho, and Mike Enzi, R-Wyoming, have made incendiary partisan remarks. But Cantwell singles out a GOP moderate from the opposite corner of the country. "Olympia Snowe gets it," she said.
* Going it Alone: Cantwell acknowledged that Democrats, who control both houses of Congress, could try to forge a reform plan without Republican votes. But it won't be easy."It may come to acting alone, but the Senate is a diverse place even among its Democrats," she said. "We range from very liberal senators to Ben Nelson of Nebraska." (Nelson opposes a government option).
* Co-ops: East Coast media has been abuzz with rumors that the Obama Administration will jettison a government-run "public option" and opt instead for co-ops as an alternative to private insurers.

Cantwell noted that public power has given the Northwest low electrical rates, and Group Health's presence from urban Seattle to rural Idaho. But she wondered how newly created health co-ops would get the strength to compete.

"You have to have access to the market," she said. Cantwell argued that plans now on the table in Congress "need more teeth" to create a viable competition with private insurance.

When the shouting dies down, Cantwell says, the public "gets it," that reform can control cost and deliver better care.

Obama did seem to shift emphasis, in a Thursday radio interview and a rally kicking off the Democratic Party's "Organizing for America" weekend events. He touted "prevention and wellness programs -- That's got to be part of the deal." Interviewed by conservative radio host Michael Smerconish, Obama talked dollars and sense: "The costs of Medicare and Medicaid will bankrupt this country if we don't reduce the cost inflation of health care." As for Cantwell, a test-weary visitor to her Senate office has provided a mantra for what health care reform must do: "I don't want to be 'Medicaided': I want to be cured."

Howie P. S.: know sbe's a Senator and all and is very busy, but it seems I already hear from Obama a helluva lot more than I hear from our junior Senator, on a variety of issues.