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Rep. Earl Pomeroy, Published August 11 2009

The case for health reform

When I was North Dakota’s insurance commissioner in the late 1980s, I was concerned about the rapid increases in the cost of health insurance reflecting medical costs that rise year after year faster than any other aspect of our economy.

The problems with health care and health insurance have grown worse every year since: Costs are up more than 300 percent since 1990. Insurance companies have responded by withholding coverage from many and shrinking coverage for everyone else while charging much more for it. For those with a medical condition who are not covered at work, it is almost impossible to find an insurance company willing to provide needed coverage.

As the cost of health insurance has become a significant issue for families and employers providing coverage to their employees, the soaring costs of Medicare and Medicaid have walloped federal and state government budgets. If nothing is done, soaring costs will inevitably mean more government debt, cuts to other vital services like education and higher taxes.

Those who oppose addressing the health insurance crisis are implicitly supporting more of the same but worse, since as costs rise, the number of uninsured grows and coverage shrinks.

Obviously we can do better, and there is broad agreement on the basic elements of reform that will make big improvements. First, we must strive for getting everyone health insurance coverage. The huge unpaid medical bills of those with no insurance drive up costs for everyone else while causing unacceptable pain and insecurity for the tens of millions without coverage.

Strategies to expand coverage must involve both employers and individuals with help for those whose incomes cannot afford the premiums. Secondly, we must reduce rising medical costs and address those things running up costs not related to improving patient health.

Unfortunately, a fundamental disagreement has erupted in the House of Representatives as to how to address these soaring costs. Legislators from big cities on the coasts want to create a new type of insurance run by the government, which would pay hospitals and doctors at the same rates Medicare pays. It is not surprising they favor this view – Medicare pays their doctors and hospitals considerably more than Medicare pays in our part of the country.

For years I have fought this disparity, which is unfair to our region, and I will never vote for “reform,” which makes it worse. The medical care we have available in North Dakota today would be jeopardized under their plan.

There is a much better way to address runaway costs. It involves system reforms designed to make the high-value health care we have in North Dakota the model for how health care is delivered nationally. We need more emphasis on family doctors and nurses with coordination between hospitals, physicians and their clinics. Our part of the country has shown patients get better care, outcomes improve and costs are lower than other areas.

I remain hopeful that positive steps on health insurance reform will pass Congress this year. However, those who think they can pass a bill that addresses rising costs by compounding the underpayment rural health care presently receives have made the prospects for reform unnecessarily difficult and controversial. Congress will not and should not enact a public insurance option that pays Medicare insurance rates. The sooner they realize that the better.


Pomeroy, D-N.D., was elected to the U.S. House in 1992. He served as North Dakota insurance commissioner from 1984 to 1992