(Ed. note: This column by Rep. John Zerwas ran in last week's issue of Texas Weekly, which asked four policy and legislative experts the same question: What version of health care reform would be best for Texas?)
Like many across this great state and the nation, I have taken an intense interest in the so-called health system reforms coming from Washington, D.C. Perhaps unique to my perspective is the various roles I have played as a consumer, a doctor, a state policy maker and a member of the Appropriations Committee of the Texas House.
As a consumer of health care services I, like millions of Americans, am satisfied with the benefits of my health care insurance. It provides me assurance that in the event of illness or accident, I will have ready access to the highest quality of care found anywhere in the world. I do not want that compromised. Would I like to pay less? Absolutely! But the reforms being proposed in the nation's capital have less to do with decreasing the cost of care, and more to do with creating bureaucracy, limited access, and mediocrity.
As an informed consumer, I support health savings accounts as a way to give consumers more control over the purchase of health care services as opposed to the Federal government's plan of rationing health care. I support improving healthcare by rewarding quality and safety with the reduction of medical errors, instead of the government's plan to make clinical decisions and second guess your doctor. You and your physician should decide what's best for you, not a government employee.
As a doctor, I recognize that the cost of care is largely the responsibility of those who prescribe and deliver the care... physicians and hospitals. I see great potential in the adoption of cost effective therapies and interventions. Many of these efforts are already in place and have the potential to bring about less variation and waste in the system.
Any reform must include legitimate tort reform. Texas has been a leader in this regard with the passage of real tort reform in 2003. Since that time, Texas has enjoyed a dramatic influx of doctors to the state that has greatly improved access to care and quality.
Finally, if the government is to take over all our health care, new facilities would have to be developed before current hospitals and clinics are inundated. Massachusetts found this out when they passed a universal health care initiative that overwhelmed their health care providers. Expanded development of Federally Qualified Health Centers may be part of this answer, but better financial incentives for physicians to accept the individuals on typical government subsidized plans must be addressed. The 80th legislative session in Texas worked to improve this situation.
As a policy maker, I share the goal of universal coverage. But I feel the best way to achieve universal coverage is to build upon those systems which have proven most effective — market-based solutions. Needless to say, the Medicaid and Medicare system are not viewed as the best models. And though the VA system has made great strides in quality and safety, timely access to care continues to elude this model.
The role of policymakers should be to open the doors and remove barriers to competitive models of care aimed at those individuals who truly need a reformed system. Not those who have the financial means but choose not to purchase health insurance, and certainly not those who are in this nation illegally. The cooperative model should be nurtured as well as health savings accounts so that people can start making cost effective decisions about their own healthcare. Tax incentives have long proven an effective way to encourage behavior whether it be individual or at a corporate level.
There will always be those for whom the government will need to play a role. As the chair of the subcommittee on Health and Human Services of the Appropriations Committee during the 81st session, I can certainly attest to this fact. I joint-authored legislation that would have expanded the CHIP program, because there was not a reasonable market solution to this population — children born into families at 300% or less of the federal poverty level ($66,000/year for a family of four). In addition, I sponsored legislation called the Healthy Texans program intended to encourage competitive health plans for working individuals and small businesses at lower incomes.
Texas enjoys a legacy of stepping up to the plate when the needs of its citizens arise. But we have done so by encouraging the growth of business and making Texas a great state in which to raise families. The federal government should respect the sovereignty of the state in this regard. And just as all politics is local, the delivery of accessible, safe, quality healthcare is local. Let Texans Take Care of Texans!
Rep. John Zerwas, R-Richmond, serves in HD-28. He's on the Appropriations and Public Health committees.
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