Idaho Statesman
December 11, 2009
By Kevin Richert

For some critics, the health care reform "public option" is a visceral issue, a representation of a government intrusion into personal health decisions.

The nuts-and-bolts debate is unfolding in a different realm, where health care reform hinges on a colder calculus. How much will it "cost" to extend coverage to uninsured Americans — and does the "cost" create "savings" elsewhere in the system?

Our editorial board took a walk through this numbers game Wednesday during an interview with Steve Millard, executive director of the Idaho Hospital Association.

Early on in the debate, he said, the hospital industry decided it could absorb $155 billion cuts in Medicare reimbursement, in exchange for a reform package that would expand coverage. If more Americans were insured, the industry reasoned, the hospitals wouldn't have to write off as many unpaid emergency room visits and inpatient procedures — and would thus break even.

But the latest version of health care reform, emerging in the Senate, would add to Medicare and Medicaid rolls. And that would upset a fine balance, Millard said. Hospitals have to shift some Medicare and Medicaid costs to privately insured patients, in order to make up the difference between government reimbursement rates and actual costs. In essence, Millard says, his industry cannot sustain a drop in reimbursement rates and an increased shift to public insurance.

As a result, he said, any shift toward a public option (or public options) would have "disastrous" effects on health care access in Idaho.

This is, of course, a snapshot from just one perspective in the debate. But it shows how — even when raw emotion is set aside — just how difficult it is to strike a balance and craft a consensus.