EDITORIAL: Senate bill ignores the goal of improving health

June 23--There's a reason why government officials like to operate in secrecy: They're afraid of what will happen if the public finds out what they're up to.

The U.S. Senate crafted its health care bill behind closed doors and now we know why. Like the House bill passed last month, it is more interested in cutting taxes for those who don't need it than it is in providing access to health care for those who do. It's wrongheaded and it's cruel.

In the House and Senate, there is a fundamental misunderstanding of what should be their goal: lower the staggering cost of health care while improving care. Leaders in both chambers have bellowed so long about repealing the Affordable Care Act, also known as Obamacare, they are unable to look beyond that aim to the unquestionable national benefit of a healthy population.

One example will suffice: Military leaders have sounded an alarm over national rates of obesity, which disqualifies candidates from military service. That's a national security issue.

Instead of finding a way to make the Affordable Care Act work -- as most Americans want, at this point -- the Senate, like the House, wants to carve up Medicaid, the health care program for the poor. That revenue would then be used to deliver a tax cut to the wealthy. It's a cynical game. No wonder Senate leaders cobbled it together in secret.

How the United States approaches this issue doesn't have to be what Canada or Great Britain or other single-payer countries do. It's possible for a Republican Congress to put a conservative spin on the program without losing sight of what is, without question, a valuable and worthy goal.

Indeed, that is what former Gov. Mitt Romney, a Republican, did in Massachusetts, creating a template for the Affordable Care Act. Neither is a single-payer plan; both make use of the private-sector insurance companies. But, importantly, the ACA prevented insurers from refusing to cover pre-existing illnesses. It allowed children to stay on the parents' plan until age 26. It expanded Medicaid to help provide better care.

The law was anything but perfect. Even with federal subsidies, premiums on the exchanges were often too high and carried exorbitant deductibles. It did not do enough to stem the rising cost of health care, which now consumes nearly 20 percent of gross domestic product. But it was a start. Congress' role today should be to make the law work in a politically conservative framework.

The measure that the Senate produced this week fails that test, abjectly. It turns its back on the poor and the sick in favor of tax cuts for wealthy Americans. It doesn't have enough votes to pass, at this point, but only because several Republican holdouts think it's still too accommodating. Regardless, it deserves to fail. Both Houses should start again, but from a more understanding place.

And it should dump the idea of forcing itself on New York State policies regarding Medicaid. An unnecessary aspect of the bill, largely driven by Rep. Chris Collins, R-Clarence, would prohibit New York -- and only New York -- from requiring counties to pay a share of state Medicaid costs.

In fact, that goal is a worthy one, but however Collins and his cohorts -- including Reps. Tom Reed, R-Corning, and John Faso, R-Kinderhook -- want to spin this, the impact of this approach will be to harm the state's finances and undercut its hospitals. It would also deliver a tax windfall to the counties that, you can be sure, local politicians will gobble up rather than return it all to taxpayers.

There are better ways to accomplish this goal -- strategies that aren't bound up in personalities and political gamesmanship. And, as Gov. Andrew M. Cuomo and Erie County Executive Mark C. Poloncarz both say, the approach appears unconstitutional on its face, since it applies only to New York and has no compelling federal justification.

The whole thing is a mess. Start over.

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