—Illustration: The Ispot

Our health care system needs work. The president and Congress want to fix what’s wrong, but if we’re not careful, we could make things worse. 

Two principles to uphold:

Controlling health care costs. 

Medicare and Medicaid costs are growing unsustainably.

Spiraling health care costs burden families, employers, and state and federal budgets. Health reform has to be accomplished in a fiscally responsible way. That includes improving how Medicare functions and increasing access to affordable, comprehensive coverage.

Private health plans often follow the pattern set by Medicare, so it’s important to modernize the way Medicare pays doctors and hospitals. Medicare reimburses for volume of services, not quality of care. This discourages providers from innovating and delivering higher-quality care at a lower cost. Congress needs to realign payments to reward quality and value, not volume. Better reimbursement for primary care and chronic care management would deliver better care and reduce costs.

Securing affordable, accessible insurance, regardless of preexisting conditions. 

Many people who apply for insurance are able to enroll without problems, but even healthy individuals and families worry that at some point—probably when they need it the most—they’ll be unable to get coverage. We need stronger rules on insurers, such as requiring them to cover people with preexisting conditions and stopping them from charging higher premiums to those in poorer health. The system should treat everyone fairly.

Two pitfalls to avoid:

People losing the health care they have.

President Obama’s campaign promise was, “If you’ve got a health care plan you like, you can keep it.” But he also wants to create a government-run health plan.

In this plan, the government would set the prices and determine which treatments are covered and control costs by offering a one-size-fits-all package. It would cause as many as 119 million Americans to shift from private coverage to the government plan, according to the Lewin Group, and put America on the path toward a completely government-run health care system.

Cost shifting already happens in Medicare and Medicaid. Doctors and hospitals are paid less by public programs. They make up the difference by passing the cost on to their other patients. If more people entered a public plan, even more doctors would stop seeing Medicare, Medicaid and public-plan patients. Employers, especially small businesses, would stop offering coverage, since they would be able to tell employees to get their coverage from the government plan. Eventually, the government plan would overtake the entire market.

Private health plans dropping out of Medicare.

Your health care options should not depend on your ZIP code. In 2003 I worked to bring private health plans to Medicare beneficiaries in Iowa and other rural states. Today, Medicare Advantage offers more choices and better benefits than traditional Medicare. Plans are widely available. More than 10 million people have enrolled. Drastic cuts could force plans to cut benefits and drop coverage in rural areas.

The doctors’ oath in treating patients is: First, do no harm.

The same should apply to Washington on health reform.

Chuck Grassley is the ranking Republican member of the Senate Finance Committee.