Sen. Maria Cantwell, D-Wash., said Tuesday that she thinks health care reform has a significant chance of passing this year, but it's going to take a change in the culture of how different parts of the country deliver medical services.
"The problem with health care is that we reward quantity," Cantwell told the Herald's editorial board. "Right now, our whole health care system is, order it and someone will pay for it."
She referred to the Dartmouth Atlas of Health Care, which reported that simply spending more on health care hasn't produced a healthier populace. Yet relying on that approach, the United States has fallen behind other developed nations in terms of what it spends per delivered outcome, she said.
The nation needs to move away from the Medicare model of fee per service, in which doctors are compensated based on the number of services they provide. Instead, the country should move toward a system that emphasizes quality of care and patient well being, she said.
Washington should be a model for the country, she said, because Medicare costs in the state are about $6,250 per patient - about $1,500 less than the national average.
But across the country, different approaches to providing health care often are ingrained in the cultures, she said.
"We have people who are just going from specialist to specialist," Cantwell said. "... Because of that kind of a delivery system, people are missing basic kinds of service. That's not the way we practice medicine in the Northwest."
She advocates reforming the whole system rather than building a new one on top of an unstable foundation with inefficient delivery in regions such as the Northeast.
Whether to start anew with a profitless health care system is something that may have to be debated, Cantwell said. She favors a public option and driving down health care costs, which should be the priority, she said.
Cantwell could envision Congress passing reforms this year, whether it covers all 47 million uninsured people in the country or not, she said.
"I say there's a better than 50/50 chance that'll happen," she said.
Cantwell sits on the Senate Finance Committee, which has 23 members, about 10 of whom represent states with relatively low per-patient Medicare costs and have a strong incentive to change that system.
But even committee members from states whose costs are subsidized to a greater degree, such as Florida, New York and New Jersey, realize Medicare is in an unstable position and won't be fixed simply by adding more money to it, she said.
Assessing some of the obstacles to health care reform - such as the notion of "socialized medicine," the cost of the proposals, and opposition from health-care providers - she said the main challenge lies in making such a big change to the system all at once.
"We've been having this conversation for a long time, but I think the health care system that we have today is complex from a funding formula perspective," Cantwell said. "... But the American people want us to move ahead, and I'm hoping that will drive us to create the change that really does drive down costs for individual citizens."