The health care bill working its way through the Congress now consists of over 4000 pages between the House and Senate versions. No one fully understands all the components since it is a classic “spit and baling wire” concoction filled with a wide range of inputs from all the 535 legislators. It resembles a tottering tower held up by ad hoc supports.

Whether you understand all of the provisions of the measure there are three things that are clear:

1. The new bill will increase costs of medical care in the USA, not reduce them.
2. The Feds cannot wring enough out of Medicare to pay for the increased costs, so taxes will have to increase to cover them.
3. With or without the “public option,” our health care system will continue to be one in which costs are paid by insurance.

Given the complexity of the new legislation, the Republicans have now come out with their response, rather than pass a complex, all inclusive bill, we should target specific reforms with easy to understand legislation. Examples would be:

1. Tort reform. As President Obama has stated, the problem here is not outrageous awards in a few malpractice suits but the costs incurred by doctors ordering a wide spectrum of unneccesary tests to protect them from law suits. Nothing in the 4000 pages addresses this problem. In fact, Howard Dean has stated that Democrats don’t want to “take on the trial lawyers.”

2. Allow health insurance to be sold across state borders. Health insurance, as with all insurance, is a state, not federally, controlled business. To do business in a state the company must be established in that state. It stands to reason that allowing insurance companies to operate across state borders under federal interstate law would allow them to lower costs. Nothing in the 4000 pages addresses this issue.

3. Turn Medicare into the “public option.” Medicare presently provides health care to low income families at the lowest costs in medical care. It does this by most states having contracted with HMOs to provide the services. Why not extend this low cost health coverage to those unable to buy health insurance? Those with incomes above the poverty level would pay part of the cost according to their income level.

And there are other ideas. However, the main point would be to take of health care with readily understood laws to address specific areas, instead of an omnibus law that may or may not solve the many problems.