It appears as though the Republican win in the election to fill Ted Kennedy’s seat in the Senate will derail the health care reform bill. There is a scramble to preserve the measure and get it adopted.

One call is to extract the less controversial parts of the omnibus bill and adopt them individually. I would make some suggestions for this approach. First, why not offer Medicaid or Medicare coverage for those who have been turned down by private health insurance firms? There is a precedent, Medicare coverage is already given to those with “end stage renal disease.” no matter their age.

Medicaid could also be offered to those who cannot afford private health insurance. This is essentially what is contained in the new health bill plan to subsidize payment for health insurance for those unable to pay in full or in part.

Expanding Medicare or Medicaid to cover those barred from private insurance or unable to afford it would also be an effective way to control costs. These two government programs are probably the most effective “brake” we have on escalating health care costs. The two programs set the fees they will pay for services and thereby control the costs. Many argue, usually doctors, that service providers will be less inclined to accept the controlled fees. But Medicare and Medicaid already provide health care for almost 100 million Americans, so turning down their fees means giving up access to a major block of clients.