Columnist

Comprehensive health care reform is high on President Obama’s agenda as it rightly should be. Health care is a growing expense for government, employers and families.

There are no easy answers, as U.S. Sen. Ben Nelson points out. Nelson, D-Neb., is a moderate former Nebraska governor and former chief executive officer of Central National Insurance Company of Omaha. He is working on a comprehensive health care plan that builds on what is working today without shifting control to costly government programs.

On May 3, Nelson wrote in the Omaha World Herald that, while we rightly focus on the 45 million or more Americans without health care coverage, we also must make sure we don’t destabilize care for those with employer-based coverage or other private health insurance.

He believes we cannot solve our health care crisis if we establish a government-run option that offers little more than cosmetic improvements while creating an unlevel playing field that worsens the current cost shift to private payers. As Nelson notes, “We already have public plans that suffer from sluggishness and insolvency.”

Nelson is right. For example, the Massachusetts Health Insurance Connector was envisioned as a public-private partnership that would spur competition, reduce costs and increase access.

The Connector is a state-run clearinghouse, a virtual shopping mall where employers and individuals shop for the best coverage and prices as providers compete side-by-side for purchasers.

But lawmakers strayed from that concept to impose employer mandates, compulsory coverage and heavy fines – up to $912 per person – for those who do not buy insurance. Costs for the Massachusetts program have increased 42 percent since its inception in 2006, more than double that of the average private employ–er plan.

Ellen Zane, president and chief executive officer of Boston’s Tufts Medical Center, says that despite the significant drop in uninsured in Massachusetts, “we aren’t seeing a commensurate drop in the use of our emergency rooms.” She suspects that tens of thousands of new people in the program are unable to find a primary care physician.

In February, Gov. Deval Patrick announced that Massachusetts will use $764 million in federal stimulus money to shore up healthcare services and prevent further job and program cuts at hospitals that serve large numbers of poor patients. In April, the state announced it was reducing reimbursements to providers.

In Maine last November, voters decisively repealed a tax increase approved by legislators to supplement the state’s Dirigo Health Choices program. The tax would have raised more than $100 million by taxing beverages and doctor’s fees, but cash-strapped voters said enough is enough.

The news from Canada is just as troubling.

According to former Canadian Sally Pipes, president of the Pacific Research Institute, some 750,000 Canadians are currently on a waiting list for medical procedures. In addition, 3.2 million Canadians are waiting for a chance to see their primary care physician and, once diagnosed, they wait an average of 17.3 weeks to see a specialist.

Pipes noted that when Canadian Parliament member Belinda Stronach – a strong supporter of Canada’s national health care system – was diagnosed with cancer in 2007, she flew to California where she paid for treatment out of her own pocket.

Nelson would invest in medical technology to electronically connect doctors, hospitals, insurers and emergency medical responders.

That would save administrative costs and lives by eliminating treatment mistakes. He would guarantee insurability for the 45 million Americans without health insurance and find ways to reduce cost-shifting. He wants government to appropriately reimburse hospitals and doctors for Medicaid and Medicare to reduce cost-shifting to the private sector.

Many health reforms before Congress and state legislators today transfer too much of the responsibility and control to government without sufficiently looking at the resulting costs to taxpayers or potential impacts on people.

The American health care system is far from perfect. It is vital that we learn from the mistakes of others before we act. There is no one “silver bullet” that will fix our health care system. But if we’re careful, we can learn from the mistakes of others and we can retain the best of what we have.

Don Brunell is president of the Association of Washington Business.