WILLMAR -- The health care reform debate this year may provide a chance to change a system of uneven Medicare reimbursements to health care providers, according to U.S. Rep. Collin Peterson.
"This is going to be hard," Peterson, D-Minn., said in a telephone interview Thursday from Washington.
Medicare provides hi-gher reimbursements to providers in states with less efficient health care systems, most notably California, Texas, Florida and New York.
If the members from those four states stick together, they have the ability to stop legislation in the House of Representatives, Peterson said.
States which have a more efficient system, like Minnesota, receive reimbursements that are as much as two-thirds less for the same care.
This problem has persisted for decades, and previous attempts to change it have failed. Peterson said he believes that "the only time we have the leverage to change this is now."
Peterson said he's not sure how negotiations on health care reform will progress in the coming weeks, but he may be playing a more active role behind the scenes.
"I may be more involved than I have been," he said. "I've got to talk to my Blue Dog colleagues." Peterson is an original member of the Blue Dog Democrats, a group of fiscally-conservative Democrats who advocate a pay-as-you-go budget for federal programs.
Peterson said a health care reform proposal now in the Senate Finance Committee is something he may be able to support. He does not support the most prominent bill to come out of a House committee, House Resolution 3200.
At this time, the bill does not have enough votes to pass, he said, adding, "They've got to deal with people like me."
The bill should be scrapped, because it has so many problems that "it cannot be fixed."
One of the most contentious provisions in the bill is a "public option" for health insurance. That idea has the potential to threaten efforts to pass health care reform legislation this year, Peterson said.
"We've gotten all hung up on the public option; it's become a litmus test," he said. "The public option is not going to pass the Senate anyway."
A public option could take various forms, but it would essentially be a government program offering a health insurance program that competes with private insurance companies.
"What I'm really worried about is this public option is going to take the whole thing down," Peterson said.
"We need to do this," he said. "We can't let this fail." The health care system is "too screwed up" to be allowed to continue as it is, he added.
In addition to eliminating the Medicare reimbursement disparities, Peterson said he thinks two major reforms are needed.
First, he said, a series of exchanges need to be set up. Similar to the insurance options available to federal employees, exchanges would give citizens the choice of a number of private insurance plans with different coverage options and different costs.
Now, it is costly for individuals to try to purchase health insurance. As members of a large group, they could get better rates. People would have access to insurance through the exchanges if they lost their employer-provided health insurance, too.
Second, people currently without insurance would be required to purchase insurance, and insurance companies would be required to provide coverage for everyone, he said. They would not be allowed to exclude people with medical conditions or to drop coverage for people who become ill.
People who can't afford insurance would be subsidized by the government, but it would be cheaper than paying for the emergency room visits people without insurance make when they're sick, he added.
Peterson said he liked some of the things President Obama talked about in his address to Congress on Wednesday. However, "I talked to six or eight Republicans afterward; he didn't convince any of them," he said.
Obama probably ought to have been more involved in the health reform debate early on, Peterson said.
"He got beat up over the (August) recess, and this wasn't even his bill," he said. But, in an "overreaction to Hillarycare," the White House left it to Congress to write a bill.
In the 1990s, the Clinton administration, in an effort led by then First Lady Hillary Clinton, wrote health care reform legislation, and it was soundly defeated in Congress. This year, the Obama administration decided to leave it to Congress to draft the legislation.
Peterson said he has offered his colleagues a simpler solution. He's told them, perhaps only slightly joking, that "the best solution is to give this bill to the Mayo Clinic and let them write it."