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Making health care affordable

As we look for ways to make our health care more affordable, many in our na-tion's capital are looking to Minnesota as a model for what the rest of the country should be doing.

Minnesota has a lot to be proud of when it comes to health care. We rank near the top in terms of residents who have health insurance coverage. Our doctors and nurses are applauded for both the quality care they provide to patients and the cost-effective way they deliver that care.

In fact, the central challenge of health care reform is to improve affordability and expand coverage by ensuring that providers deliver "the best care for the best price." It is to make sure our taxpayer money isn't being shipped out to pay for states with less efficient health care.

Peter Orszag, the nation's budget director, has long warned that rising health costs are "unsustainable" and "represent the central fiscal challenge facing the country." At $2.4 trillion per year, health care spending represents close to 17 percent of the American economy, and it will exceed 20 percent within a decade if current trends continue.

Despite all that our nation spends, nearly 50 million Americans have no health care coverage, and millions more, including many Minnesotans, struggle to afford the health care they have. Meanwhile, businesses are squeezed on the bottom line, forced to reduce or drop health coverage for their workers.

As a matter of both sound economics and basic fairness, we simply can't wait any longer for health care reform.

My overriding concern for America's health care is to make sure it is more affordable and doesn't undermine the progress that Minnesota has already made in delivering high-quality, cost-effective care. I also want to make sure reform takes into account the needs of Minnesotans living outside of major metropolitan areas.

Affordability is an especially important issue for rural families, who are less likely to have access to employer-sponsored health insurance. Rural residents also tend to be older and may have to travel long distances to visit their health care providers. Critical Access Hospitals are essential in providing rural Minnesotans with access to care when they need it.

During the past month, I've visited health care centers in Wabasha, Park Rapids, Grand Marais and other communities. I've seen how they have embraced innovative, cost-saving practices that also result in better outcomes for patients, including prevention and wellness programs as well as management of chronic diseases to stave off complications and costly care.

But these common-sense practices are absent in many other parts of the country. In Miami, Medicare spends twice as much on the average patient as it does in Minneapolis, even though quality is much better here.

According to researchers at Dartmouth Medical School, nearly $700 billion per year is wasted on unnecessary or ineffective health care. That's 30 percent of total health care spending.

The main reason is that health care is purchased on a fee-for-service basis, so more tests and more surgeries mean more money. Quantity, not quality, pays.

As a result, states with excessive medical spending are rewarded for their wasteful practices, while efficient states like Minnesota are punished.

To begin making health care more affordable, we need to get all health care providers across the country focused on high-quality, cost-effective results. That's why I've introduced bipartisan federal legislation supported by Minnesota's doctors and hospitals to create a "value index" as part of the formula used to determine Medicare's fee schedule.

It would give physicians a financial incentive to maximize the quality and value of their services instead of the volume, something we do well in Minnesota. I've also introduced a bill to cut down on Medicare fraud so we can make sure that money and services are going to our nation's seniors.

Finally, the number of new primary care practitioners is on the wane, creating serious shortages in many rural areas. Research suggests that elevating the role of primary care is one of the best ways to improve the efficiency and quality of health care delivery.

These reforms, if implemented, promise to reinforce and reward the high-quality, cost-effective approaches to health care that many Minnesota providers already practice and that will be essential in achieving more affordable health care.

Amy Klobuchar, DFL-Minn., is a member of the U.S. Senate.