Just like cap and trade, the health care discussion is turning into a debate on economics and costs. The legislation on the floor of the Senate takes in tax revenues from 2010-2014 but postpones spending until after 2014. Sen. Judd Gregg calls this a shell game. Unlike the House-passed bill, the Senate bill includes an increase in the Medicare portion of the payroll tax. The current Medicare tax is 2.9 percent, and it is paid equally by employers and employees.

Under the Senate bill, the Medicare payroll tax rises to 3.4 percent for workers making more than $200,000 a year and joint tax filers with annual income over $250,000.

Rea Hederman and Curtis Dubay, senior policy analysts at the Heritage Foundation, note that the House passed bill includes:

• 5.4 percent surtax on joint filers with adjusted gross income over $1 million or single tax filers whose adjusted gross income exceeds $500,000 (estimated to raise $460 billion).

• An excise tax of 2.5 percent on the sale of medical devices ranging from wheelchairs, breast pumps, insulin injectors and syringes for patients with diabetes ($20 billion).

• 8 percent payroll tax on businesses with over $750,000 in total payroll.

• Limits on flexible spending accounts ($13.3 billion savings).

• Exclusions for over-the-counter drugs, saying they cannot be paid for by health savings accounts.

• Eliminating deductions for expenses which are allocated to the Medicare Part D subsidy program ($3 billion savings).

And the list goes on, from an excise tax on “Cadillac” health insurance plans that cost more that $8,500 a year for individuals or $21,000 for families, limiting qualified medical expense definitions and the creation of a 5 percent tax on cosmetic surgery and procedures like Botox treatments, tummy tucks and face lifts. A lot of taxes but not much cost containment. Interestingly, the taxpayer will be asked to pay more and more taxes if a government-based health care plan is allowed to subsidize itself in the future.

A recent health care forum hosted by the Fishers Chamber of Commerce saw providers, employers and consultants prescribing medicine to cure our present system. Panelists noted that true reductions in cost and improved efficiency can be obtained only through better management of chronic disease, sharing of of medical information through electronic medical records across provider and state lines, changes in the way medical providers are compensated, elimination of perverse reimbursement formulas for health care providers, and medical liability reform.

Nowhere in any of the nearly 2,000 pages of the House or Senate bill do we see wellness programs or ideas which change our culture or which allow for enhanced personal accountability. One example cited by a panelist at this health care forum is helping the senior citizen who should be fitted for the right type of sock and shoe when circulation and diabetic issues are at hand.

We need a new focus on primary care. We need non-physicians helping patients with nutritional counseling, with preventions for diabetes and with heart disease. We need doctors who are paid the same for each patient and who share and profit from savings in the health care system through use of best practices which are rooted in outcomes research and use of evidence-based practices.

Healthcare reform would be more effective and affordable if we implement simple insurance reforms that ban insurance companies from dropping individuals with pre-existing health conditions and guaranteeing that an individual’s health insurance will not be taken away by disease or sickness in the future. This will require an individual mandate and penalties for those who chose not to pay for health insurance. In line with car insurance, the key issue will be affordability.

The insurance reforms are not worth much if the health care policy is unaffordable to those with pre-existing illnesses. Presently, the Senate bill provides no way to assure that the policies will be affordable when these new insurance reforms are implemented.

We should focus subsidies on the small businesses with less than 50 employees since most uninsured work full-time or part-time at these small businesses or are the spouse or child of a worker at a small business that does not have the profit margins to pay for health insurance.

Furthermore, instead of a public option, instead of taxpayer support of abortion, instead of government-based rationing, instead of taxes on medical devices, instead of increased Medicare premiums and instead of unrealistic cuts in Medicaid and Medicare reimbursements to providers, simple insurance reform with subsidies to individuals at small businesses would accomplish the reform most Americans are wanting.

When the final two versions of health care reform move to conference committee for the ironing out of differences between the House and the Senate passed bills, our representatives do not have to vote for the bill. The measures, in their present forms, should be rejected. We need market-based health care reform. Contact your senator and congressman and help them see the light.

• Mark Hurt is a Kokomo attorney who served as health care adviser to Rep. Fred Grandy, R-Iowa, Sen. Dan Coats, R-Ind., and Michigan Gov. John Engler.