The health care debate is heating up in Washington, D.C., and as a member of the Senate Finance Committee, I'm working to help Washingtonians get the coverage they deserve and ensure this care is of the highest quality at the lowest cost.

As a nation, we spend too much on health care and get too little in return, leaving businesses and families with outrageous bills and eroding benefits, and our country with exploding deficits. We need to focus on fixing what's broken and building on what works.

I've long maintained that Washington state can serve as the model for improving health care nationwide. For years, we have been at the forefront of innovation, providing programs and services to bring costs down and improve quality of care.

Our state routinely ranks in the top quarter of the nation in healthy outcomes and at the bottom end for wasteful spending. Rather than rewarding doctors, hospitals and health care providers for the number of procedures they perform, Washington state rewards them for the healthy outcomes of their patients. This is exactly the type of approach we should take nationally.

Over the past few months, I have heard from thousands of Washingtonians and health care experts across our state on their concerns. Working closely with many Washingtonians, I introduced the Medical Efficiency and Delivery Improvement of Care (MEDIC) Act to address three specific areas of health care reform:

_ Reforming Medicare's pay structure so that it rewards quality of care, not quantity of care, as in the current structure

_ Developing long-term care services and programs to provide patients with options and alternatives to nursing homes and

_ Increasing the number of practicing primary care doctors to ensure coordinated care for patients.

The MEDIC Act includes the following proposals:



Medicare payment improvement

For years our state has been penalized under Medicare for providing some of the highest quality care in the nation for lower costs. While providers could make more money in other states, those in Washington often are forced to decide between taking on new patients and staying in business because of this unfair reimbursement structure.

My plan would provide incentives when providers administer low-cost, high-quality care and pair it with a new physician payment component that rewards quality, not quantity, of services. Washington already ranks 16th out of all 50 states and the District of Columbia in keeping costs per Medicare beneficiary low, with an average of $7,110 statewide instead of New Jersey's $9,551 and Florida's $9,379.

If everyone spent per beneficiary what we spend, the country could save more than $50 billion a year.



Preserving patient access to primary care

If patients don't have access to quality doctors, no health insurance plan is going to be enough. Experts estimate that by 2020 we will need 40-percent more practicing primary care physicians to meet patient demand.

My plan adopts long-overdue reforms to improve pay levels for primary care providers who provide integrated care coordination. It also ensures an adequate primary care workforce, especially in rural areas. Data shows that patients in integrated care systems with primary care physicians have improved health outcomes, reduced mortality rates, lower utilization of health care resources and lower overall costs for their care.



Physician workforce enhancement

All the delivery and cost reforms in the world won't solve our problems if we don't have more doctors working in the fields where people need them most - family medicine, preventive medicine, pediatrics, and behavioral and mental health.

My proposal would help increase the quantity of physicians trained in these specialties and expand graduate medical education programs to more suburban and rural hospitals.



Delivering home- and

community-based services

Current law prevents people from accessing long-term care information and services until they have depleted their entire life savings and become poor enough to qualify for Medicaid. By then, it is often too late to provide cost-effective home care and people end up being forced into nursing homes too soon.

My proposal would help people stay in their own homes longer and avoid using Medicaid, with healthier results for patients.



Home and community balancing

Most seniors and people with disabilities prefer access to home- and community-based long-term care over moving to a nursing home.

Because home- and community-based care costs almost 70-percent less than a nursing home, and long-term care already makes up 30 percent of all costs to the Medicaid program, my plan would help states offer home- and community-based long-term care by offering a federal Medicaid matching rate to states that implement programs promoting home- and community-based services, keeping seniors in their homes and providing them with access to high-quality, individualized care.

I believe that with the MEDIC Act we can achieve our goals of improving the health care workforce, stabilizing the physician payment structure, improving access to care and decreasing the financial and emotional burdens associated with long-term care while simultaneously providing significant savings throughout the health care system. My goal is to make these key initiatives an integral part of the larger health care reform effort, aimed at providing access to all, preserving and expanding quality of service, and curbing the exploding growth of health care costs.

U.S. Sen. Maria Cantwell, D-Mountlake Terrace, is a member of the Senate Finance Committee.