It's unlikely that a health-care reform plan that includes a government option will be approved by Congress, Republican Sen. John Thune says.

But Democratic Sen. Tim Johnson holds out hope for keeping a so-called public option in the reform package that he expects to pass by the end of the year.

The two South Dakota senators agree that reforms are needed in the nation's health system. But Thune won't support a health care plan that includes a government option, a position he believes most South Dakotans agree with.

The current proposals in the House and Senate don't do enough to find cost savings but are more likely to shift costs from one payer to another, Thune said. Nor does either address the need for reforms in medical malpractice law, he said.

Health care reform should be more targeted to state needs and less to big-government mandates and control, Thune said.

"We should be providing incentives to states to reform their insurance markets and expand coverage in ways that work best for them, not a one-size-fits-all program imposed by the federal government," he said. "We also need to make sure that health care reform accounts for unique needs of rural areas and does not simply expand programs that underpay rural providers."

Democratic Rep. Stephanie Herseth Sandlin opposed the last U.S. House version of reform, in part because it failed to address federal payment inequities to medical providers in rural areas. She and other moderate-leaning House Democrats in the Blue Dog Coalition were instrumental in delaying a vote on the reform package in that chamber.

Johnson is more outspoken than Herseth Sandlin in his general support for health care reform. He said intentional distortions about the health care proposals are making it harder for citizens to understand and accept the plans. A provision in a House version that provides Medicare payments for end-of-life counseling was misrepresented as being mandatory and was lumped in with claims that "death panels" would be formed, Johnson said.

Johnson called the end-of-life counseling option an "innocent provision" aimed at helping people consider such options as living wills and hospice care if they choose to.

"But it isn't mandatory. It has caused so much trouble that I'm afraid this will be dropped from the bill altogether," Johnson said, adding that he would vote for the provision. "Having lost both parents in the same year, this year, I see the common sense of it all. Unfortunately, the extreme right has caused this provision to be misinterpreted and destroyed it."

Johnson believes the public option part of the proposal is being wrongly portrayed as the equivalent of systems in Canada or England.

"All that is being talked about is some sort of health care coverage like the federal employees get and members of Congress get," he said. "There is no plan to impose socialized medicine, or even the Canadian single-payer system on the American people."

Johnson said he thinks a health care plan can be passed by the end of the year - he hopes with a public option included. But he would also be open to a plan without that option in this version of the plan, especially if it included a "trigger" that would impose a public option in a few years if private insurance plans failed to offer what the reform needed.

Contact Kevin Woster at 394-8413 or kevin.woster@rapidcityjournal.com