U.S. Rep. Jason Altmire, D-McCandless, wrote in a Nov. 20 Post-Gazette column (“Why I Voted No on Health Reform”) that he did not vote for H.R. 3962, the House bill to overhaul our health-care system, because it “failed to address out of control health-care spending.” He went on to say that “we should pay providers based on the quality of care they provide.”

My representative writes that he wants to expand coverage and lower costs but he does not believe that the current legislation meets those goals. His argument sounds reasonable but it poses a false dichotomy.

First and foremost, Mr. Altmire neglects to point out the many efforts to contain costs and improve quality of care that have been under way for a decade. Likewise, he neglects to mention that two of the largest drivers of skyrocketing costs in the Medicare population are the Prescription Drug Part D Medicare program and the Medicare Advantage payments to private insurance companies. Both are addressed in H.R. 3962.

Mr. Altmire is right that we can and must improve quality of care to patients. This not only saves money but also is morally correct. We also must move away from a system that encourages the overuse of medicine.

So how do we change this? Is it simply a matter of quality improvement? Not really.

Continuous quality improvement has been a mainstay in American medical practice for years. The Institute for Healthcare Improvement was founded in 1991 as an independent, nonprofit organization. IHI’s work has led to thousands of health-care improvements.

Another well-respected group is the Agency for Healthcare Research and Quality, which conducts research on quality improvement, effectiveness of care, clinical practice, delivery systems, health-care costs and sources of payment. In the stimulus bill passed by Congress early this year, the Obama administration made a significant contribution of $1.1 billion to fund effectiveness research, with $300 million going to the agency.

Since 1995, the Centers for Medicare and Medicaid Services that administers the Medicare program has sponsored a number of demonstration projects to study the potential of quality-improvement efforts. The list includes studies of pay-for-performance, care management, rural hospice nursing, cancer prevention for minorities and, most recently, the “medical home” model.

The medical home concept is gaining momentum among all professional medical groups. It is exactly the kind of quality improvement that Mr. Altmire claims he is waiting to see implemented before he can support health-care reform.

A central element of the model includes payment reform. The emphasis is to shift from disconnected management of chronic illnesses by multiple professionals to coordinated management of patient health. One physician is paid to coordinate with other providers. Congress, led by Mr. Altmire, can make this change at any time. It does not have to be part of health-care reform legislation.

What the reform bill does need to do is fix the Medicare prescription drug benefit program and curtail federal subsidies to Medicare Advantage Plans.

The cost of the prescription drug benefit is $400 billion a year because there is no competitive bidding for drug prices, which means taxpayers are funding huge profits for drug companies. The House bill would require the secretary of health and human services to negotiate lower prices.

As for Medicare Advantage, a law passed by a Republican Congress in 2003 increased Medicare payments to private insurance plans to provide additional benefits to enrollees. It was seen by Republicans as a step toward privatization of Medicare. The promise was that additional benefits would make elders healthier and drive down costs, saving Medicare approximately 10 percent for each beneficiary.

The opposite has occurred: Medicare Advantage payments to private insurers have risen 14 percent over the past six years and now run $44 billion a year. In 2009 alone, these payments amount to an extra $1,138 for each Medicare beneficiary. The House bill would phase down payments to private insurers and cap the cost-sharing they impose on members to the same levels as traditional Medicare.

We are not leaving quality improvement to future generations. And there is no reason to vote against health-care reform for this reason — as Mr. Altmire did.

What we cannot leave to future generations is the dilemma of millions of Americans who lack health insurance and suffer the consequences.