It may be desirable to add tens of millions of uninsured Americans to the federal health care rolls, but this is not reform. Expanding a flawed and outrageously expensive system is not reform by any definition. To reform the system, to bring actual improvement, the fundamental economic incentives need to change. You can start by paying doctors for quality, not quantity.

Unfortunately, amid the debate and turmoil over health care reform, this truth is rarely the center of discussion. They talk of adding to the system, not making it better. They ruminate over who should get what and how much from the existing system, without dealing with its most obvious problem — it costs too much, and the way we pay for it ensures that the costs too great today will be a greater burden tomorrow.

Fortunately this problem has been recognized by some, including Sen. Maria Cantwell, D-Wash., who along with Sen. Amy Klobuchar of Minnesota has inserted a clause into the health care reform bill pending in the Senate Finance Committee, to change fundamentally the way doctors are paid under Medicare.

The current payment method is called fee for service. Doctors are paid by how many procedures they perform. Whether those procedures are effective or necessary is entirely beside the point. They do more to be paid more, regardless of the outcome. Doctors, even those of great skill and pure intention, are human beings and respond to the incentives presented to them. The result is at least $120 billion a year in waste in the Medicare system, by official estimates.

Cantwell’s reform would discard payment by procedure and replace it with a “value index,” to compensate physicians for the quality of care they provide. Payment will be based on results, on defined outcomes. The goal is to refocus on the health of the patient, rather than what can be done to the patient.

Some 26 other senators signed a letter to President Obama endorsing the concept and asking to change the way we pay for Medicare. The Mayo Clinic, often held up as the great example of quality health care provided at low cost, has endorsed the Cantwell proposal.

Whether this measure can be retained and made effective remains to be seen, but it takes the right path. It is certainly not small in scope: Medicare pays for nearly half of health care. If Medicare changes, private policies are sure to follow form. It also could prove to be of great benefit to Washington state, where under the current system Medicare pays providers less as a penalty for their efficiency. It’s true. Don’t try to understand it.

That’s right — under Medicare fee for service, the faster people get well, the less it pays. That must change. Nothing else can be called reform.

What's next for our all-purpose avenue?

North Wenatchee Avenue is a lot of things to a lot of people.

It is half the city’s ingress and egress. If someone wants to drive into or out of Wenatchee, the chance their tires will touch North Wenatchee Avenue is near 50-50.

It is a major artery for industry. It is the route taken by huge numbers of trucks, sending Wenatchee’s products to market, bringing goods in, or just passing through.

It is a source of commerce. It brings customers to countless businesses that front on the avenue, and hundreds more beyond.

North Wenatchee Avenue is how we get here and how we do things, and just about everyone agrees it needs some help, to keep it accessible, to keep traffic flowing as best it can. To that end the Wenatchee Valley Transportation Council is compiling a master plan for North Wenatchee Avenue, and took input on the issues at an open house last week. The stated goal of the plan is to “identify ways to improve safety and traffic flow while accommodating planned growth and development in the valley and maintaining a successful environment for business along the corridor.” That gives you an idea how difficult the task will be.

Many issues were raised. Congestion makes travel times unpredictable. It is nearly impossible to turn left out of a business without endangering yourself or blocking traffic. The many trucks make everything more difficult. Cars get backed up at certain events or businesses and then block everyone else. Buses block traffic when picking up passengers. Pedestrians and bicyclists are not accommodated, and connections are too few.

And, if Wenatchee grows to the north, all of this gets worse.

Solutions aren’t easy to identify. Geography and ancient infrastructure are problems difficult to overcome. It will be a very long, and possibly futile wait for state money for a new bridge across the Wenatchee River or the Columbia. Before then, there may be creative remedies — better connecting roads, better local traffic flow, islands and banned left turns, new routes for trucks, better connections for pedestrians across the avenue and to the riverfront. There are even supercreative possibilities, like using the little-used railroad bridge to Olds Stations for mass transit, by modified buses. Call it light rail.

The best course will take serious thought. Any change will seriously impact traffic, safety and business. It is fortunate that the Transportation Council is taking this methodical and thorough approach to developing its master plan. North Wenatchee Avenue is important in so many ways, to so many people, that we can’t shortchange the planning, and we can’t avoid the long-term perspective.

This is the opinion of The Wenatchee World and its Editorial Board: Editor and Publisher Rufus Woods, Managing Editor Gary Jasinek and Editorial Page Editor Tracy Warner.