At 17 percent of our economy - $2.4 trillion - America's health care system is larger than the gross domestic product of 200 countries including the United Kingdom, Canada and Russia. Changing our delivery system is an enormous task.
The debate did not start with President Obama. Twelve years ago, Republicans in Congress and President Clinton enacted sweeping reforms that created Medicare Advantage and a new children's health insurance program, SCHIP, was started.
In 2004, President Bush created Medicare Part D to help seniors get life-saving medicine. In the last session of Congress, 2,000 bills were introduced to deal with health care. While we may disagree on the route, everyone wants to make health care more affordable and accessible.
According to the Census Bureau, 45.7 million people are uninsured in America. Analyzing this number is key to finding a solution.
Of those, 10.7 million are unaware that they are already enrolled in Medicaid or eligible for it or some other government insurance program. For these individuals, we do not have an insurance problem but a communications challenge which we can resolve without changing the law.
Non-citizens account for 9.3 million. Even illegal aliens are, by law, not turned away at the emergency room. Perhaps we should find out who they work for and send them the bill.
There are 10.1 million Americans who make $66,000 or more and can afford to purchase insurance but don't buy it. Along with them are 5 million childless adults, ages 19-34, who are passing in and out of the job market and have chosen to let their insurance lapse. Here we have a philosophical question: Should we deny them the freedom to choose? Do we want the federal government to take that power away from them?
The remaining 10.6 million are "too rich" for Medicaid or too young for Medicare but because of pre-existing illness or other problems, they have fallen through the cracks. It is these individuals who should be our focus.
While some believe a nationalized health care scheme is the only way to help these individuals, I believe targeted reforms would be more effective.
For the 44-year-old unemployed breadwinner with three kids and a pre-existing illness, we should provide a voucher that would allow him to choose a private plan that works best for him. Rather than nationalized, each state should have a high-risk insurance pool that affords basic coverage to those in need.
For the 26-year-old waitress, a tax deduction equal to those with employer-based coverage would help her find an affordable plan.
The neighborhood barbershop with three employees should be able to combine forces with barbers across the nation through Association Health Plans to get the same purchasing power as IBM.
Tto reduce costs and increase competition, citizens in states like New Jersey where a basic policy starts at $5,880 should be able to purchase across state lines to places like Kentucky where a basic policy is $780. We should expand Health Savings Accounts which encourage shopping around for the best coverage at the lowest price and pocketing the savings.
As we've seen with plastic surgery and Lasik, injecting market forces eliminates the cat and mouse payment game of insurance companies, government and providers.
Finally, if we can stop frivolous law suits, we can reduce the cost of preventive medicine.
Now let me shift from legislating to meddling - it's time to shape up, America. If we stop our indulgences in too much eating, smoking and drinking, we can save billions without the federal government getting involved.