What's In It for Me? What are our obligations to each other?

As what passes for a health care debate rages all around us, I have come to realize that between the polarized extremes there exists a very important group of people who are the key to what will happen this fall, and that is the large group of Americans who have health insurance and who are worried they may lose advantages in any reform. All of the noise in our media is an attempt to reach this group, who are likely asking, "What's in it for me"?

I believe that those who currently have health insurance and good access to medical care would be well advised to support proposed health care reform for the following reasons:

• They may lose their insurance coverage! Right now, 14,000 insured people lose their coverage every day when they lose their job or the employer cannot continue to afford benefits, and that number is expected to increase greatly with current trends.
• Business can't afford the increasing costs! Under the current system, costs are expected to double during the next 10 years.
• Young people are priced out of the system! Those looking for work at the beginning of their careers are most likely to get jobs without benefits, leaving them uncovered and raising the cost for all others.
• Insurance often does not work when you need it, even if you have it! The for profit system is full of people who work hard to "ration your care" by figuring out how not to pay for things.
• The payment system must be reformed! Our current mess of a non system is caused by the payment incentive and lack of incentives we now have.
• Quality is often lacking! A sad and poorly understood fact is that even people with good insurance get the recommended care they should have only about 1/4 of the time. The care is not organized in a way that allows most doctors to manage their patients the best way possible.
• They may lose their doctor! Very few medical students are going in to the primary care disciplines, due primarily to the fact that they cannot afford to. Retiring family doctors are not being replaced. Reform which supports primary care is crucial to attracting the best and brightest into primary care.

When all is said and done, however, thinking just about ourselves misses one of the most important reasons for reform. Perhaps the most important thing to consider is, what are our obligations to each other? Our entire American society is engaged in global competition with all the countries on earth for the innovations, jobs, products and benefits of the world to come. We must have a society with well educated, healthy and productive citizens to secure the benefits of the future. Our companies need a level playing field that does not saddle them with the unequal and exorbitant costs of a failed system.

If the the future is scary to you, it is really not because of the risk of changing, but because we might not change. Don't be fooled.

How do people in different countries view their health care ? How do their opinions compare to those in the US?

As we debate how to achieve an improved health care system for the United States, the opponents of change often raise the specter of "socialized medicine", and invoke stories about the horrible care and service in other countries. What has been lacking in this discussion is, how do the residents of the United States and other countries actually feel themselves about their experiences within their respective health care systems?

A new seven-nation survey has just been released by The Commonwealth Fund. It shows that U.S. adults were the most likely to say they experienced medical errors, more likely to report they went without care because of the cost, and more likely to feel the health care system needs to be rebuilt completely. The results, are published in the journal Health Affairs.

The article, Higher-Performance Health Systems: Adults' Health Care Experiences in Seven Countries, 2007, also shows that U.S. adults have the highest out-of-pocket costs and the greatest difficulty paying for needed medical care.

The survey was conducted among 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. One-third of U.S. adults surveyed called for rebuilding the system, and this was the highest rate of any country surveyed. In addition to cost concerns, the experiences of U.S. patients indicated more fragmented and inefficient care in the U.S., including medical record and test delays.

Commonwealth Fund Senior Vice President Cathy Schoen, the lead author of the study, said "Patients in the U.S. are frustrated by high costs and a complicated health care system,".

The survey also examined the experiences of adults who have a "medical home", which was defined in this study as a regular source of care that is accessible and helps coordinate their care. Across all seven countries, only about half to 60 percent of the adults reported having such a relationship with a health care provider. In each of the countries in the survey, those adults who did have a medical home reported a significantly more positive care experience.

Food for thought as we discuss how to improve our system!