In America it requires 270 votes in Electoral College to be elected President of the United States. During his campaign for the Presidency, President Barack Obama made a promise to increase access to health care for all Americans. And simply stated, a majority of Americans voted for his concept and idea of "Change,” which included universal health care!

Germany, a country of 82 million people has had universal health care since 1880. Our country is the most powerful in the world, yet our healthcare system ranks 37th. The United States is currently 50th in life expectancy. Over 47 million Americans-including our neighbors, brothers, cousins, grandchildren and friends-are uninsured. We have the most expensive healthcare system in the world, yet the least effective in terms of public health outcomes.

While most people would agree with the statements above and that we need to reform our healthcare system, the debate on this issue has begun to lose focus. If the rate of escalation in health care spending and health insurance premiums continues to grow at current trends in the United States, the cost of status quo will severely affect employers' success and consumers' livelihood. With the cost of our healthcare system growing 4% ahead of inflation, we should be focusing on the fact that our healthcare system will bankrupt our families and our nation if it is not reformed. Due to costs associated with poor quality of care and excessive administrative costs, the United States has spent $480 billion more dollars each year than many nations, like Germany, that have universal access to healthcare. To put things in perspective, our nation’s healthcare spending is 4 times the amount spent on our national defense. I believe a significant reason for this is directly related to our insurance industry being made up of “for profit” corporate entities. Most of the other 40 to 50 developed countries in the world have a “not for profit” insurance system. The not for profit insurance system helps keep the cost of insurance down in those countries and keeps the focus on healthcare outcomes, not balance sheets.

The insurance industry in America is made up of companies who bet against their customers; gambling that they will maximize their profit by insuring the healthy, and minimizing their risk by not insuring people who are unhealthy. These "for profit" companies' primary interest is in increasing the value of company shares and raising profits. This is a great business model, but this is not how we, as a country, should decide who should live and who should die.

We have also not spent enough time focusing on other factors involved in the rising costs of health care, including the cost of medical liability lawsuits and exorbitant medical procedures/tests that are performed unnecessarily by doctors, in an attempt to prevent being sued. In Germany, medical malpractice awards are capped by law; in our country, they are not. Lawsuits are a major cause of the exorbitant cost of health care, yet there has been very little debate in Washington on reforming costs related to medical malpractice.

Considering what we know, what should a 'real' health care reform package in the United States include?

1) A short term and long range set of goals on health care that will lead to a coordinated system with one set of rules and how to pay for it.
2) A serious global overview and accounting of health care systems and integrate the best practices from models currently generating healthier results, i.e. France, Germany and Japan.

3) Recourse of all known issues within the system:
• A reduction in the impact of litigation cost on health care.
• An increase in the number of doctors and nurses.
• An increase of affordable access to medicines, treatments and insurance while preserving patient choice of insurance plans and doctors.

4) Consideration of Medicare as a need-based program and increase qualifying thresholds on Medicaid.

5) Whether underinsured or uninsured, use of Medicaid as safety net for catastrophic illnesses.

The most contentious aspect of the President's healthcare reform plan is the creation of a public insurance option that will compete with private insurance companies. The people who oppose the public option are the same people who argue that competition in the market place is the best remedy to lower costs and increase quality. The same people, who oppose the government adding competition in the insurance industry, also argue and support the use of public dollars to fund private education. Reverse concept indeed, but the general principle related to competition has proved to work. The U.S. should use this same principle and allow the market place to lower costs of insurance and improve access to quality health care. However, to be successful, the public option has to have the strength and credibility to compete with the private insurance companies, large and small.

It is important that all factors be dealt with in a planned and systematic fashion. Gradual health care reform blurs our vision and won't improve the health and longevity of Americans. Real solutions must present deliberate, multifaceted, thoughtful, strategic and comprehensive actions. And all Americans should genuinely want to improve upon the one thing we ALL have in common, the desire for a sense of well being.