CONGRESS AND PRESIDENT Barack Obama have the best chance since the early years of the Clinton administration to fix our nation's health care system. This time, let's not waste the window of opportunity.

Our nation cannot afford failure. We must find a way to cover 46 million uninsured Americans. We must find a way to rein in costs that make per capita health care spending in this nation almost 50 percent more expensive than any other nation.

As Obama said in his speech this week to the American Medical Association, "If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In 30 years, it will be about one out of every three — a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans."

Unfortunately, for many of the players — hospitals, drug firms, doctors and especially insurance companies — this is often a political battle not about containing costs, but rather about maximizing profits. It's about greed. It's about grabbing a bigger piece of the health care pie, which is currently more than $2 trillion a year.

What's clear is that the status quo is not working. Currently, roughly a third of health insurance premiums go toward administration, marketing and profits. Doing nothing is not an option.


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In an ideal world, we would cut out the middleman. Unfortunately, the insurance industry's influence is too great. As tempting as it might be, moving to a single-payer system is not politically feasible. Moreover, while it works in other countries, switching to single-payer in the United States would require a revolutionary restructuring that is probably beyond the scope of players who are so used to operating on profit incentives.

In other words, we must work within the traditionally framework we have. But we must radically alter that structure. Insurance companies must be required to offer coverage to all, without regard for pre-existing conditions. Premiums and co-payments must be affordable and the poor must be provided subsidies to ensure they can access the medical system.

Most significantly, there must be a public insurance option. The insurance industry, despite being able to cherry-pick its patients from the healthiest among us, has demonstrated that it cannot, or will not, contain premium costs. A government-sponsored alternative will provide a balance where the marketplace has clearly failed.

Bringing down the cost of insurance premiums and expanding their availability to all Americans is just the start. We must change the experience for the patient — reduce the paperwork, and ensure that access to doctors, hospitals, pharmacies and laboratories is readily available when needed.

We must change the experience for doctors — reducing their paperwork, computerizing records, and putting them, not the insurance companies, in charge of medical decisions for their patients. At the same time, we must give incentives to doctors to provide the most effective tests and treatment, not the most profitable. And we must protect them against the threats of unmerited lawsuits that encourage them to order unnecessary scans and laboratory work out of fear of litigation.

We must also provide incentives to ensure that our next generation of doctors includes enough primary care physicians. The other specialties can be highly lucrative while doctors on the front line are often undercompensated. It is the primary care doctors who are essential for steering patients toward preventive care.

Which brings it back to us, the patients. We must take better care of ourselves, eat healthy, exercise, monitor our weight and take our medication when prescribed for our treatable diseases. An ounce of prevention is worth a pound — or, in this country, thousands of dollars — of cure. But, while we do our part, our lawmakers must do theirs.

As Obama said, "We know the moment is right for health care reform. We know this is an historic opportunity we've never seen before and may not see again."