Improving quality and accessibility in our health care system: cost effective controls in a reformed system.

We need to examine the elements of health reform and to debate them based on what type of health care system we want in the future. If we continue down the current course, the numbers of uninsured will grow; benefit coverage will be reduced; increasing numbers of small employers will not be able to afford to buy coverage; and, we will rely on cost shifting to pay for emergency and critical care for those who cannot pay. The alternative is to strive to remove unnecessary costs from our current system, to assure universal coverage, and to emphasize preventive and early ambulatory care over emergency and delayed care. This will cause some disruptions and will put some constraints on the independence of providers and patients. But this is already happening, and frequently without the input of either provider or patient. The insurer and employer are making many of these decisions. Health care reform needs to support patients and providers as the key decision-makers; I believe the President's plan will move us in this direction. I think now is the time to make health reform work for us. I do not see any catastrophic changes that will erode quality of care or the livelihood of health professionals. However, I do see an increasingly bleak future if we delay longer and avoid addressing the fundamental issues of access to high quality care for all Americans at an affordable cost.