I've been listening to the debates between Senator McCain and Senator Obama, especially to get the details on what reforms they would make in the United States health care system. Here are the changes that I am looking for:

1. Affordability: Health care has to be affordable. That is, it has to be affordable not only for the poor, but for the average individual or family. Individuals, parents and children all need to be insured. A parent shouldn't have to decide whether to insure or feed a child. Of the 8.1 uninsured children in the United States, 2.8 million have parents with health insurance. A woman shouldn't have to have a breast mass for six months and then finally go into her doctor with metastatic breast cancer. A man with diabetes shouldn't have to decide whether to pay for his medication or gas for his car.
2. Accessible: Health care has to be accessible. Under the current system, if you apply for health care as an individual or a family, and one of you has a pre-existing condition, the insurance company can make your premiums so high that you can't afford it or you can be denied outright and be made persona non grata in the health insurance universe. In Washington and Alaska, if the insurance companies deny you coverage, you can purchase "catastrophic" health insurance which will cover major medical expenses. The catch is, that you have to apply for this and that you have to be able to afford it.
3. End employer based health insurance benefits as the mainstay of the American health insurance system: Under the current system, many Americans have health insurance benefits only through their work. According to the Kaiser Family Foundation report, Employer Health Benefits, 2008 Annual Survey, "63% of employers offer health benefits in 2008" which means coverage for "158 million nonelderly people in America." That number is more worrisome than it looks--what it means is that 37% of employers do NOT offer health benefits, a number that is probably higher in rural and remote areas. Also, not everyone at the workplace gets benefits. For example, in Seattle, some employers will offer benefits if you work as few as 16 hours a week, others require 20 hours, and a few require as much 32 hours. Just remember, many of the people who are working fewer hours are also making less money.
4. Keep health benefits portable: If you're one of the lucky 63%, you're good only as long as you can hang onto your job. If you lose your job, you can usually take your health benefits with you for a limited amount of time (as long as you can pay for them), after which you have to reapply for coverage. At this point, the insurers get to decide whether they keep you on the rolls. Heaven help you if you or someone in your family has a pre-existing medical condition that they sought medical treatment for. We need to go to a nationwide health insurance plan that is not employer based.
5. Everyone should contribute and no one should go uninsured: Americans need to be able to buy good, broad health insurance coverage at a reasonable price. If you can't afford the full premium, the government needs to subsidize most of the cost. Everyone should contribute something but we need to lighten the burden on people who have the smallest resources.
6. When you talk about employers, and health insurance benefits, understand the differences and get the numbers straight: The size of the employer matters, too, with 49% of firms with 3-9 workers offering benefits vs 99% of firms with 200 or more workers. Why is this? One individual with cancer can raise the costs for a small employer so much that the employer can no longer pay the premiums. The bottom line is that the old system, where employers subsidized health insurance is outdated. It started nearly 60 years ago when employers wanted to offer workers benefits without increasing wages.
7. Keep it simple. Keep it separate. Keep it steady. When you talk about health care reform, please don't plan on linking it to income taxes. What do I mean? Well, for years, we had our own little family business, and for years, we would get hit with so many taxes, our heads would spin. Don't believe me? Ask Governor Palin what the phone bill for a typical Alaskan looks like--we have taxes on taxes. Basically, I'd hate to think that our health insurance bill was going to fluctuate dramatically from year to year--how can we do any long term planning if we don't know what our costs are going to be from year to year.
8. Put some teeth in Stark. Don't know what I mean? All right. Don't let individual doctors own big ticket medical equipment and then refer all of their patients to their own CT scanners or MRI scanners.
9. Check out the Swiss system of health insurance where individuals purchase their own with assistance at several levels of government.
10. I'd like to know that both Senator Obama and Senator McCain read the Kaiser report. Required reading anyone?