Recently, my daughter e-mailed asking me to explain health reform. I responded to her by writing the following:

Health reform is one of the most important public policy issues of our time, but it is complicated and confusing.

First, there are two New England Journal of Medicine articles that are most important for you and anyone in your generation to read: Daniel Polsky and David Grande’s “The Burden of Health Care Costs for Working Families – Implications for Reform” published July 30th, 2009, and Victor Fuch’s “Three ‘Inconvenient Truths’ about Health Care” published October 23rd, 2008.

Second, although there are differing views about how to actually fix our healthcare system, the bottom line is that health reform needs to happen.

In my opinion, as you listen to the discussions about reform, you should be seeking the answer to three questions about whether the proposal before Congress and the President is going to:

1. Maintain or improve access to healthcare services and assure that we will have choices in seeking care?

2. Incentivize providers to continually improve the quality of healthcare services we receive?

3. Reduce the overall cost of care in present day dollars so we can pay for healthcare and other things in the long run?

Regarding point number three, one of the key challenges in enacting a health reform plan is how to share the financing between government, employers, and individuals. Of particular concern to policymakers is what effect a health reform plan would have on the federal budget.

A 2009 report from the Centers for Medicare and Medicaid Services (CMS) paints a bleak picture of the market for “affordable” healthcare in the United States over the coming decade.  Published in the journal Health Affairs, the study projects a scenario in which health spending growth is expected to outpace economic growth by over two percentage points; in addition, by 2018, health spending is expected to reach 20.3 percent of GDP, just over one-fifth of the economy. Read the latest projections from the CMS on national healthcare spending.

This country cannot afford to have these projections become reality. Although projections are based on assumptions and subject to uncertainty, the stark reality remains that spending in this sector will continue to climb, exacerbating all of the problems that we face today, and leaving individuals and businesses even less able to pay for healthcare.

As terrifying as this scenario is, we are not powerless to stand by and watch it unfold. We, as individuals, can take steps to control costs:  

• Become a more educated and active consumer of healthcare. Granted, this is not always easy – of all the purchasing decisions we make, healthcare purchases are among the most difficult about which to find reliable, detailed information.  Most of us have no idea how much a routine test at the doctor’s office will cost, let alone a major surgical procedure. Slowly, this is beginning to change. Transparency is beginning to take hold and better cost and quality information is being made available to consumers by hospitals and other sources.   

• Be more diligent about your own care.  Remembering to go for a yearly check-up and following your therapy and medication regimens closely can make a huge difference. Individuals with chronic medical problems should work closely with their physicians and other available resources to develop management plans for their conditions and then adhere to such plans closely. Even a simple step like regularly refilling and taking your prescription medicines can prevent a trip to the hospital and save valuable resources for yourself and the system at large. 

Individuals cannot change the healthcare system in this country overnight, but neither can the government nor the private sector.  It is only through cooperation that we can create an affordable system that provides excellent care. For now, we can all take the first step by assuming more responsibility as consumers, demanding more transparent cost and quality information, and actively working to improve our own health.  These may seem like small, insignificant changes, but they are the sort that could revolutionize care – if only we would all give them a chance.   

So get mobilized; get your friends mobilized; e-mail your representatives in Congress. Get meaningful health reform out of Washington and into your lives.

Regardless of which side of the aisle you choose to sit, this is the crux of where we are today. How we respond will affect generations to come.

Eric