We recently witnessed the entry of yet another health reform bill, this time from Republicans promising, among other things, preservation of employer-based insurance.  This echoes President Obama’s similar pledge. Such rare bipartisan agreement is consistent with polls showing that most Americans are happy with their health insurance, just not its cost.

Unfortunately, that’s like a third of all Americans saying they’re happy about being obese, just not about its health risks. You can’t have one without the other.  The fact is that employer-based health insurance is, inherently, a big cause of our health care problems—so is Medicare.  I’ll go into more detail on the fundamental failings of both programs in subsequent postings.

Right now I want to focus on a more basic question: what are the goals we want health reform to achieve?  Trying to preserve one particular form of insurance, whether employer or government-sponsored, is not one of them. Allowing everyone to obtain affordable health insurance is.  Getting health care costs under control is not by itself a goal.  Getting sustainable quality and affordability is.

My point is this: if we don’t carefully define our goals, we won’t be able to evaluate anybody’s proposed solution and we won’t like what we end up with.  So I’d like to draw a line in the sand and propose eight essential goals for American health reform:

  1. Universal insurance availability: Everyone in America should have access to affordable health insurance, regardless of individual health status, history, or genetics.
  2. Sustainable value and affordability: We must get spending under control while improving quality and promoting innovation—all on a sustainable basis.
  3. Free-rider prevention: No one should be allowed to game the system by delaying insurance purchases until they become ill.
  4. Voluntary participation: Buying health insurance should be voluntary, as is the purchase of everything else we buy.
  5. Financial protection: Health insurance should protect people against the unaffordable costs of necessary medical care.
  6. Individual choice of insurance, providers, and treatments: Everyone should be able to choose the vendors that best meet their own needs, priorities, and circumstances.
  7. Portability: People should be able to keep their own health insurance regardless of employment status or eligibility for government-sponsored coverage.
  8. Personal responsibility for prevention: People must be responsible for managing their own health risks like obesity, smoking, blood pressure, cholesterol, and blood sugar.

I believe we can attain all these goals in the United States, but it won’t come from any of the current proposals in Congress—from either side of the aisle. That’s not surprising, since there isn’t a single country in the entire world that has ever delivered on all eight.  But this is America, damn it, and we’re used to resolving seeming insoluble problems. We can certainly do it with health care. I explain how in my book Cured! and will do so on this website.