I really hope that Congress abandons both of the mammoth versions of health care reform and starts over. Health care is an important issue that needs to be addressed but we need to use common sense when changing the system. An iterative approach makes more sense because the system is complex, most people are happy with their current coverage and we need to be careful of the "law of unintended consequences." There are two main problems that need to be fixed: high costs and lack of access.
Rather than have increased government supervision and control of our health care system, there are several things that could be done quickly that would begin to reduce costs. After implementing them, we can then see what further measures would be helpful.
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1. Tort reform: Health care costs are inflated by the high cost of malpractice insurance plus the need for doctors to practice "defensive medicine" by ordering tests and procedures solely to avoid lawsuits.
2. Increased competition among insurance companies: If we allowed insurance companies to compete across state lines, there would be more options for consumers to choose from and prices would go down. In order to foster this, a role for the federal government might be to profile 10 or 12 standard plans (with a variety of benefit levels and deductible options) that insurance companies would underwrite, so that consumers could be better able to compare plans and see what they are really getting.
3. Allow smaller companies to band together to get cheaper and better insurance for their employees. Right now, they and their employees are at a huge disadvantage.
4. Continue to encourage people to use Health Savings Accounts to pay for their insurance and medical costs. For people who don't have employer-provided insurance, this is one way to make buying insurance more feasible.
5. Deal with the issue of pre-existing conditions. This can be tricky for a few reasons. First, insurance by its very nature is a way of managing risk. Companies in all kind of insurance (auto, life, etc.) charge different rates for those who pose different levels of risk. Without being able to do this, everyone pays a higher price for insurance. Second, if you just say that insurance companies can no longer rate for pre-existing conditions or refuse coverage, then people will wait to buy insurance until they are sick (and why wouldn't they?). This also will increase costs for those who are insured. And I don't think that forcing people to buy insurance just for being a citizen of the United States is constitutional. Finally, the current system is unfair to those who have kept insurance coverage all their lives, done the right things but lost their coverage due to loss of employment or other reasons. These people need to be able to get continuation of coverage without being subjected to pre-existing conditions carve-outs. Likewise, children should be able to get health insurance (if their parents have it) without being subjected to pre-existing conditions. You could make a law that says if you have had insurance but lost coverage (due to unemployment or early retirement or whatever) then you cannot be refused or penalized for pre-existing conditions. I'm sure there are other ideas and options on dealing with this critical issue.
Obviously there are many other issues that can be addressed. But we should start with the most obvious ones and re-evaluate in a few years time. I hope our Congress will listen.