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Why are Americans so worked up about health care reform? Statements such as "don't touch my Medicare" or "everyone should have access to state of the art health care irrespective of cost" are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system's history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let's try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let's look at the pros and cons of the Obama administration health care reform proposals and let's look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life's major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

A recent history of American health care - what has driven the costs so high?
Key elements of the Obama health care plan
The Republican view of health care - free market competition
Universal access to state of the art health care - a worthy goal but not easy to achieve
what can we do?
First, let's get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let's turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail's pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let's skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a "wait and see" approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950's) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; "nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor's offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the "perfect storm" for higher and higher health care costs. And by and large the storm is only intensifying.

At this point, let's turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure - I have never seen a health care plan that isn't. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let's look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.

To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don't comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.

To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.

The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.
The protection order secured by focuses 1 and 2 above is a commendable objective and most industrialized nations outside of the U.S. give "free" (paid for by rather high individual and corporate charges) human services to most if not the greater part of their residents. It is essential to note, nonetheless, that there are various limitations for which numerous Americans would be socially ill-equipped. Here is the essential disputable part of the Obama design, the protection order. The U.S. Incomparable Court as of late chose to hear contentions with regards to the lawfulness of the medical coverage order because of a request of by 26 expresses lawyer's general that congress surpassed its power under the trade condition of the U.S. constitution by passing this component of the arrangement. The issue is that if the Supreme Court should run against the command, it is for the most part trusted that the Obama design as we probably am aware it is damned. This is on account of its significant objective of giving medical coverage to all future extremely restricted if not ended through and through by such a choice.

As you would figure, the charges secured by point 3 above are somewhat disliked with those elements and people that need to pay them. Medicinal gadget organizations, pharmaceutical organizations, healing centers, specialists and insurance agencies all needed to "surrender" something that would either make new income or would decrease costs inside their circles of control. For instance, Stryker Corporation, a vast therapeutic gadget organization, as of late reported no less than a 1,000 representative lessening to some degree to cover these new expenses. This is being experienced by other medicinal gadget organizations and pharmaceutical organizations too. The lessening in great paying employments in these divisions and in the healing facility area may ascend as previous cost structures should be managed to oblige the diminished rate of repayment to clinics. Throughout the following ten years a few appraisals put the cost decreases to healing facilities and doctors at a large portion of a trillion dollars and this will stream specifically to and influence the organizations that supply doctor's facilities and specialists with the most recent restorative advances. None of this is to state that efficiencies won't be acknowledged by these progressions or that different occupations will thusly be made however this will speak to agonizing change for some time. It causes us to comprehend that human services change has an impact both positive and negative.

At long last, the Obama design tries to change the way therapeutic choices are made. While clinical and fundamental research supports nearly everything done in prescription today, specialists are animals of propensity like whatever is left of us and their preparation and everyday encounters manage, as it were, the manner by which they approach diagnosing and treating our conditions. Enter the idea of confirmation based drug and relative adequacy examine. Both of these try to create and use information bases from electronic wellbeing records and different sources to give better and all the more opportune data and input to doctors with regards to the results and expenses of the medications they are giving. There is awesome waste in social insurance today, assessed at maybe 33% of a more than 2 trillion dollar medicinal services spend every year. Envision the reserve funds that are conceivable from a lessening in superfluous test and methods that don't contrast positively and social insurance intercessions that are better archived as compelling. Presently the Republicans and others don't by and large like these thoughts as they have a tendency to portray them as "large government control" of your and my human services. Be that as it may, to be reasonable, paying little heed to their political influences, the vast majority who comprehend social insurance by any stretch of the imagination, realize that better information for the reasons depicted above will be vital to getting medicinal services efficiencies, tolerant wellbeing and costs headed the correct way.

A short survey of how Republicans and more traditionalist people consider social insurance change. I trust they would concur that costs must go under control and that more, not less Americans ought to approach human services paying little mind to their capacity to pay. In any case, the fundamental distinction is that these people see advertise powers and rivalry as the best approach to making the cost decreases and efficiencies we require. There are various thoughts as to driving more rivalry among medical coverage organizations and medicinal services suppliers (specialists and doctor's facilities) so the buyer would start to drive cost around the decisions we make. This works in numerous segments of our economy however this recipe has demonstrated that upgrades are illusive when connected to social insurance. Fundamentally the issue is that human services decisions are troublesome notwithstanding for the individuals who comprehend it and are associated. The all inclusive community, in any case, isn't so educated what's more we have all been raised to "go to the specialist" when we feel it is vital and we likewise have a social legacy that has incited inside the greater part of us the inclination that human services is something that is simply there and there truly isn't any reason not to get to it for whatever the reason and more awful we as a whole vibe that there is nothing we can do to influence its expenses to guarantee its accessibility to those with significant issues.

Alright, this article was not proposed to be a comprehensive investigation as I expected to keep it short trying to hold my crowd's consideration and to abandon some space for talking about what we can do contribute relentlessly to tackling a portion of the issues. To start with we should comprehend that the dollars accessible for human services are not boundless. Any progressions that are set up to give better protection scope and access to care will cost more. Furthermore, some way or another we need to discover the incomes to pay for these progressions. In the meantime we need to pay less for restorative medicines and techniques and accomplish a comment the accessibility of problematic or inadequately reported medications as we are the most elevated cost human services framework on the planet and don't really have the best outcomes as far as life span or keeping away from endless maladies substantially sooner than should be expected.

I trust that we require a progressive change in the way we consider social insurance, its accessibility, its expenses and who pays for it. Furthermore, on the off chance that you ponder to state we ought to self-assertively and radically diminish spending on medicinal services you would not be right. Here it is kindred subjects - social insurance spending should be safeguarded and ensured for the individuals who require it. Also, to free up these dollars those of us who needn't bother with it or can postpone it or dodge it have to act. Initially, we have to persuade our government officials that this nation needs supported state funded instruction as to the estimation of preventive wellbeing methodologies. This ought to be a best need and it has attempted to decrease the quantity of U.S. smokers for instance. If counteractive action somehow happened to grab hold, it is sensible to expect that those requiring human services for the heap of way of life caused interminable illnesses would diminish drastically. A great many Americans are encountering these illnesses far sooner than in decades past and quite a bit of this is because of poor way of life decisions. This switch alone would free up a lot of cash to deal with the medicinal services expenses of those in desperate need of treatment, regardless of whether because of an intense crisis or perpetual condition.

How about we go further on the main issue. The vast majority of us decline take care of executing essential wellbeing procedures into our every day lives. We don't practice yet we offer a considerable measure of reasons. We don't eat right yet we offer a great deal of reasons. We smoke and additionally we drink liquor to overabundance and we offer a great deal of reasons with respect to why we can't take care of dealing with these known to be dangerous individual wellbeing propensities. We don't exploit preventive wellbeing registration that take a gander at circulatory strain, cholesterol readings and body weight yet we offer a great deal of reasons. In short we disregard these things and the outcome is that we capitulate substantially sooner than should be expected to incessant infections like heart issues, diabetes and hypertension. We end up getting to specialists for these and more normal issues since "human services is there" and some way or another we think we have no obligation regarding diminishing our request on it.

It is troublesome for us to tune in to these certainties however simple to accuse the wiped out. Possibly they should care more for themselves! Indeed, that may be valid or perhaps they have a hereditary condition and they have progressed toward becoming among the terrible through positively no blame of their own. In any case, the fact of the matter is that you and I can execute customized preventive malady measures as a method for drastically enhancing human services access for others while lessening its expenses. It is much better to be gainful by accomplishing something we can control at that point moving the fault.

There are a colossal number of free sites accessible that can guide us to a more refreshing way of life. A soon as you can, "Google" "preventive social insurance methodologies", look into your neighborhood healing center's site and you will discover all that anyone could need assistance to kick you off. At long last, there is a ton to consider here and I have endeavored to plot the difficulties yet additionally the capable impact we could have on protecting the best of America's medicinal services framework now and into what's to come. I am restless to get notification from you and until then - assume responsibility and increment your odds for good wellbeing while at the same time ensuring that human services is there when we require it.