Nothing is more revealing about a society than the way it treats its old, its poor, it sick, and its children. And nothing has had more of an impact on the bottom line of American businesses, organizations, and families than the rising costs of health care. Nearly 50 million Americans are without health insurance, and an AMA study suggests half of Americans lack a primary care physician. While America has the finest health care in the world for the wealthy and the well-insured, that's simply not good enough. We have the highest infant mortality, lowest life expectancy, and highest incidence of every category of disease, of any country in the industrial world. We pay more for this dysfunctional system than any other country, and, taken as a whole, we're getting less.

I'm convinced that one major cause of the problem is the huge administrative costs and profits flowing to the private health insurance industry. We need a better alternative for every American than the deeply flawed private insurance industry. Hopefully, that will spur private insurers to compete more effectively for policyholders. If not, it frees the capital and labor engaged in private health insurance for other enterprises.

While a bill like HR 676 represents an ideal solution, I doubt it will pass without being butchered in conference. Instead, I would like to lay out five principles that would apply to a bill I would vote for:

• Universal Access: Anyone can buy into the plan, regardless of preexisting conditions, employment status, or income.
• Community Rating: Your base premium should be set on the basis of the cost of health care in your community, rather than your specific medical history.
• Patient Choice: You should be able to choose your own doctor, and if medically appropriate, any specialist.
• Public-Private Competition: Private insurers should not be allowed to cherry-pick the healthiest, youngest, and wealthiest patients out of the insurance pool, leaving the taxpayer to support care for the costliest patients. The public provider must compete on cost and services on as broad a basis as possible, spreading risk across a large pool of policyholders from a variety of life-stages.
• Preservation of taxpayer funds: The public provider should be self-sustaining wherever possible. It should use its leverage to negotiate favorable deals with providers and suppliers, and it should be funded largely by premiums. Subsidies should be limited to families at or below 200% of the poverty line, with self-funded waivers for states with higher costs of living.