The longer we delay fixing the health care system – reigning in costs, covering everyone, and fairly sharing risk – the harder it will be to reform the system at all. And it's not just because America is currently facing, in the words of just about everyone, “the largest economic crisis since the Great Depression.” As David Lightman and Kevin G. Hall point out today in McClatchy Newspapers, the simple demographics will be against us if we wait:

Beginning in 2011, the first wave of baby boomers – Americans born between 1946 and 1964 – will reach official retirement age. From that point forward, the federal government's finances will be strained, as more and more Americans retire expecting a shrinking number of active workers to pay their promised health and pension benefits.

To put it more starkly: Medicare's trustees project the hospital insurance fund will become insolvent in about 10 years, as its expenditures grow at a 7.4 percent annual rate. The government, the trustees said, will need $342 billion to cover insurance costs during that period.

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“The longer action on reforming health care and Social Security is delayed, the more painful and difficult the choices will become,” said a Government Accountability Office study in June. “The federal government faces increasing pressures, yet a shrinking window of opportunity for phasing in adjustments.”

Medicare, the report said, “represents a much larger, faster-growing and more immediate problem than Social Security.”

A series of factors are driving up Medicare costs. According to the GAO and the trustees, medical technology is often overused; the health care market doesn't operate on a supply-and-demand basis as people often don't shop for the lowest price; and chronic health problems – such as obesity or substance abuse – require expensive, lengthy treatment.

Medicare (and similarly, Medicaid) face such staggering budget shortfalls to a large extent as a consequence of America's private, patchwork health care system. Preventative care is less costly in the long run, yet, because the health insurance industry has been so deregulated as to allow them to deny care at every opportunity and price care out of the reach of millions, America has 47 million uninsured and millions more under-insured. This means millions of Americans don't see their doctor as regularly as they should to catch medical problems early before they become costly emergencies. And, as the economy sinks, people are cutting back on care, making the problem worse.

Medicare (and to some extent, Medicaid) functions essentially as a high risk pool, a group of people (in this case, the elderly) who are less profitable to insurance companies because they use so much health care. High risk pools, basically by definition, don't work. If the theory of insurance is to spread out risk (everyone in a system all pay into a pot so when one person needs to use their coverage, that cost can be absorbed by everyone), then high risk pools make no sense. Putting everyone who you know are going to use a lot of health insurance into the same pot and asking them to share costs is silly – there are no “low risk” people in the system to absorb some of the cost. And because everyone at some time in their life is “high risk” for large health insurance costs (everyone eventually gets sick or old), Medicare functions as a dumping ground for the private insurance industry. Private insurance takes monthly premiums from the young and healthy all their life, and when they get old and sick (and unprofitable), they are dumped on the government.

This is why Medicare is projected to be the largest driver of the national debt in the near future, and, because baby boomers are about to enter the system in huge numbers, this is why health reform needs to happen in this country immediately.

Simply getting everybody covered adequately would be a huge step forward. A guarantee of a certain level of care, no matter if you're on private or public insurance plans, would make sure people receive the care they need throughout their life, lowering overall costs. A subsidized public insurance plan that would take everybody would go a long way towards eliminating the number of people in America without insurance. And regulating all insurance plans – public and private – to make sure they cover pre-existing conditions and can't dump “unprofitable” customers would ensure risk is shared fairly, as it is meant to be.

This, of course, is Health Care for America Now's vision, shared by 83 Members of Congress, including Barack Obama and Joe Biden.

Contrast that with the conservative vision, championed by John McCain:

• Less regulation on insurance companies to do away with state based insurance, allowing companies to set up shop in the states with the least regulation and forcing Americans to shop on their own for health insurance.
• Taxing your employee health benefits, doing away with the employer-based system
• Funding a paltry tax credit (which goes straight to the insurance industry) with cuts to Medicare and Medicaid

No guarantee of care, no incentive to promote prevention, no fair risk sharing, and a plan that is estimated to grow the ranks of the uninsured in America by 5 million in just five years.

There is a clear difference here, and that's why it's so important to make health care a priority in this election and immediately after the next president is inaugurated. It seems the nation is waking up to that difference, too. In the past few weeks, health care has been a focus of some excellent debate questions, it has been targeted in campaign advertisements, and the subject of numerous news stories. And of course, Health Care for America Now has thrown our hat into the ring, spending $4.3 million to put advertisements about John McCain's health care plan (as well as 7 congressional candidates) on the air across the country:

America is finally having the health care debate it needs to be having. What's at stake is our economy, our national debt, our health, and our happiness. Let's just hope the urgency is still there in January.

(also posted at MyDD and the NOW! blog)

I'm proud to work for Health Care for America Now.