Clearly the number one domestic issue facing this country is the future of our health care system. That doesn’t mean that we shouldn’t pay attention to energy independence, protecting our shores from terrorism, the budget deficit and immigration reform.

All are important but nothing so directly affects all of us as the availability and affordability of health care.

Both parties will pay close attention to this issue as the 2008 presidential election approaches. While it is far from certain that Congress can pass anything dramatically affecting the future of health care in the next two years, the presidential candidates of both parties will be expected to focus on this issue during their campaigns and to actually try to pass something once they take office in 2009.

Let’s examine the scope of the problem. First, there are 46 million people in our country without health insurance. Many more have inadequate coverage. The vast majority of these people have jobs and are thus not eligible for government programs such as Medicaid, which help the poor.

Many of those without health insurance wind up in already crowded hospital emergency rooms. Some can pay for the cost of their treatment. Many others cannot and the hospitals have to absorb the cost of treatment, running up charges for everyone else.

Secondly, many major businesses in our country are straining under the cost of providing health care for their employees and retirees. This very significant cost comes off the bottom line and in many instances makes American made products less competitive with products made in foreign countries with some form of national health care for their workers.

Major sectors of the American business community supported initial efforts by the Clinton administration to deal with the health care issue in 1993 but lost their nerve and disappeared from the scene once the issue became too controversial.

There are additional issues such as the rapidly increasing cost to state governments of the Medicaid program for the poor, the future solvency of the Medicare program for the elderly and the opportunity for the federal government to negotiate prices of prescription drugs with major drug companies under the new Medicare prescription drug program.

These latter three issues are important and need to be addressed but they don’t go to the fundamental question of availability and affordability of health care for our working population who are not in poverty and not elderly. That’s where it really gets hard.

There is a fundamental difference on how to approach this problem. Some advocate a government run program for everyone (known as a “single payer” system). This is the type of system used in a number of other western countries. Opponents argue that it limits the choice of doctors and can lead to an inefficient bureaucracy.

The other approach is a system of private insurance with individuals and employers making the choice about coverage based on what is affordable. The problem with this system is that some people cannot afford to pay the premiums charged or cannot obtain coverage because of pre-existing conditions.

Also, employers often limit coverage (in some instances offering it to the employee only and not to his or her family) because of the cost. Under this system, which is what we currently have in place, millions of people either voluntarily or because of the unavailability of coverage wind up with no insurance at all.

The question that politicians will have to confront is how to blend these two approaches, assuming that there is not public support for a real “single payer” government run program.

Some suggestions have been offered. These include permitting people between the ages of 55 and 65 (the minimum age for Medicare coverage) to buy into the Medicare program at the government’s cost. Another approach is to permit individuals and employees of small and medium-sized businesses to participate in the government program currently offered to federal civil servants.

This is a “cafeteria” approach, whereby federal employees can choose from a variety of private plans that offer different levels of benefits at different costs. The premiums are affordable because the group (all federal civil servants) is large.

Other suggestions include requiring everyone above the poverty level to buy private insurance (just as some states require all drivers to have car insurance) but with subsidies for lower income workers and tax credits for everyone else to help underwrite the cost.

There will be a myriad of approaches. The important thing is that the problem must be addressed and that the public will expect presidential candidates in 2008 to step up to the plate with real solutions which could then be considered by Congress during the first part of a new president’s term.

It is unacceptable that the richest and greatest nation in the world does not have an adequate health care system for its people. Let’s hope the politicians really do get serious about this major national problem in the immediate future.

Martin Frost served in Congress from 1979 to 2005, representing a diverse district in the Dallas-Ft. Worth area. He served two terms as chairman of the House Democratic Caucus, the third-ranking leadership position for House Democrats, and two terms as chairman of the Democratic Congressional Campaign Committee. Frost serves as a regular contributor to FOX News Channel and is a partner at the law firm of Polsinelli, Shalton, Welte and Suelthaus. He holds a Bachelor of Journalism degree from the University of Missouri and a law degree from the Georgetown Law Center.

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