The national discussion of health care reform has huge implications for our state, and I believe it is critical that Congress and the president reach an agreement that moves us down the road to real reform. The heated rhetoric and spurious charges that opponents of any reform were making in August seem now to have quieted down a bit, and both houses of Congress are moving toward their own versions of a reform package. Speaker of the House Nancy Pelosi released the new House leadership bill (the Affordable Healthcare for America Act, H.R. 3962), and Senate Majority Leader Harry Reid is expected to release a new Senate leadership bill some time in early November. While I have strong preferences as to what needs to be in the final legislation, the good news is that some fundamental reforms that will address the most serious problems of our health care system are now under serious discussion.

It is important to remember why we are undertaking this exercise: The current system is not working. In New York, 2.5 million people, or 13 percent of the state’s population, do not have health insurance. The uninsured are overwhelmingly represented by groups like the poor (47 percent of uninsured adults in New York State have incomes under 200 percent of the federal poverty level), minorities (while 13 percent of whites are uninsured, 21 percent of African Americans, 23 percent of Asian/Pacific Islanders, and 31 percent of Latinos are uninsured), and immigrants (30 percent of the uninsured are non-citizens).

An Unacceptable System

Health care costs continue to skyrocket while millions go without any health coverage at all. To the extent that these millions receive care, it is through emergency rooms – after they are already far more ill than necessary – which is a horribly ineffective way to deliver services, both in terms of the health of the individual and of the cost to the system.

Critics of reform claim health care will be rationed under the new system while they fail to acknowledge that we have more rationing of healthcare in the United States now than anywhere else in the developed world. But since that rationing occurs under the guise of inability to afford to treatment, or by the denial of coverage by insurance companies, some seem to see that as acceptable. It is not.

The costs of continuing our current system are simply unsustainable. Over the last decade, employer-sponsored health insurance premiums have increased 119 percent – four times the rate of inflation. A study of bankruptcy filings in 2007 found that 62 percent of them were related to medical expenses, and that it was not just the uninsured who were affected. In 80 percent of those bankruptcies, the filers had insurance that failed to adequately cover their costs. Without national health care reform, by 2018, national health care expenditures are expected to reach $4.4 trillion – more than double 2007 spending.

What Reform Must Do

Fundamental reform must meet the following basic criteria:

• Access to insurance for all Americans, regardless of income;
• Cost containment through increased competition and improved efficiencies;
• Preservation and strengthening of Medicare and Medicaid as a foundation for expanded coverage;
• Shared responsibility: Government, individuals, the industry, taxpayers and businesses must all equitably participate in reform; there need to be targeted incentives and penalties to encourage full participation by employers and individuals;
• Ensure reform is sustainable during all economic conditions: The federal government must create a system of counter-cyclical funding so that states have the necessary financial resources to ensure health care for al even during economic downturns. States like New York, which are ahead of other states in providing public health options, need to maintain our existing federal matches and must not be penalized for having been in front of the curve.

Obstacles to Change

The plans proposed by the House and the Senate all attempt to balance these goals with greater or lesser degrees of success. I believe the reluctance of some in the Senate to support a public option undermines the ability to achieve the appropriate balance of these goals because it leaves private insurers with little incentive to change their long-standing practices and huge profit margins, which have led to the skyrocketing costs we now see. A robust public option will provide more choice for consumers and businesses and create greater competition in the insurance market.

The arguments against a public option are also often blatantly self-contradictory -- arguing that we can't let government into the insurance business because government is inefficient, at the same time suggesting government would drive private insurers out of business by offering better benefits at a lower cost. And these critics seem to forget that government has run Medicare and Medicaid with much enrollee satisfaction for years.

The health care industry is a huge part of our economy, directly employing the equivalent of more than 357,780 full-time workers in New York, including 72,000 registered nurses. Nationally healthcare makes up more than 17 percent of our gross domestic product.

Reforming health care is not an easy thing, and we have certainly seen past presidents who took on this issue fail. But this time around there seems to be a greater recognition that we must address this crisis now, both for the well being of our citizens and for the economic health of the country. We can and should fight over the details of the final plan, and hopefully do so in a civil and constructive manner, but in the end we must recognize that the worst possible outcome is the status quo -- a broken health care system, with out-of-control costs, which leaves millions of Americans unprotected.

Liz Krueger, a Democrat, is the New York state senator from District 26 on Manhattan's East Side.