Perspectives on Health Care Reform FREE

When speaking to a colleague about health care reform, Senator Edward Kennedy said, “Look, there are about 15 ways for this to happen. But you'e got to find the one to make it happen” (1). Although most stakeholders agree that U.S. health care is a mess and that we must find a way to substantively reform it, there is little agreement about how to make that happen.

Things might be less daunting if, as Senator Kennedy suggested, there were only 15 potential solutions. On the contrary, it seems that the number of ideas about how to fix health care might soon rival the number of uninsured Americans. Although this abundance of ideas can be dizzying, it is good that lots of people are actively thinking about the issue. Fixing health care in the United States won't be easy. Substantive reform will require much creative thought and a willingness of various stakeholders to step out of their own boxes. To generate dialogue about the way forward among our readers, this issue includes 3 perspectives on health care reform (2 - 4).

In the first perspective, political scientists present their view of cost control in medical care (2). They explain why they think the Obama administration's approach is unlikely to slow growth in costs, and they offer suggestions, largely drawn from other countries, about strategies to control health care spending that they believe would be more successful. The second perspective, from Healthcare Professionals for Healthcare Reform (http://www.hpfhr.org), presents the group's vision of a 3-tiered system of coverage (3). At its center is a health board analogous to the Federal Reserve that would oversee the development and delivery of a system that provides basic health care for all while preserving options for more-than-basic services under private insurance or self-pay mechanisms. In the third perspective, the FRESH-Thinking Project (http://www.FRESH-thinking.org) shares 8 fundamental essentials for successful reform (4). These recommendations represent the consensus of a diverse group of health care, policy, academic, and business leaders who came together in a series of workshops to discuss health care reform.

Although these proposals only scratch the surface, we hope that both those orchestrating reform and those who will feel its effects consider the ideas that they offer. Readers can share their opinions on these 3 perspectives by joining the forum for dialogue on health care reform on http://www.annals.org/healthcarereform/. To give voice to additional ideas, Annals also invites submission for formal review of short commentaries (no more than 2000 words) that offer constructive ideas for improving the health care system. Certainly, there are more than 15 ways to approach this problem. No thoughtful idea should go unheard.

—The Editors