OK, so we've seen the movie and we're sufficiently outraged and we're starting to talk about our broken health care system.

What now? What can we actually do about it?

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There really isn't much any of us can do individually, other than to keep talking about it and raising awareness. We can start making healthier lifestyle choices, and that would help. But most of us have few if any choices in picking an insurance company. And complaints or activism directed at your insurance company probably aren't in your best interest given the current environment.

I've been trying to figure out what I personally, and we collectively, can do about it. I concluded that any reforms will have to be at the federal level. Local and state governments can't do it. Sure, local governments can fund more health clinics and indigent care. And the states are trying with Medicaid, but look at what a disaster TennCare has been. And what about the underinsured and even the insured who are not always getting adequate, affordable coverage?

Change has to come at the federal level, and there has to be pressure from grassroots, local and state governments, labor and business organizations, and people in the health care industry who are focused more on health care than on profits.

I was thinking we should demand that every candidate for political office, from County Commissioner on up to President, take a pledge to reform health care in the US. I was wondering, what should this pledge be? There are lots of ideas floating around, but I came up with:

• Support policies and legislation that guarantee every American affordable access to health care in the next ten years.

• Work to reduce the number of uninsured to zero within five years.

• Support policies and regulation that end "cherry picking", exclusions, and denials of claims by insurance companies.

• Support policies and legislation that promote wellness and preventive care.

• Support policies and regulation that control costs and improve quality of care and patient outcomes.

• Remain open to ideas and dialog and compromise towards reforms that accomplish all of this in the most open and accessible way to all Americans, whether it ends up being a single-payer system, a better regulated free market system, or a hybrid of some kind.

• Refuse to accept campaign contributions or any other financial support from health care and pharmaceutical industry interests.

I, like most Americans, have always been leery of "socialized medicine" such as they have in the UK. The French system is a hybrid that might be more politically feasible in the US. But the reality is that I don't know what would work best here, and neither do you unless your full-time job involves public health policy and a lifetime of studying other systems around the world. It's almost like we need a national plan of action similar to an "Apollo Program" or a "Manhattan Project" for health care reform.

Or maybe not. HR676, introduced by John Conyers four years ago, proposes something I've long thought might be a good solution: Open up Medicare for everybody. This bill would essentially accomplish every point in the above "pledge" with a single act of Congress. It's not quite an overnight solution, but almost.

When I first read it a couple of years ago, I thought it was crazy and had no chance at all of even being taken seriously. But the more I think about it, the more I think this is a solid foundation for a single-payer universal insurance program. The systems are in place, the funding mechanisms are in place, and the bill lays out an orderly transition.

It would eliminate for-profit health insurance, and consolidate all federal and state programs including Medicaid and VA into one National Health Insurance program based on the existing Medicare program. It would be funded by shifting resources already being spent along with some modest tax increases.

It's not perfect, there are some details that need to be fleshed out, and it will be met with vicious opposition by the insurance and pharmaceutical companies. But it's a good starting point and it's better than anything else that's been proposed in the last twelve years or so.

I believe that an open and legitimate debate with HR676 as the proposed basis for reform would get us to a solution within a couple of sessions of Congress. Say what you want about Michael Moore, but the movie SiCKO may have just ignited the political will to get it done, or at least get the debate started in Congress.

So what I would propose to do is to write your and Senators and Representative asking them to take this simplified pledge:

1. Pledge to not accept campaign contributions or any other financial support from any health care or pharmaceutical industry special interests, and

2) Pledge to a) Support HR676, or b) support at least a fair and open debate of the bill in Congress, or c) offer an alternative solution that accomplishes the same goals of providing affordable universal health insurance to all Americans.

You should also ask whatever candidate you support in the 2008 presidential election to pledge the same, and ask the same of your candidates in the 2008 congressional elections.

We should also demand that every candidate in every debate, local or national, be asked if they will pledge the same. Maybe we can ask the League of Women Voters to include these two points in their local candidate surveys and debates.

And while they wouldn't be directly involved in the debate, state and local candidates can be held to the same pledge. They can lend political support and apply pressure by raising awareness and educating the public about the benefits (and savings) to local public health and state Medicaid programs.

Contact everyone you can think of, and email this info to five or ten other people and ask them to do the same.

Here's some contact info to get you started:

Congressman John J. Duncan, Jr.
2207 Rayburn House Office Building
Washington, DC 20515
Phone: (202) 225-5435
Fax: (202) 225-6440
Web contact form

Senator Lamar Alexander
455 Dirksen Senate Office Building
Washington, DC 20510
Phone: (202) 224-4944
Fax: (202) 228-3398
Web contact info

Senator Bob Corker
Dirksen Senate Building
SD-185
Washington, D.C. 20510
Phone: (202) 224-3344
Fax: (202) 228-0566
Web contact form

(For you folks over in Memphis, Rep. Steve Cohen has already signed on as a co-sponsor of the bill, along with 74 others.)