The upcoming vote on health care reform is of historic proportions. The issue has vexed American leaders since Teddy Roosevelt called for universal health insurance in 1912, followed by Presidents Truman, Nixon, Clinton and now Obama. Even the hard-nosed Truman, who stared down the murderous dictator Joseph Stalin, met his match in the opposition to health reform.

Today, no ordinary American can be confident of continued quality coverage in the face of 15 to 20 percent annual premium hikes. Something must be done.

The issue is most critical in rural America, where more of us are uninsured or underinsured because we depend on self employment and small business employment. With each premium increase, fewer rural Americans can risk giving up their employer-provided insurance to start a business or farm. And as rural entrepreneurship declines, so goes the rural economy.

We’re also at risk of losing access to care as providers reach retirement age and no one takes their place. The Senate bills would improve rural access to care by expanding college loan forgiveness for health professionals who practice in rural areas and enticing more rural students to study for health professions.

All of the major bills would make insurance more affordable by providing refundable tax credits to offset insurance premiums to families making up to $80,000, with the greatest assistance going to those with the greatest need. The bills establish an insurance exchange to increase competition among insurers and lower prices for individuals and small businesses. Some bills establish a Medicare-like public insurance option to keep private insurers honest by making them compete on equal terms. We could all still choose to keep the insurance we have.

Each of the plans promotes healthy behavior to reduce health care costs. And each would discourage providers from using ineffective, but profitable treatments. Under the current fee-for-service system, providers make more by using more expensive treatments – even those that don’t work.

All of the plans would expand research to identify which health treatments work best and guide health care providers toward effective treatments. Each includes a pilot project to reward providers for using cost effective, successful treatments. The pilot projects would pay a fixed rate for effectively treating a particular health problem. Providers would earn the most by curing patients – so they don’t need ongoing treatment – in the most cost effective manner.

The current insurance system is broken. And the economic imperative for reform is equaled by the moral imperative. From 18,000 to 45,000 Americans die each year because they lack insurance and don’t get adequate care in time. We must reform health care to make America a more prosperous nation and, in the words of Abraham Lincoln, a more perfect union. We have been talking about it for 100 years. It is time to act.

Agree or disagree? Contact Chuck Hassebrook, chuckh@cfra.org or call 402.687.2103 x 1018.