Many people ask, “can we afford to pay for health care reform?” However, the more pressing question is whether we can afford not to reform our health care system. The collapse of our financial markets and the general deterioration of the economy make fundamental health reform an urgent priority. Investing in our health care system will pay off by helping to keep Americans healthy and economically stable.

On February 10, 2009, Senate Budget Committee Chairman Kent Conrad (D-N.D.) said that health care reform plans cannot add substantial costs to the system, one which already is straining the federal budget.  At the same time, the course the current health care system is currently on is unsustainable and changes based on major new spending are not the answer.

Former Congressional Budget Office Director Peter Orszag has noted that reforming the health care system is not just a human imperative, but is also the nation’s greatest economic reform opportunity. Without cost-related changes to the system, private and public health care spending will reach an estimated 37 percent of the gross domestic product in 2050.

During the February 10 hearing, current CBO Director Douglas Elmendorf also testified.  He has outlined options for expanding coverage and controlling costs in two CBO reports (Key Issues in Analyzing Major Health Insurance Proposals and Budget Options, Volume 1: Health Care) that were released in late 2008. These reports indicate that there is consensus regarding the broad direction for health reform—such as stronger incentives to control costs and provide more information about care quality and value—but the specific details are less certain, often because there is a lack of evidence on how cost-effective these proposed measures would be.


The window of opportunity for health reform is wide open, as is the opportunity to develop strategies that will allow such reform to be accomplished in a fiscally responsible way. Lawmakers must build Americans’ confidence in allowing the government to take the necessary actions to reform the health care system without reinforcing fears that government involvement will not be in the best interests of Americans. Some things to keep in mind:

  • Reinforce Obvious Truths.  When it comes to health care dollars and services, more is not always better. Americans know that our current health care system does not provide value for all that it expends on the costs of providing services. Health care reform must reinforce the importance of providing quality care in as cost effective a manner as possible. We need to prove that it is possible to save money without sacrificing quality.
  • Make Everyone an Ally. A sense of individual and of shared responsibility must play a role in health reform, so that all participants understand that . We must make everyone—consumers, states and businesses—feel the impact of health care reform on their wallets so that we as a nation can reach a consensus on a long-term vision for health reform. The federal government cannot solve the problem alone. Many states, for example, have launched their own efforts to control the costs of health care, as have many employers. Most consumers feel the direct effect of paying for some or all of their health care and the need to make personal choices regarding their consumption. Coordination among all the participants may create the necessary shared sense of responsibility that will inspire change.