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A road map to healthcare reform

If we heed lessons of the past, we can achieve universal coverage.

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The economic stimulus package just passed by the House contains much to jump-start our economy in the next few years. And congressional moves to expand Medicare eligibility and healthcare for children (through SCHIP) are commendable. But these steps still leave largely unaddressed the most fundamental long-term threat to economic security that President Barack Obama vowed to tackle during the campaign: our crumbling framework of medical financing.

Now is the time to fix it. The window of opportunity for comprehensive action is open wider than at any time for decades. But without quick action, it will close, and America's businesses, workers, and families will continue to suffer at the hands of a healthcare nonsystem that costs far too much, leaves far too many at economic risk, and does far too little to improve our nation's health.

The task is monumental, but it is not insurmountable. In fact, our current economic crisis makes it not just more pressing, but also more possible. The task is more pressing because the problems in job-based health benefits will only grow worse as the recession deepens: Businesses will continue to drop coverage and shift costs onto workers, and more and more Americans will lose their homes and their life savings because they lack insurance or their insurance doesn't shield them against runaway health costs.

Reform is more possible because the hastened erosion of our system is galvanizing Americans and their leaders, and also because we must spend aggressively now to keep our economy afloat, reducing the roadblocks to the up-front investments needed to get to universal insurance. But the long history of past defeats should remind us that successful reform is never assured. A clear road map is needed to navigate the perilous political and policy terrain ahead, and it should contain four big signposts:

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