I am reminded of the old saying that “fools rush in where others fear to tread” as I begin this piece. Health care reform has risen to the ranks of religion and politics as a subject that is better left unspoken in polite company. However, it is also a topic that a Chamber of Commerce will be expected to weigh in on at some point. A couple of years ago one of the predominant themes coming from our Member Survey was that, but for the escalating cost of health care, business owners would offer a host of other benefits to their employees. Clearly the cost of health care is an issue that we cannot duck.

There are a few fundamental, and somewhat paradoxical, dilemmas that many who engage in this debate need to come to grips with. It seems that we want what we want when we want it and we don’t want it to cost much. We rail against the idea of rationing at the personal level but proclaim its benefit for others; we argue that we want newer and better drugs on the market but demonize the industry that invests in research and development; upon entering the hospital, we demand every conceivable test but publicly argue that doctors order too many unwarranted tests; we want the best, brightest and well trained to provide our care and then we complain that costs of medical education keep driving costs up. Add to it the view that our ‘social contract” demands that every person living in our country is entitled to health care to some degree and the concept of controlled costs and inexpensive health care goes out the window.

Is there an answer? Frankly I know that I’m not smart enough to figure it out but these are some hard decisions that we will have to confront. Here are some ideas to spark a lively debate:

• Everyone is required to “purchase” an insurance plan: it matters not if it is private, public, or a hybrid; if you are over 22 and able-bodied, a portion of your income flow should go to health care. This assumes that there is an entry or basic plan that is readily available.
• Everyone pays something when they show up for care: If you have skin in the game, you’ll think about the choices that you make.
• If you are over ___ (insert an age) years old: no joint replacements.
• If you smoke or engage in other significant negative lifestyle choices: the price that you are required to pay for health insurance is significantly higher than those who lead a healthier lifestyle. Also, you may be denied certain types of treatment.
• If you are over _____ (insert an age): no organ transplants.
• If your liver is shot due to certain lifestyle choices: no liver transplants.

I’m not saying that I am fond of any of these choices. In truth, some would have had an effect on members of my own extended family. However, absent a change in our thinking about what Frank Sinatra called the “autumn of my years” (where about 80% of the costs are incurred) we are not going to be able to significantly affect the rate of cost escalation.