The House health reform bill's language explicitly prohibits the coverage of abortion by health plans funded by the Federal government. Furthermore, Americans who receive tax credits who purchase private insurance via health insurance exchanges, too, couldn't receive abortions under these health plans.

The exceptions are pregnancies due to rape or incest, or when a mother's life is at stake.

One of the practical implications of further limiting access to abortion for the less well-off is to move these women "off the grid" of the regular health providers they use and into the hands of potentially less safe and unknown providers. The health consequences of such a forced choice will inevitably result in some women showing up in emergency rooms with medical conditions their insurance plans will, ironically, eventually cover.

The Hyde Amendment already restricts women from receiving abortions covered by health plans funded by the Federal government.Thus, the House bill takes Hyde further in eroding women's access to abortions that are currently covered by private health plans. And this, as President Obama points out, changes the status quo.

The bill's abortion amendment moves Americans who have already experienced health insurance access disparities to being further compromised.

Congress has not come close to addressing the drivers of health care spending. We have to understand, as pointed out in Dr. Deborah Cohen and Dr. Tom Farley's book, "Prescription for a Healthy Nation" and former Surgeon General Dr. David Satcher's comment that over 80 percent of what drives health happens outside the health care system. How we design communities, price food, educate people, and create peer groups supportive of healthy behaviors will drive down health care spending far more than tinkering with health insurance coverage or negotiating lower rates with insurance plans.

When Congress intervenes in the health care system, the best thing it could do would be to support more integrated health care, with a focus on building community-based health care teams led by a trusted clinician in a medical home. The current legislative proposals are far too timid in moving in this direction. The President got it right when he mentioned great examples like Kaiser-Permanente, Intermountain Health and Geisinger in his health care speech to Congress in September. These integrated systems are most likely to reduce cost increases over time.

Unfortunately, the multiple bills passed through various House and Senate Committees do not go far enough to create a broad-based payment system that rewards integrated, low-cost, high-quality care. The fundamental flaw in all of these proposals is that they are based on the assumption that if everyone has health insurance, they will get more and better health care. However, health insurance access is not the same as health care access, and getting easier access to health care does not significantly improve population health. Until we make people so much healthier that they do not need to use the health care system as much, we will not reduce cost increases.

The proposed bills we've seen out of both the House and Senate make significant steps forward in bringing millions of Americans into a safe, sustainable insurance system. A robust public option is crucial to breaking the monopolistic stranglehold many insurance companies have in their regions. Coupled with meaningful efforts to prevent the worst excesses of the insurance industry, the public option will be a substantial step toward bending - and perhaps even reversing - the out-of-control cost curve.

But those headline-grabbing parts of the bill miss the real opportunity we have to make America and Americans healthier - and bring costs down, too. By building healthier places where people live and play we can help do what the health-care system is supposed to do: keep us from getting costly illnesses in the first place.

This fact is never more clear then when we look at the growing obesity crisis in our kids. As the principal adviser to the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity, I can tell you that - unchecked - the obesity epidemic among our kids will cost us untold billions of dollars in future care for diabetes, heart disease, and other obesity-related illnesses. Our children need better health care, yes, but they also need better school lunches, safer parks to play in, and more nearby places to buy fresh food. Healthy communities create healthy kids - and healthy kids cost our health-care system significantly less.

Of course, this is not to say health care itself isn't important. The health reform package should also clear away some simple bureaucratic hurdles that keep two-thirds of the nation's eight million uninsured children from getting the health care they are already eligible for through the Children's Health Insurance Program (CHIP) and Medicaid. Taking care of our kids' health on the front end makes far more fiscal sense than waiting for a trip to the emergency room.

The House and Senate versions of the reform bill both include some money to fund the community-level prevention efforts that will really make a difference, but there is still time to fund much, much more. The ultimate goal of our health system should be to support healthy people in healthy places. Cost-containment will be a crucial benefit that will come alongside a healthier America.

There is no perfect system outside the United States for health promotion, heath care or health insurance, but there is much done overseas from which we can learn. The French have been far more effective in driving healthy behaviors in schools and communities, but they have a more centralized government system than we do, with much less local government or individual autonomy.

India has pioneered innovative, low-cost surgeries like eye surgery at the Aravind Eye Care Hospital, where cataract surgery is about $15, and heart surgery that costs about 6 percent of what it does here, with equal or better quality. India also has led the way with some amazing telemedicine breakthroughs in rural areas, but its overall health-care system is poor.

The United Kingdom, because it has a centralized health care delivery system, has an excellent electronic health records system, but its system and the Canadian system only work because many citizens get care abroad for treatment they cannot get there with long waits or high costs.
Sweden has had good basic care in a single-payer system, but experiences significant delays in a wide range of surgeries, and is actually migrating more toward a combined public-private insurance model. Switzerland has universal, for-profit private insurance, but it has a significant individual mandate penalty and significant cost sharing (no Cadillac health plans in Switzerland), and has poor mental health coverage. The Dutch also have a hybrid model, with 95 percent of the coverage being funded by either employers or private insurance, with only 5 percent coming from the government, but care quality and satisfaction have decline in recent years.

The one common theme in these developed countries is that they are wrestling with fast-increasing and unsustainable costs and difficulty retaining high-quality care.

This bill is only a start to health-care reform. The token Republican senator who voted for the bill proves that both parties are beginning to listen to the needs of their constituents. The discussion surrounding the passage of this bill however seems more designed to promote Sen. Olympia Snowe than to promote real health-care reform. The bill itself is a compromise seriously lacking in appeal. Without a public option, it is not what can be called reform. If the democrats continue to woo Snowe and her cohorts it is clear we won't see a public option in any final reform either. Furthermore, I find it very concerning that this bill outlines cutting future Medicare spending and taxing higher-end plans as viable means to pay for health care. I thought the idea was to relieve the burden health-care costs are putting on Americans.

While I applaud Snowe for her courage to break with her party on this issue, there are reasons Americans voted for Democrats and health care is one of them. Maybe someone should remind the Democrats of that.

Democrats on the Senate Finance committee squandered a historic opportunity. 

For the past year, Finance Chairman Sen. Max Baucus was a lonely Democratic voice on the need to not just expand coverage but to fundamentally change the delivery system.  He never bought into the ridiculousness of "health insurance reform."  In fact, he released thoughtful papers with serious ideas on how improving the quality of care would not only improve patient safety but lower costs at the same time.  It appeared that he understood that insurance was not an island unto itself, but that insurance is merely a reflection of the delivery system.  

Unfortunately, as the process wore on, the Finance Committee ultimately side-stepped delivery reforms.  Worse, it devolved to the left's tried and true formula to expand coverage: higher taxes and more government.  You need not look any further than the CBO estimate from last week to see that there are no delivery reforms at all.  Just look at its evaluation of section III of the bill, "IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE, SUBTITLE A-TRANSFORMING THE HEALTH CARE DELIVERY SYSTEM."  The CBO estimates that all of these self-described transformations--hospital value-based purchasing, quality infrastructure, the oxymoron of a CMS Innovation Center--will save a grand total of $7.3 billion over the next ten years.  That is decimal dust when we may spend upwards of $35 trillion during that span. 

A trillion-dollar bill that masks its true costs with budget gimmicks (doesn't fix doctor payment; pushes tens of billions in costs to states; accounts for ten years of revenue but only seven years worth of costs) is not the kind of "reform" our system needs.

There's a long road ahead for health-care reform -- five bills to be merged and countless hours of debate still to come. A lot could change over the course of the next few months, and the content of the final reform bill is likely to vary from any of these individual bills. The question we need to keep asking ourselves is whether reform will drive the kind of wholesale transformation needed for the industry and consumers -- the kind we've seen in banking, travel and other service industries. Ten years ago, we wouldn't have imagined that people would do so many things themselves. Technology and business model innovation enabled new types of services -- putting consumers in charge, dramatically changing engagement and economics. Imagine the possibilities for new services in health.

Taking this into account, what's needed is a new 'health delivery' framework that drives value, rewards experimentation, puts consumers in charge, and enables innovation--essentially changing the attitudes, beliefs, and behaviors of everyone involved in health delivery. We all have to be prepared to work together in different ways.

We have an opportunity now to move the traditional healthcare business model in a new direction:

At the end of the day, the ultimate success of health-care reform will depend as much on how we will work together and change our behaviors as on the legislation ultimately passed by Congress and signed by President Obama. I applaud the administration for shining the light on health care as it has never been done before.

Sen. Baucus may have won a hotly contested playoff game, but a tougher divisional match and ultimately the championship still lie ahead. In the weeks and months to come, what the House and Senate produce will say as much about President Obama's political game and the legislature's resolve as it will about the fundamental American ethos. Since its inception and the framing of the Constitution, the American republic has been rooted in John Locke's theory of individual rights and shaped by competing Federalist views. We've espoused the mantra of limited government but with bipolar tendencies toward expansive federal programs (i.e., Social Security and Medicare). Historically, we've tolerated government incursions in health care but only when it concerned the purview of the deserving poor, disabled or the elderly.

On the other hand, our individualism has been tempered by a righteous sense of empathy and social fairness. Even so, the question lingers: are we ready to climb that proverbial Mount Everest of ideological shifts? Will we foray into that cultural tempest of universal coverage? Or will the heavy burden of government-sponsored anything scare us back into the arms of familiar traditions? At stake, will be a broken system and the millions of uninsured.

Indeed with the Finance Committee's 14-9 vote, the Congress undoubtedly inched closer to advancing what has been an arduous path to reform. Odds are some form of health legislation will pass, but whether the final incarnation represents substantive change, however, remains to be seen. The Baucus bill, the least politically offensive, won the coveted moniker of bipartisan, though barely. In exchange for a lone Republican vote and in the hopes of assuaging more conservative Democrats, Senator Baucus abandoned the public option. Instead he pegged health-care cooperatives and insurance exchanges as a viable alternative. These approaches, inherently weaker in nature, will unlikely wield enough leverage against an insurance industry, which in recent days has proved onerous and sadistic.

If individuals will be mandated to purchase health insurance then the public should be offered meaningful competition, which is best achieved through a more muscular government-backed option. The insurance industry and many others in the health-care sector are poised to reap an influx of potential customers. The Finance Committee proposed safeguards to protect ordinary citizens. It ensures guaranteed issue and caps annual out-of-pocket expenses. Rather, it concedes variations in premiums based on age, family composition and tobacco use. Ultimately, it leaves open the door for consumers to be bullied by gluttonous industry practices.

Throughout history we've acted out-of-character. Nixon, a limited-government Republican, proposed employer-mandated coverage in addition to a form of public option. Likewise, both Republican and Democratic administrations have tolerated a "backdoor approach" to universal coverage with incremental expansions of Medicaid. But yet again history is calling. And, if we follow the leads of FDR and Johnson we may be able to do something bold and characteristically American.

The best Senate Finance Committee bill is a done bill. In order to move forward, we needed to get it out of committee.

I'm not satisifed with this version of health-care reform, but everyone needs to
remember: the final health-care reform bill will not be a Xerox of the Baucus bill. When the Senate HELP bill, the Senate Finance Committee (Baucus) bill and the House
legislation merge, provisions from all of the bills will make their way into the final
health-care reform bill.

Will the Baucus bill trump the others? Much depends on whether the White House exerts its weight in those final discussions. The House bill, endorsed by three House committees, is much closer to the administration's vision of heatlh-care reform. It includes a public sector insurance plan that would set a high benchmark for affordable, high quality, comprehensive care.

According to the Commonwealth Fund, savings from administrative costs alone would mean that a public sector plan would cost a family at least $2000 less than a private sector plan.

Under health-care reform, medical care does not have to be more expensive. If it's done right, it will be less expensive and our health-care system will be better, both for patients and for doctors. Physicians will be paid more for delivering better care, which is what the vast majority of doctors want to do.

Mandates, whether for individuals or employers, are one of the most critical issues in the reform debate. Republicans fear employer mandates will impose significant financial burdens on companies and put them out of business. Democrats argue that employers have to take responsibility for the health of their workers. Both have a point.

Is it realistic to believe that if employers were not required to contribute funds to employees' health plans, they would reinvest that money into salaries? These days, sadly not. It follows that many businesses, fighting to stay alive in a global downturn, may choose the path of self-preservation and least expense. And if that path leads to a fine, management may very well choose it.

That's probably true in many, if not most, cases. Fortunately, there are a few notable and laudable exceptions in the business community. Starbucks, for example, is a successful American company that provides health benefits to all of its full and part-time employees. They serve as the example that comprehensive employee coverage and success in business aren't mutually exclusive.

On the other hand, if we legislatively compel employers to contribute to workers' health plans and the costs put them out of business, unemployment rises and with it, the ranks of the uninsured. And then we're back at square one because we'll be worse off than we currently are.

Rather than becoming mired in a debate about the means, let's focus on the desired end: How do we ensure that workers have good, reliable and continuous coverage without breaking the backs of America's small businesses?