Some of the relatively low-cost, high-return ways to improve health and reduce health care cost increases are relatively unglamorous and do not involve big government programs. For example, at Pitney Bowes, we reduced the rate of seasonal influenza and other infectious diseases by having an aggressive outreach on seasonal immunizations and on hand-washing and other hygiene-focused practices, such as more frequent cleaning of surfaces on which viruses or bacteria reside and spread. The rate of hospital-acquired infections, which cost our health care system dearly, could be reduced significantly if all hospitals focused similarly on infectious disease prevention.

Another relatively low-cost area of focus, which pays both significant short and long term dividends, is more aggressive outreach on prenatal counseling and lifestyle modification. Today, government programs are predominantly focused on the medical interaction required close to the time the mother delivers. However, the real benefit of prenatal counseling is at much earlier points in the pregnancy, at points during which an intervention can reduce the incidence of low birth-weight, premature babies. At Pitney Bowes, we used a program called Great Expectations, which provided financial incentives to get expectant mothers to participate, and we achieved lower incidence of premature births.

Any investment in getting children and adolescents to adopt better living habits pays back handsomely. For example, increasing the price of tobacco products by 10 percent reduces the percentage of teenagers who start smoking by 4 percent as a number of studies summarized in 2004 by Professor John Taurus of the University of Illinois at Chicago shows.

We have to refocus our efforts on improving health, as opposed solely to increasing insurance access. If we do not solve the health and health care access problems, and only give everyone an insurance card, we are effectively rearranging the deck chairs on the Titanic.

You can't please all the people all the time. There are no simple solutions. This is a compromise situation. But is giving up on millions of Americans the answer?

The Senate Finance Committee bill would achieve coverage for 94 percent of us, which is indeed a substantial improvement from the current 83 percent. And without a doubt, that 94 percent is a hard-won achievement for those crafting the bill, given the strong views and conflicting priorities in Congress, let alone the Committee.

Committee members have worked for weeks with the certain knowledge that regardless of their efforts and compromises, someone's not going to get what they want. Many of us are going to think the final package is too expensive. Others will say it didn't do enough to fix the inequities in a broken health care system. Some won't be satisfied unless health care is free to all.

I get it. It's a tough situation and they're doing their best.

But I refuse to believe that the best we can do still leaves millions and millions of Americans behind. Final legislation must get closer to the principle that led us to embark on reform in the first place: in this nation, it is unacceptable that people suffer and die because they can't afford to go to the doctor.

Today's vote is a huge and helpful step for America's families, and it is truly historic. Never before has the Senate Finance Committee adopted meaningful health insurance reform. Never before have all five congressional committees with jurisdiction over health care adopted measures designed to make high-quality, affordable health coverage available for America's families. And never before have we reached the point that both the Senate and House are poised to debate and adopt health insurance reform. These are clear signals that passage of health insurance reform is virtually inevitable this year -- and it couldn't happen too soon.

The Senate Finance Committee bill is complex and touches upon many subjects of significant interest to specific stakeholders. As a person who built and refined an employer-based health care program, and who feels passionately about health-care delivery and payment reform, as well as promotion of public health, I feel there is much to like in the bill, as well as some troubling provisions.

I support the idea of universal, affordable coverage, but feel that the $750 penalty for those not purchasing insurance is too low, and will have the unintended effect of causing far more sicker and older people to seek insurance and more healthy young people to pay an insufficiently low penalty in lieu of insurance.

I like the many efforts to address payment and delivery reform, and quality improvement. As a recently retired CEO of a large, self-insured employer, I like the increased plan design flexibility the bill creates, and do not object strongly to the idea of a "Cadillac plan" tax. However, the bill reduces significantly the tax benefit of flexible spending accounts, a vital health care planning tool, and it needs refinement in defining what it considers a "Cadillac plan."

I like the idea that the bill is taking a fresh look at many obsolete and costly state insurance mandates, and that it will create additional affordable choices for consumers. However, I believe that the additional fees charged to health insurers will simply get passed on to consumers and work against the goals of the bill.

I hope that Title III, Subtitle A of the Senate Health, Education, Labor and Pension Committee bill that provided for a National Prevention, Health Promotion, and Public Health Council survive, because, ultimately, improving overall health is essential to "bending the cost curve."

I support taxes on "Cadillac" plans as long as we adjust the cost for plans that enroll a higher percentage of less-healthy patients. Research shows that a richer plan does not produce better health or health care.

The "Cadillac" plans typically have bad plan designs that provide 100 percent reimbursement for hospitalizations and outpatient surgeries, and close to 100 percent reimbursement for expensive and overused diagnostic tests. When plan participants are paying little or nothing for the most expensive components of care, they have no incentive to manage their health or the quality of their care. They also are less likely to adhere to chronic disease treatment plans because they implicitly know that their hospitalization is completely covered.

It is inconvenient and challenging for many people to change their behaviors to better manage their health or diseases. There has to be some degree of cost sharing for the most expensive and technologically-intensive treatment to get them to alter their behaviors.

By contrast, those plans that align the plan participants and payers by giving incentives for high-quality care and healthy patient behaviors should be rewarded. In those plans, because there are cost-sharing arrangements and differences in premiums and payments to providers, there are opportunities to affect both doctor and patient behavior for the better.

For example, we should give discounts for patients with chronic diseases like Type 2 diabetes who do everything they are supposed to do to maintain or improve their health, since we know that Type 2 diabetics can actually improve their condition. We should use workplace-based clinics that deliver convenient, lower-cost care, and an exceptionally high degree of employee satisfaction. We should aggressively promote preventive screenings that save on health care costs.

As I saw at Pitney Bowes, an intelligently-designed health plan produces better health and health care at a significantly lower cost than these "Cadillac" plans.

The issue of malpractice liability is part of a broader problem with the way government, the insurance industry and consumers look at medicine. The most common misconception about medicine is that it is a formulaic, cut-and-dried activity, with a "right" way to treat a situation and a "wrong" way. For the clear-cut examples, there would be little disagreement that patient safety and the failure to meet a minimum standard of care should trigger malpractice liability and an appropriate level of damages. However, there are many areas in which quick judgments have to be made with incomplete information, and in which the choices involve trade-offs among risks and outcomes. Prostate cancer is a good example. Sometimes there are multiple alternatives for treatment and there is usually no clear best choice from among them. In cases like these, we should equip patients with complete information on the available choices and prompt them to make well-informed decisions.

We will significantly reduce the frequency of many diagnosis and treatment malpractice lawsuits by paying medical professionals to take time to do proper diagnosis and treatment. The current Medicare and private insurance payment systems encourage professionals to rush through patient encounters and get quick answers, since health care professionals earn more by doing more activity, and earn nothing extra for better quality.

Some doctors practice defensive medicine, but the work compiled in the Dartmouth Atlas survey would indicate that this is only one of many contributors to excess medical costs. Excess care is more often the result of local practice preferences and an excess supply of hospital beds, technology and providers.

Therefore, I favor malpractice reform, but I believe more broad-based informed patient consent practices, combined with payment reform that drives physicians to spend more quality time with patients and a re-examination of discretionary care will have a bigger impact.

Sen. Kennedy's death is a deep loss, particularly for those who care deeply about health-care reform. I was struck by the fact that even when I met Republican lawmakers quite far away from Kennedy on the political spectrum, they felt that he had a unique ability and passion to get people with deeply adversarial positions together and find sufficient common ground to get legislation passed. He obviously had a unique skill, and he will be missed.

It is highly unlikely that any current leader can single-handedly do what Kennedy would have done. However, sometimes groups of leaders will emerge to fill a vacuum, and that could certainly happen here. There appears to be a broad-based desire to get some legislation passed, and there is actually more common ground among lawmakers of both parties than the media coverage would indicate. The key to getting this done will be for all stakeholders to step back and determine what they must have to achieve their policy goals, as opposed to what they would like to have to score a "victory" over their opposition.

What Kennedy did beautifully and regularly across a variety of issues was to make everyone focus on their "needs," rather than their "wants." Once that happened, there was ample room for compromise. Never has it more necessary to get that to happen.

The loss of Sen. Kennedy as a true legislative, political and social leader can not be over stated. I only hope that our elected leadership will go back and listen to or watch his many powerful speeches given on behalf of the disadvantaged and under-represented people of our country. Despite coming from a most privileged background, he committed every ounce of his ability and effort to helping to establish basic rights for every member of society. His bipartisan accomplishments in health care, including numerous improvements to the FDA and the establishment and re-authorization of the Children's Health Insurance Program (CHIP) represented the tip of the iceberg compared to his hopes for establishing an essential right to affordable, high-quality health care for every American. He was not afraid to use his own personal experiences to advance this agenda. I am certain he would have encouraged the use of his untimely death to pass meaningful reform.

If Congress does not pass health care reform legislation before the August recess, that probably increases the chances of sensible health reform legislation, because it will get elected representatives to understand better that the key priorities for Americans are to get the care they need from the doctors they want at a price they can afford.

To achieve these goals, the legislation will need to transform how doctors, hospitals and other providers are paid, to reward good low-cost care instead of activity, to eliminate system inefficiencies and to invest in improving public health.

The legislation presented so far is too focused on providing universal insurance and on various ways of increases taxes on people and businesses to pay for it, the wrong places to attack the problems Americans have with our current health care system. Elected officials need to understand that a publicly-administered universal health insurance plan does not equate to universal, affordable, high-quality care. In fact, if we increase the number of insured persons by tens of millions of people, but do not increase the supply of doctors and nurses, health care quality will degrade for everyone. Hopefully, elected officials will hear that from voters when they go home.

Opposition to current House and Senate bills is broad-based and bi-partisan, and is actually prioritizing issues as President Obama has, when he has spoken about "bending the cost curve." Think about it: it's hard to understand how health care can be more affordable when the independent Congressional Budget Office estimates that it will cost at least an additional $1 trillion.

The President has demonstrated finely tuned political instincts on other issues. The recess will give him to time to rethink his approach on this vital issue, and should increase the chances of legislation passing.

This week's question is outside of my own expertise, so I am only weighing in as an optimist. While I respect the need to maintain momentum and prevent ourselves from being distracted from this important domestic agenda item, I can not help but wonder whether a brief delay could be a good thing. Our elected officials have made health care reform (in its full meaning) a major priority; and there is little doubt that thousands of hours of real work has been incorporated, thus far; But getting the details right and building a true bipartisan base of support should be equally important.

If this bill cannot be bipartisan as it stands now, then the extra time will still have been useful in demonstrating that the opposition is obstructive rather than merely looking out for our nation's best long-term interests. There is such strong consensus that health care delivery and insurance-coverage is broken and headed in the wrong direction: it just seems impossible that we can not generate full support for positive change, once we get the details right.