To stir emotions the health care reform debate doesn’t have to peel the onion back very far. There are those who could always afford health insurance and are worried that their costs will significantly rise in the attempt to cover the cost of care for those who have gone without. There are those with numerous and expensive to treat medical problems, who have no health insurance or inadequate health insurance coverage and they need relief, now! And there are those who are healthy, have chosen not to have health insurance, and resent a mandate requiring them to “buy-in” or face monetary penalties.The Health Care Affordability Act of 2010 is wide in its scope and goals. First, it moves us to a place where most Americans will be covered by health insurance. This will remove “the” key impediment to “routine” health care services for millions of Americans. Subsidies will insure health care insurance regardless of an ability to pay and just because you have pre-existing medical conditions you will still be eligible for “reasonably priced” coverage. Stated another way, insurers will not be able to reject you or drastically increase your premiums if you suffer from chronic illnesses that generate a high level of claims, nor will they be allowed to set dollar limits on health insurance coverage.To fund these objectives the Health Care Affordability Act requires all Americans to purchase health insurance. There will be subsidies if you are in a low income category and if you have no ability to pay anything you will be eligible for Medicaid as these state level programs will be more accommodating and act as the ultimate safety net. Through its mandates, the law requires millions of healthy individuals to pay into the system. The idea here is that those of us who are not in need of health care will fund those who draw from it. Since any of us can succumb to a health emergency at any time and thus become in need of potentially costly health care interventions those who support the mandate feel that this is fair – we are simply looking out for each other. Next, there are numerous plans in testing phases that are designed to make the delivery of health care more efficient and more cost effective. These pilot programs are being managed by the Center for Medicare and Medicaid Services (CMS) and include the cooperation of health systems throughout the country. These are complex to say the least and in early development stages and until proven, which is years from now, it is not known what their effect will be.I support the attempt by the Obama administration and others to get something done on this pressing national issue. But there is a lack of candor about the cost, where the funds will come from, what treatments and medical technologies will be restricted due to very high costs and how the demand of millions of newly insured patients will be managed in terms of timely access to care and treatments. I have spent forty-one years of my life in a medical technology career that focused on global health economics and reimbursement issues and believe me, something will have to give. In every country outside of America, health care budgets are limited and capped. Fees to hospitals and physicians are set, annually reviewed and kept in check and new medical technology prices and access to them are restricted in subtle and not so subtle ways. And if you think that these policies won’t happen in America – think again, as spending limits are being set and will be set and we will have to live within them!Having said that, let’s continue on with the reforms, some government mandated, some driven by the market place as conservative health policies propose. Just know that we will be dealing with health care reform for a very long time and there are going to be a lot of disillusioned folks along the way, newly enfranchised and otherwise. The emerging health care system will be “more just” but it will require real and noticeable sacrifice from the majority of Americans who heretofore never much worried about the fairness of it all.