The negative reaction to proposals for health care reform in America is utterly baffling to those of us who deal with the tragic inadequacies of the U.S. health care system every day. There is far too much misinformation in the "debate" for us not to speak up for those who suffer the system's inadequacies.

Opponents say that health care reform will result in socialized medicine and government control. Medicare is the best example to refute this contention. Virtually everybody loves this government-run program that ensures that our seniors get health care. While it was opposed by the AMA and conservatives when proposed in the 1960s, it has been a model of efficiency and fairness. Medicare is administered via contracts with private management and insurance companies, and a significant number of Medicare members in Hawai'i have their coverage through HMSA or Kaiser Permanente. This is what the "public option" is likely to be based on and is a great model for expanded coverage through health care reform.

Opponents of reform often point to their preference for market-driven solutions. In reality the system we have now is market-driven, and it has failed miserably. The rate of medical inflation has exceeded the normal inflation rate, in some cases by double digits, for the past 20 years. Insurance rates continue to skyrocket, robbing businesses of needed capital for expansion and cutting into employee wages through higher contributions. Plans are paying for less and patients are paying more through higher deductibles and co-payments. Finally, doctors and hospitals are complaining that reimbursements aren't sufficient to cover their costs. There is very little about the current system that works well and yet reform opponents would have you believe that everything is just fine. Whether or not you have insurance, you know the truth. If we actually had a better-regulated system and invested the billions of dollars that go into it in a rational way, we would be closer to having a cost-effective and humane system.

Opponents try to frighten us by saying that the elderly will lose benefits. This common scare tactic is often effective because seniors are the fastest-growing segment of our population. But this false argument makes no sense in that Medicare is our country's best health care program and a model for reform. The primary threat to Medicare comes from not reforming our health care system since the costs associated with it will soon bankrupt the nation.

Opponents say that we just can't afford health care reform, but the reality is that our current system of financing health care is unsustainable and jeopardizes the future of America's economy. We're paying more per capita and getting less for our money than any industrialized nation with a national health program, and the sickest 10 percent in the country are consuming 70 percent of our resources. By ensuring that everyone has access to care and compensating physicians appropriately, we can reduce the terrible financial burden that chronic diseases have taken on our system and remove the hidden costs of uncompensated emergency and hospital room care that push insurance premiums higher every year. True reform would cover more people, improve health and cost less.

Finally and most mysteriously are opponents who say the system isn't broken. I can only respond that they don't know how very vulnerable they are. For one thing, they don't realize that our hospitals and emergency rooms are in peril due to uncompensated care. If hospitals are forced to downsize or close, services are eliminated for those with insurance, too.

Even more to the point is our reliance on employment for private health insurance. While most workers in Hawai'i are fortunate to have employer-sponsored care (and note that is because the government requires it), any one of us could lose our full-time job and the health insurance we get there. Health insurers in Hawai'i reported a reduction of 17,000 members in the past year, primarily due to job losses.

What would you do if you became one of the 45 million Americans without any health insurance at all or one of the tens of millions more with insurance that doesn't cover what you need? I have worked for the medically disenfranchised in Hawai'i for more than 25 years and I can tell you that people who lack either private or public insurance do not get the health care they need. Period.

You may go to a community health center, which will do a wonderful job of providing early and comprehensive primary medical, dental, and mental health services. However, if you need specialty care, advanced diagnostic services, dialysis or cancer treatment, you are at the mercy of a costly, fragmented and cruel system. You are likely to be diagnosed late and not get the care you need. Make no mistake about it: Lack of insurance can kill you.

It is time for thoughtful and rational people to step forward in support for health care reform. A substantial overhaul is a moral imperative and an economic necessity. Maintaining the status quo is just not an option.