The question remains, which side are you on?

We are reaching a critical moment in the effort to reform health care in America this year, a moment in which we will find out who is serious about addressing the health care crisis we have we have in this country and who is not.

Everyone knows problem: health insurance for the middle class is becoming more and more uncertain for two reasons.

The first is that that the costs of health insurance are rising far faster than wages. Health insurance premiums have doubled over the last 9 years, going up three times faster than wages. As costs rise, health care becomes unaffordable for individuals and businesses drop health care coverage for their employees,

The second reason is that insurance companies deny people coverage and care. In the fine print of insurance policies are provisions that limit lifetime benefits that enable insurance companies to decide that a treatment we need is experimental and uncovered, that deny care for pre-existing medical conditions, and that allow insurance companies to dramatically raise our premiums or drop us entirely if we become sick.

If we don’t control insurance companies practices and premium costs, the middle class in America will drown. But the reform bill currently under consideration in the House of Representatives is the lifeline we need.

To begin with, the bill allows us to keep private insurance if we like it. But it regulates insurers, eliminating lifetime limits, prohibiting them from denying us the care we need, and stopping them from charging us more or dropping our coverage if we become sick. And just to guarantee that we will always have health insurance, the bill creates a public health insurance plan that we can join if have no alternative.

The bill also makes health insurance affordable. It limits out of pocket expenses. It simplifies forms and reduces administrative costs. It fixes the donut hole in Medicare pharmaceutical benefits. It gives middle income people the help they need to afford insurance premiums. And the new national public health insurance option would lower overall costs by creating competition in the health insurance industry.

Health reform is not cheap. But under the House bill, the middle class will not bear the costs. A bit more than half will be paid for by making health care more efficient and effective. A bit less than half will come from income taxes on the richest Americans. In Pennsylvania, 99% of all taxpayers will see no increase in their tax burden.

Some members of Congress—Representative Jason Altmire among them—have said we should pay for expanding health insurance by squeezing inefficiency out of the system instead of raising taxes.

There is no question that substantial savings can be made if we reform health care delivery and payment systems. But no serious analyst believes that these reforms can be put in place quickly. Tests of new delivery and payment models are encouraging. But we do not know how well they will scale to the whole system. And even if we were sure which of these new models are best, putting them into place will take time.

HR 3200 provides a framework with which to enact these reforms without threatening the quality of health care by moving too fast. Reforms in Medicare and the creation of a public health insurance plan will give us the structural means by which to force efficiencies in the health care system. The bill could be strengthened, along the lines suggested by President Obama, by creating an independent board to push forward changes in health care delivery and payment systems.

However, it will still take time to squeeze all the inefficiencies out of the health care system. Saying otherwise is a politically convenient excuse for avoiding the small increase in taxes that we need to pay for health care reform

Hundreds of people in this country, including two in Pennsylvania, die every day for lack of health insurance. Others suffer greatly The opportunity to enact the reforms that will reduce this death and suffering comes once in a generation. To miss the opportunity for reform in 2009 would be tragic. And to miss it because we lack the courage to enact a small tax increase on a tiny percentage of people—people whose incomes have skyrocketed in the last twenty years while the incomes of everyone else has been stagnant—would be contemptible.