OK, so we've seen the movie and we're sufficiently outraged and we're starting to talk about our broken health care system.

What now? What can we actually do about it?

There really isn't much any of us can do individually, other than to keep talking about it and raising awareness. We can start making healthier lifestyle choices, and that would help. But most of us have few if any choices in picking an insurance company. And complaints or activism directed at your insurance company probably aren't in your best interest given the current environment.

Any reforms will have to be at the federal level. Local and state governments can't do it. Sure, local governments can fund more health clinics and indigent care. And the states are trying with Medicaid, but look at what a disaster these programs have been (Exhibit A: Tennessee's TennCare). And what about the underinsured and even the insured who are not always getting adequate, affordable coverage?

Change has to come at the federal level, and there has to be pressure from grassroots, local and state governments, labor and business organizations, and people in the health care industry who are focused more on health care than on profits. And we can vote for candidates who support progressive reforms.

What should be the goals of such reforms and what should we expect from public officials we elect to enact them? There are plenty of ideas floating around. Here are my suggestions:

• Support policies and legislation that guarantee every American affordable access to health care in the next ten years.

• Work to reduce the number of uninsured to zero within five years.

• Support policies and regulation that end "cherry picking", exclusions, and denials of claims by insurance companies.

• Support policies and legislation that promote wellness and preventive care.

• Support policies and regulation that control costs and improve quality of care and patient outcomes.

• Remain open to ideas and dialog and compromise towards reforms that accomplish all of this in the most open and accessible way to all Americans, whether it ends up being a single-payer system, a better regulated free market system, or a hybrid of some kind.

• Refuse to accept campaign contributions or any other financial support from health care and pharmaceutical industry interests.

Most Americans are leery of "socialized medicine" such as they have in the UK. The French system is more of a hybrid that might be more politically feasible in the US. But the reality is that I don't know what would work best here, and neither do you unless your full-time job involves public health policy and a lifetime of studying other systems around the world. It's almost like we need a national plan of action similar to an "Apollo Program" or a "Manhattan Project" for health care reform.

Or maybe not. HR676, introduced by John Conyers four years ago, proposes something many feel would be a good solution: Open up Medicare for everybody. This bill would essentially accomplish every point in the above "pledge" with a single act of Congress. It's not quite an overnight solution, but almost.

When I first read it a couple of years ago, I thought it was too radical, even crazy, and had little or no chance of ever being taken seriously. But the more I think about it, the more I think this is a solid foundation for a single-payer universal insurance program. The systems are in place, the funding mechanisms are in place, and the bill lays out an orderly transition.

It would eliminate for-profit health insurance, and consolidate all federal and state programs including Medicaid, VA, SCHIPS, etc. into one National Health Insurance program based on the existing Medicare program. It would be funded by shifting resources already being spent along with some modest tax increases.

It's not perfect, there are some details that need to be fleshed out, and it will be met with vicious opposition by the insurance and pharmaceutical companies. But it's a good starting point and it's better than anything else that's been proposed in the last twelve years or so.

It should also be noted that public funding of government insurance/health care programs already plays a significant role in the U.S. system, so it's not like we aren't already doing it. Some quick facts:

• Medicare enrollment as of 2005: 42.4 million (1)

• Medicaid enrollment as of 2006: 45.7 million (2)

• VA enrollment as of 2004: 7.4 million (3)

• SCHIP enrollment as of 2005: 4 million (4)

• Public funding of US health care in 2003: 46% (5)

An open and legitimate debate with HR676 as the proposed basis for reform might get us to a solution within a couple of sessions of Congress. Say what you want about Michael Moore, but the movie SiCKO may have ignited the political will to get it done, or at least get the debate started in Congress.

So a more simplified version of the above "pledge" might be:

1. Pledge to not accept campaign contributions or any other financial support from any health care or pharmaceutical industry special interests, and

2) Pledge to a) Support HR676, or b) support at least a fair and open debate of the bill in Congress, or c) offer an alternative solution that accomplishes the same goals of providing affordable universal health insurance to all Americans.

Candidates in the 2008 presidential and congressional elections should be required to make their position very clear. It should be brought up in every debate so voters will know where the candidates stand.

And while they wouldn't be directly involved in the debate, state and local candidates can be held to the same standard. They can lend political support and apply pressure by raising awareness and educating the public about the benefits (and savings) to local public health and state Medicaid programs.

75 U.S. Representatives have signed on as co-sponsors of the bill.