The American system of delivering and insuring health care needs to change. The only question is how much.

If starting a health care system from scratch, the current U.S. employer-based, private insurance model would not be endorsed. Its present status is not only inequitable and oppressive to business, but unsatisfying and underperforming for those covered by it.

Yet the alternative most hailed, a government-run "public option" insurance program, is not the answer either. This would create a new bureaucracy to solve a problem created by bureaucracy. We want the current system reformed for equity and efficiency, not replaced wholesale.

As Congress restarts reform debate, we urge them to take the public option — or its derivatives — from consideration. It should neither be mandated nor "triggered" if private insurers fail to meet certain benchmarks established by government. This would ensure the trigger is pulled.

Instead, Congress must fix what's broken, to ensure Americans who need insurance coverage and health care can receive it, to reward those who deliver it cost-effectively and with high quality, and avoid penalizing businesses offering it to employees, despite a system fraught with problems.

Here is where we stand, in detail, on health care reform:

• In this employer-based insurance system, the refusal to offer insurance creates a skewed playing field, for both businesses and workers. Companies not offering health insurance to their employees must do so, or be taxed commensurately. One plays, or one pays. 

• Hurting businesses that do provide insurance is self-defeating. If Congress reduces the tax exemption to business for providing insurance, as now being discussed, it will lead to more employees losing their insurance as employers become unable to afford to provide it.

• Americans who purchase insurance as individuals or small groups should enjoy the same tax deductions as businesses do. Creating this strong incentive to buy insurance would be a more sensible, cost-effective alternative to instituting a public option.

• The tangled regulatory webs that choke the interstate marketplace of insurance and allowed virtual or real private insurance monopolies to exist must be torn down. At the least, consumers need more choices in buying insurance. We also endorse the creation of insurance exchanges, where private companies would compete — with subsidies if needed — to cover the currently uninsured or underinsured.

• Under this blend of reforms, plus Medicare and Medicaid, universal coverage must be achieved. Those who need health insurance should be able to afford it, and insurers must be mandated to provide it, regardless of pre-existing conditions or other restrictions.

• Tort reform for health care providers is a necessity. The Brookings Institution has also suggested developing certain practicums of care, which if followed, would reduce the liability doctors and insurers. This seems a smart way to remove incentives for practicing expensive defensive medicine.

• Competition must be fostered within health care delivery. Regions or providers that offer cost-effective, high-quality care — according to agreed-upon measures — should be rewarded. Those that do not should be penalized.

• The costs of care must be transparent. In every other business, the true costs are made available so consumers can make informed choices. Health care should be no different.

• Insured must be made to take ownership of the cost of their care. A system, for example, where insured people shared in the savings of care would be effective.

• Imitation is the sincerest form of flattery, and history must be respected. In reforming our system, the lessons learned from successful programs, like the European models of blended insurance, or fiascoes, like Maine's Dirigo Health, must be heeded.

Inaction on reform is not an option. Progress must be made at all costs, which is a recipe for consensus and compromise. Yet these sentiments seem rarely mentioned. If political point-scoring fail to improve the conditions of the American people, it would be a travesty.

Congress has its mandate to act.

editorialboard@sunjournal.com