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With all of the discussion and legislative attention that has been paid to addressing the health care crisis facing our community, state and nation, we seem to be mired in continuing disagreement about the best way to make sure everyone has access to, and coverage for, basic health care.

A new report out of the Centers for Disease Control and Prevention estimates that more than 40 million people cannot afford adequate health care. In our state, almost seven million people are uninsured, a number larger than the population of Massachusetts. Last year, hospitals provided an estimated $8.6 billion of uncompensated care in California.

As an academic medical center, UCSD cares for a large number of San Diego’s uninsured, while providing advanced care and regional services in a setting that also supports teaching and research … costly but necessary investments to keep our community at the forefront of leading edge care, delivered by highly trained professionals.

Faced with declining reimbursements, workforce shortages leading to escalating labor costs, and a growing and aging population with chronic care needs, our hospitals are struggling. More and more patients are using emergency rooms as their point of entry into the medical system, since hospitals must see every patient who comes to the ER. As a result of this perfect storm of challenges, more than 70 hospitals and emergency rooms have closed in the past decade, exacerbating overcrowding in the remaining ERs.

As debates about legislated solutions rage on, we have seen some breakthroughs. For example, Governor Schwarzenegger’s proposed plan was endorsed by the California Hospital Association, which expressed willingness to pay a 4 percent fee to support reform. However, I unfortunately am not optimistic that we are going to see any real comprehensive legislation passed during this election season.

So, if the Governor’s plan or any of the others that have been proposed are not realized, are we saying we are satisfied with the status quo? If not, then: Should health insurance be mandated? What is the best model for ensuring that affordable coverage is available for all consumers? For what services? Should we have government-sponsored coverage that ensures access to at least a basic level of health care for all? Or should all players, including the government, businesses, consumers, hospitals and physicians, have skin in the game, and pay into a general fund that guarantees access to basic care for everyone?

I am interested in hearing what you have to say. What are you willing to consider as an alternative to the system we have today?

— RICH LIEKWEG

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