For most people, American health care is the envy of the world. If our elected leaders asked for my opinion about how we can improve and reform the health-care system, here is how I would begin to answer.

1. Go to the doctor

Dr. Joel Hirschberg's prescription for change: Require that everyone in Congress spend one full day in a doctor's office and half a day in an emergency department. You need to understand how we are practicing medicine and how health care really works. We hope you decide that health-care reform becomes more about securing and encouraging the relationship between health-care professionals and patients and less about regulating that relationship.

2. Full coverage

We all want every American to be covered by health insurance. Current proposals expect to insure 25 million to 30 million more Americans. I applaud this. However, in current form, payment for universal coverage comes in large part by forcing hospitals and doctors to receive less money for each Medicare and Medicaid patient visit.

To this point: In Eisenhower's last fiscal year, the medical center lost $40 million in under-reimbursed Medicare and contributed more than $16 million in documented benefits to the community, including indigent care. If this continues, over a 10-year period without health-care reform, Eisenhower is projected to lose or contribute back in community contributions over $500 million!

With health-care reform, proposed legislation forecasts more than $300 billion in Medicare cost savings. According to the California Hospital Association, if the current proposals are enacted, Eisenhower Medical Center will lose an additional $119 million over 10 years from this focused strategy of mandating that patients, hospitals and doctors accept artificially lowered prices for services rendered. In time, it will be hard to find a good doctor and a good hospital.

To date, Massachusetts' universal-care program has shown that state-forced mandates and forced pricing have not worked for lowering health-care costs.

3. Pre-existing conditions

With universal coverage, insurers should be prohibited from refusing insurance because of pre-existing conditions. Most of us have a pre-existing condition. Americans must have health coverage or risk a penalty. True, Americans living at the poverty level need to be subsidized to receive insurance. But those above the poverty level need to pay something, even if it is 1 percent of their income.

4. Easy access

Incentives for a new model of practicing primary care will reduce costs of care for the chronically ill. Research shows 20 percent of people with chronic conditions result in 75 percent of all health costs, including 80 percent of hospitalizations. Dr. Joseph Scherger is a national leader for this model, which calls for physicians to be reimbursed for phone call and e-mail consultations, just like attorneys or consultants. Patients and physicians need to access each other to stay healthy.

5. Provide choices

Give me choices that help me lower my health-care overhead. Rand Corp. studies show consumers respond to increased cost sharing by becoming cost conscious if they are offered choices, such as:

a. Ability to choose from any insurance plan in any state.

b. Health savings accounts.

c. Tax credit for insurance purchases.

d. Choice to contract directly with any doctor with no penalty.

6. Good relationships

Encourage more effective working relationships between hospitals and doctors to provide better quality care at lowers costs. Right now, there are so many legal barriers between the physician and the hospital that it takes a massive effort to forge a team, where all we should be doing is focusing our energies on the needs of the patient.

7. Local solutions

Ask hospitals how they would like to solve the uninsured problem. We would rather open free community clinics in each hospital service area around the country and staff them with physicians and health-care professionals who are required to donate their time, pro bono, than be forced to accept a thousand cuts from lower reimbursements.

8. Regulate for quality.

Currently, the payment and reimbursement structures are clogged with government regulation and bureaucracy. Regulate for quality outcomes but don't build more bureaucracy that ultimately dictates the doctor-patient relationship. Leave that relationship to those who originally chose to go into the profession to serve humankind.

9. No unnecessary tests

Help create a system in which doctors do not order unnecessary tests and procedures for fear of litigation. Physicians do practice “defensive medicine” — the act of spending health-care dollars on additional tests in the event they are sued. There are many ways to advocate for the patient that do not involve the threat of litigation. Bringing reform to this constant implied threat would bring more change to the health-care system than any of us can imagine.

10. Work together

True reform takes collaboration to achieve. The problems are more complex than trying to figure out how to land on the moon. How can we achieve reform when the entire debate is being rushed? Both political parties, for the good of the generations of Americans to come, need to cross party lines, work collaboratively with business, physicians, hospitals, health-care professionals and patient advocates to forge what really could become true health-care reform.

Michael Landes, president of the Eisenhower Medical Center Foundation, participated in the recent Town Hall Discussion sponsored by The Desert Sun and AARP. E-mail him via LFowler@emc.org