No one denies that reform is needed. Health care costs are soaring out of control. Soon, they will be out of the reach of the average American. "Illness is no the leading cause of personal bankruptcy. There are already about 37 million men, women, and children who go without basic health care because they have no insurance." It is inevitable that a change in America's current system is needed. It is true that there is no shortage of ideas under consideration in Congress. "Ninety-nine groups have come before the House Ways and Means Committee to testify and more than 30 different reform bills have been introduced." What would a better health care system consist of? It would include: controlling costs, promoting health, insuring against long-term health care cost, and giving the poor access to health services. It would also reduce the hospital sector and restore confidence to doctors. Is there one specific program that America can turn to and depend on? The general approaches to solving the national health care dilemma are: pay or play, single payer, piecemeal, and the income-tax credit approaches. The pay or play plan has some of the same ideas as the Democrats have proposed. This plan would require businesses to provide health insurance coverage to all employes, or contribute a percentage of total payroll funds to finance a public insurance program.

The single payer would abolish the current employee-based health insurance system and replace it with a government-run program to provide health care for all people.

"Unfortunately, 339 billion dollars or more in taxes, that on study estimated, would be needed for the United States to implement a Canadian-style health care system." It would raise tax rates so high that the United States would be among the most highly taxed countries in the world.

"To fund it, either income-tax or payroll-tax rates would have to increase by at least 14 percentage points." Also, Canada's system has not adequately protected citizens against the costs of long-term care. The National Committee members "want protection from the high cost of long-term care and to ensure future Americans access to quality care and to be covered in a comprehensive way."

The piecemeal approach, which is favored by the Bush administration, would use tax incentives and cost controls that offer malpractice reform to lower cost of physicians' insurance. It also works on expanding small businesses' ability to get health insurance and enlarging Medicaid. Another approach involves income-tax credits. Under this plan, each working individual and family would get tax credits to be used to buy health insurance policies which meet their needs.

"The size of the tax credit would go up as the health care costs increased or when expenses exceeded ten percent of family income." In addition, businesses would be required to add to employes' pay an amount equal to the cost of the health benefits now provided. Insurance companies could no loner deny coverage to a person who had a pre-existing health condition such as high blood pressure or diabetes. The pro-tax credit camp believes that if people have to pay a little of their own money for health care, then they would have a financial incentive to use only the services needed, total U.S. health care spending would be reduced. Under this plan, Medicare would be abolished. Rather than pay premiums to Medicare, seniors would purchase commercial insurance to cover their health care needs, but most would be covered by the government. One major drawback of tax credits is the year or more it could take to get reimbursed by the Internal Revenue Services. Another drawback is the reluctance seniors might have about trading Medicare for tax credits. A different plan that involves a tax credit is Stuart Butler's Heritage Foundation's plan. It has produced the simplest, most promising, and the most progressive idea for health care reform.

It is quite different from the Canadian government-run system, and from the leading Democratic proposal that employers provide insurance for their workers. The Heritage proposal focuses on an unacknowledged government program: the tax exemption for employer-paid health insurance. "This costs the federal government 48 billion dollars a year in lost revenue, and the states lose billions more."

This plan is regressive in that the higher a person's tax bracket and the more lavish his health plan, the lager his government subsidy.

The desire of the Heritage plan is to invigorate competition while still protecting people from ruinous expenses. If this approach works, it will be redistributive in another way: by reducing the incomes of doctors, medical equipment manufacturers, pharmaceutical companies, and others who extract what economists call "monopoly rents" from the current system.

Reviewing the approaches that have been introduced, the Heritage's plan for tax credits is looking the most favorable for our economy.

This plan reduces government spending and unnecessary costs while still helping the middle and lower class. The tax credits will assure everyone an opportunity for health care, without taxing on group more than another. It takes a percentage of a person's income without exceeding 10% of that income. A national consensus is needed now for a health care reform.

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