Billions of dollars and the long tern health of hundreds of millions of Americans are at stake. The issues and questions are complex and reach into the core of American values, so easy answers are hard to find when it comes to health care reform.

Why shouldn’t a regular Joe have access to the same care that millionaire’s can buy? Should the government compete with private enterprise? Shouldn’t all people, in the richest nation civilization has ever known, have affordable health care?

It’s no wonder, then, that President Obama’s effort to reform our health care system has sparked such interest and fury. Even accounting for media exaggeration, the debate has been as intense as any domestic policy matter in a generation or more. Obama was elected on a campaign of change, and he — and even his opponents — say the system is broken.

But how to fix it?

Local citizens get to weigh in on that question Wednesday when U.S. Rep. Brian Baird hosts a public town hall meeting at the Cowlitz County Expo Center in Longview.

In advance of that, we’ve tried to give people some information to help them prepare.

Q. Why do so many people think health care reform is necessary?

Cost. Health care costs continue to rise far faster than inflation. This costs families, businesses and the government more each year, contributing to the national debt, discouraging employers from adding workers due to rising benefit costs and making health insurance unaffordable for some 46 million Americans.

“Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. And it’s also devouring our government,” according to New Yorker magazine.

U.S. medical expenditures total about $2.24 trillion annually. About half of that is for hospital care (31 percent) and clinical/physical services (21 percent). Retail drug sales account for about 10 percent.

Q. Why are health care costs rising so fast?

There are many reasons, but not everyone agrees on all of them. Here’s a quick list:

• Consumers don’t often pay directly for health care because insurance or government pays most of the costs. If someone else were buying you a TV, would you care if it cost $300 or $600?

• Availability of more expensive, state-of-the-art drugs and medical procedures creates consumer demand for these services, and companies must recoup the cost of developing them.

• An aging population and associated rise in chronic diseases with advancing age puts more burden on the system. By some estimates, chronic disease accounts for 75 percent of all health care spending.

• Administrative costs — billing, marketing, etc. — have been estimated to account for at least 7 percent of health care expenditures.

• A rise in the number of people without insurance leads to more people getting sicker because they don’t get preventive care. When care finally becomes essential, hospitals and doctors pass on to paying customers the cost of treating those uninsured.

• Many Americans don’t take good care of themselves, leading to a rise in chronic and serious diseases that drives up health care spending.

• Lawsuits, leading to rising malpractice insurance rates. Doctors say they often must order all sorts of expensive tests to leave themselves less vulnerable to lawsuits. The counterpoint here is that the insurance industry is gouging the public.

Q. What is the Democratic Party’s health reform plan now in Congress?

In the House, three committees with jurisdiction over health policy all have passed what the Democrats call America’s Affordable Health Choices Act of 2009. In the Senate, the Health, Education, Labor and Pensions Committee also has passed a version of it.

Here are some major features of these bills:

• Requires all individuals to have health insurance and all employers with 25 or more employees to provide it. Businesses that don't would pay a $750 annual fee per uninsured full time worker and $375 per uninsured part-time worker, according to the Senate version. Smaller business not required to provide coverage would get tax credits if they do so.

• The poor would get subsidies to buy insurance.

• Insurers would be barred from denying coverage or charging more based on pre-existing conditions.

• Creates an “insurance exchange” for individuals and small businesses to comparison shop among private and public insurers. It also creates a public insurance program. The administration backed off some on this issue last weekend because of stiff opposition. But the White House said Monday that Obama has not given up the idea.

• Expands Medicaid for the low income, financing it with federal dollars.

• Expands prevention and wellness programs and boosts a scholarship and loan programs to train more primary care doctors, nurses and public health specialists.

Q. Is there are Republican plan?

A proposal by U.S. Sen. Jim DeMint, R-S.C., shares some of the same features as the Democratic plan. Here’s a summary of his “Health Care Freedom Plan”:

• Would provide those without employer-based health insurance vouchers of $2,000 for individuals and $5,000 for families to purchase health insurance.

• Would allow people with Health Savings Accounts (HSAs) to use those funds to pay for insurance premiums, which DeMint says would encourage employers to contribute to their employees’ HSAs.

• Would create a national market for health insurance by allowing individuals to purchase health insurance plans in any state.

• Provides block grants to states to develop innovative models that ensure affordable health insurance coverage for Americans with preexisting health conditions.

• Seeks tort reform to cut what DeMint terms “predatory and frivolous malpractice lawsuits against physicians and hospitals.”

Aims to boost availability of health care price information.

Q. Would these bills create a government health plan?

No one is talking about putting doctors and hospitals to work for the government.

What is being talked about is creating the equivalent of a government-run health insurance plan, providing coverage to those who now lack insurance or those who want to leave their private plans. Proponents say that competition from a public plan would prompt private insurers to adopt more patient-friendly practices and put an end to their focus on profits rather than patient care.

Opponents say that if people left their private insurers because the public option was more attractive, the country could head toward a system where the government sets prices and decides what’s best for every American.

Q. How would these programs pay for themselves? Will my taxes increase?

The Congressional Budget Office (CBO) puts the price of the House plan at $1 trillion over 10 years.

The Democrats say half of the cost of the program would be met through savings by streamlining Medicare to reward efficiency, avoid hospital readmissions, and eliminating overpayments; adopting new tools to combat waste and fraud; and reducing paperwork.

In addition, a tax would be imposed on the top 1.2 percent of the wealthiest Americans. For example, a 1 percent surcharge would be levied on families earning between $350,000 and $500,000, and 1.5% for those earning between $500,000 and $1 million. Families making over $1 million would pay 5.4 percent.

According to the nonpartisan Joint Committee on Taxation, 96 percent of small businesses would see no tax increases under this proposal.

Still, the CBO says these plans would add $239 billion to the deficit over 10 years. If true, that would fall short of Obama’s plan that health reform pay for itself.

DeMint says his legislation would be funded by terminating the Troubled Asset Relief Program (TARP) and forcing companies to repay their bailout funds within five years. TARP is a federal program adopted last year to purchase assets and equity from financial institutions last year to address the subprime mortgage crisis.

Q. Some people say that the House health-care overhaul bill would require counseling sessions where senior citizens would be advised on how to end their lives. Would it?

No. The language in the House bill merely would have made sure that doctors would be compensated if they took the time to discuss end-of-life care — such as pain management, hospice care, durable powers of attorney and living wills — with senior citizens. The bill didn’t mention euthanasia or suicide. But the whole provision was axed after former Alaska Gov. Sarah Palin asserted, wrongly, that the bill would create a “death panels,” that would decide whether people are worthy of health care.

This report is based on multiple sources, including Kaiserhealhnews.org; Cleveland Plain Dealer, New York Times; Associated Press; healthreform.gov (Obama Administration page); demint.senate.gov (web site of Sen. Jim DeMint); www.speaker.gov (web site of House Speaker Nancy Pelosi).

Have a question about health care reform? We’ll try to answer it. Send your question to: andre@tdn.com to Andre Stepankowsky, P.O. Box 189, Longview, WA.. No phone messages, please.

Town hall meeting

Southwest Washington Congressman Brian Baird will host a public town hall discussion from 7 p.m. to 9:30 p.m. Wednesday at the Cowlitz County Expo Center in Longview.

Baird also changed the location of tonight’s his Town Hall meeting in Clark County to allow for more space and participants. It will take from 7 to 9:30 p.m. at the Clark County Amphitheater in Ridgefield.