The foundation of my health care plan is a belief that American families—not government bureaucrats or insurance companies—should choose the coverage that best meets their unique needs. We need real reform that controls spiraling health care costs, strengthens the doctor-patient relationship, and most importantly, provides access to quality and affordable care for every American. But the road to real reform does not lead through Washington and an expensive, bureaucratic, government-controlled system. We have all tangled with the existing bureaucracy to know that it will diminish, not improve, quality.

I have introduced a series of policy reforms to put patients and doctors back in control of health care decisions. We need a coordinated and comprehensive strategy to reform our health care system that builds on its many strengths while reforming its weaknesses. These include initiatives to make care and coverage more affordable and accessible, enhance the quality of care while addressing costs, and allow health insurance to be portable from job to job.

At the core of any health care reform effort must be policies to address the fundamental problems of cost and access. Simply offering increased access to a system that costs too much will not provide real reform. Rising costs hurt those who have insurance by making it more expensive to keep. They hurt those who don't have insurance by making it even harder to obtain. Rising health care costs hurt employers and the self-employed alike. And in the end they threaten serious and lasting harm to the entire American economy.

Only by restoring doctors and patients to the center of health care decisions can we improve quality and reduce costs without yielding to bureaucrats' decisions that should be between doctors and their patients. Government bureaucracies and the distortions they have created in the market for health care are a prime driver of the practice patterns that lead to rising health care costs. Expanding government's role in Americans' health care will make things worse, not better—just ask our neighbor to the north.

Reform of the health care system must stand on four pillars: affordability, portability and security, access and choice, and quality.

Affordability
Affordability must be the starting point of reform. Costs that continue to grow year after year have become unsustainable. Rising health care costs make it difficult for families and businesses to afford private coverage, and they consume an increasing share of middle-class wages. Rising costs put health insurance out of reach for tens of millions of uninsured Americans. And they put increasing pressure on taxpayers who pay the bill for public programs.

To make insurance affordable for all Americans, I will provide a refundable tax credit of $2500 for individuals and $5000 for families to use for health insurance. People who currently get their health insurance through their employer would see little change and would continue to keep their coverage or investigate other options that might better fit their needs. However, for the first time those who purchase insurance on their own or have no coverage at all will have access to the same tax benefit as those under employer coverage.

Portability and Security
One of the biggest limitations of our current health care system is that leaving a job often means leaving your health care plan. This makes it harder for Americans to build a relationship with a doctor over a long period of time, and it makes it less likely that insurance companies will invest in keeping their patients well rather than simply treating them when they are sick. Additionally, "job lock" reduces opportunities for American workers because they often pass up new jobs for fear of losing their health care coverage. Under my plan, there will be options for coverage that will follow the family from "job to job" or "job to home."

Access and Choice
To make premiums more affordable, the key is to put doctors and patients back in control of health care decisions and increase competition for better care. Opening the health insurance market to nationwide competition would give people many more choices of policies that aren't burdened by expensive state regulations that drive out competition and drive up prices. People could choose the best plan for them and their families and, by their choices, would put pressure on companies to provide better care at lower costs.

I also understand that many people, particularly those with preexisting conditions, face prohibitively high health insurance costs or denial of coverage. My plan will create a new Guaranteed Access Plan, or GAP, to help those who have trouble getting insurance. This would not be another unfunded mandate to the states or a new federal entitlement program, but rather a partnership between the federal government, the states, insurers, patients, and the medical community. There would be reasonable limits on premiums, and additional assistance would be available to help people with lower incomes.

Quality
Our country's doctors continue to be the best in the world, but our system of health care financing and reimbursement often impedes their ability to practice effective medicine. We know from experience that when providers collaborate to coordinate care, patients get better health outcomes, often at lower costs. The biggest public programs, Medicare and Medicaid, can lead the way by paying for outcomes, not just for the number of procedures and tests doctors perform. I believe these reforms will allow doctors to practice medicine with the interests of their patients first and without the artificial obstacles and restrictions of the current payment system.

Physicians understand that health care reform will not work unless we also begin to address the chronic conditions that consume three-quarters of the nation's annual health care spending. We must find better ways to diagnose, manage, and—most importantly—prevent chronic conditions such as cancer, heart disease, high blood pressure, diabetes, and asthma. Many of these chronic conditions are linked to the epidemic of obesity in our country, which is growing at a particularly alarming rate among children. We must find innovative ways to draw on our public health infrastructure, invest in early intervention programs, and find new models to promote healthy habits and begin to roll back these troubling statistics.

Our current tort system drives numerous inefficiencies in the health care system. Doctors are forced to perform repetitive and often unnecessary tests in order to protect themselves from the risk of lawsuits. Not only does the tort system drive up the cost of health care, but it also limits the availability of many specialists. Obstetrician-gynecologists in particular have been targeted by trial lawyers, with the result being that it is harder for women to find the doctors they need. I have always been a strong advocate of medical liability reform legislation. Legislation to change our current unsustainable tort system will continue to be an important priority for me, because it is important for doctors, for patients, and for our health care system.

My record in Washington has been one of working consistently across party lines to get things done. Health care reform is an issue that cannot be accomplished without reaching across the aisle. I am committed to reforms that will restore patients and doctors to the center of health care decisions, and I am equally dedicated to working in a way that achieves this goal.