Daniel Marsula, Post-Gazette Click Illustration for larger image. Related article: Forum: Rendell's remedy / Sandra Fox

Five hundred and seventy-six people called Consumer Health Coalition's helpline last year. Many callers contact us during particularly vulnerable times in their lives. From the man with brain cancer who needed health insurance to cover his therapy, to the woman who needed a functioning wheelchair to carry out her daily activities, many callers are confronted with critical health needs.

The clients we serve represent only a small fraction of the 767,000 uninsured adults in the commonwealth that Gov. Ed Rendell's "Prescription for Pennsylvania" seeks to cover. However, their stories put a human face on the special challenges that the uninsured and underinsured confront when trying to access the health-care system.

The patient perspective also can serve to remind us why the ultimate goal of the governor's plan -- to make quality health care more affordable and accessible for all Pennsylvanians -- is so critical and timely.

The common thread shared by almost all of our clients is the inability to afford health-care services. Changes in the workforce and rising health insurance costs have contributed to a measurable decline in employer-sponsored coverage. We also know that employer-based health-insurance premiums are expected to grow at about double the rate of workers' earnings.

		Dr. Andrea R. Fox is chair of the Consumer Health Coalition and medical director of the Squirrel Hill Health Center. Jessica Seabury is the coalition's executive director.

The cost of health care has serious implications. We work with families who have to choose between paying their utility bills and going to the doctor. Others struggle between putting food on the table and paying health insurance premiums. Even higher-income families have lost homes in battles to balance mortgage payments with catastrophic health expenses.

From a consumer perspective, the health and financial consequences of so many people lacking insurance demand action -- now. So we applaud the governor for moving health reform to the top of the commonwealth's agenda. Announcing his "Prescription for Pennsylvania" the day after his inauguration sends a strong message about the urgency and importance of reform that we would like to echo.

The governor's leadership and initiative also has allowed Pennsylvania to join the ranks of other states that are adopting innovative health-care reforms. After the passage of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (Part D), the Bush administration's interest in large-scale health reform waned. Competing policy priorities and a lack of political will have further stalled chances to provide universal health-care coverage at the national level. States are stepping up to address the challenges of a growing uninsured population, rising health care costs and the need to improve health-care quality.

With the governor's launch of "Prescription for Pennsylvania," the need to make three points has become evident to our coalition.

The first is that there are multiple ways to achieve universal coverage, and the various policy options are often confusing and complex. Many individuals have difficulty understanding what terms like "individual mandate," "federal poverty level" and "adjusted community rating" mean, and how they might impact people's lives. As a coalition that represents the voices of at-risk consumers, we see a clear need to better educate the public about reform options and an awesome hunger for this knowledge.

Second, consumers crave genuine involvement in the conversation about how to expand access to high quality, affordable health care, and they ultimately seek to be part of the governance of a new health system. Patients do not want to be represented by professionals or bureaucrats and are poised to speak for themselves. How can Pennsylvania successfully engage in reform to cover the uninsured without the input of people who lack coverage? How can we possibly deliver patient-centered care if we do not ask consumers what they need?

In cultivating patient involvement, it is important that the faces of communities that disproportionately suffer from illness and early death are represented. Listening to the voices of people with low incomes, individuals with all types of disabilities -- physical, mental, behavioral, developmental and sensory -- as well as people from racial and ethnic minority backgrounds is crucial if Pennsylvania is serious about ending disparities and the unequal burden of disease.

Finally, we must not lose sight of our values and must keep the broader goals of reform in mind. Our coalition values affordable and accessible health care for all. We seek to enhance quality in the delivery of health care. We strive for a healthy community and improved public health.

Over the coming weeks, the Consumer Health Coalition and other stakeholders will continue to flesh out the details of the governor's plan and contribute to the conversation about how to achieve universal health-insurance coverage and how to control costs while improving quality. The "Prescription for Pennsylvania" embodies many of our values.

If we can keep these goals in mind, as well as the health and financial consequences of inaction, perhaps we can accomplish what the health-care consumers of Pennsylvania need most of all -- patient-centered change.