I was tempted to titled this blog entry Health Reform and “I Won’t Let People Die in the Streets.” I also was tempted to describe the November 8 election as the day health reform died. One retort could be that the Republicans are now in charge of health reform. They need to play offense as opposed to only playing defense. And we should move forward.

For starters, let’s discuss the dual action of repealing the Affordable Care Act (ACA) and maintaining the Republican pledge not have individuals with pre-existing conditions be excluded from health insurance in the post-ACA world.

Making health insurance available to individuals with pre-existing conditions is one of the key pieces of how health reform works or does not work. The choices available for the country are single-payer or private insurance with an individual mandate. The choice is not high-risk pools, which, even in a well-insured state such as Iowa, did not work in pre-ACA days. Unfortunately, high-risk pools appear to be in strong consideration if one reads  proposals from Speaker Paul Ryan and the nominee for Secretary of Health and Human Services Tom Price. High-risk pools concentrate very sick individuals in a single category that will be extraordinarily expensive. Even worse, in a world of employer group health insurance, individuals without a mandate and without a business connection will avoid buying health insurance or will not be able to afford health insurance and will go without health-care coverage. We will go back to the days of uninsured patients, free medical clinics, delayed medical diagnoses, and lack of early diagnosis now made possible by preventive evaluations.

I have lived at a time when my previously insured patients, patients I was seeing in a free medical clinic, or one of my diabetic patients in Iowa’s high-risk pool were not receiving top-notch health care due to the cost. I had patients coming in to see me too late with health conditions I could have resolved in my office had I seen them sooner.

What to do? As I said in a previous post on this blog, my first proposal would be to open up Medicare to individuals 55 years of age and older. I have also said the ACA needs to be “tweaked,” not eliminated.

This is the time to speak out for a future that moves health care forward for all Americans. We cannot go backward. Twenty million people now have health-care insurance because of the ACA. More Americans are now insured than ever before. We need to continue to move health care forward. Speak out. We all must do it. We all must do it now.