Twenty-two years ago I was with a publication that ran an article that described how a lack of health insurance affected low-income patients in need of eye care. It quoted an oft-cited statistic of the time, that uninsured Americans numbered more than 30 million.

The article was mostly forgettable, but one ophthalmologist's reaction to it stayed with me. I did not keep his letter but I well remember his suggestion that we "get real."

The intervening years have seen that number swell to its current estimated size of nearly 50 million. They have also seen a shift in how most of us view the need to address the issue. What was a problem that mostly concerned social reformers back then, consensus now accepts as a major drain on the economy and a key to successful overhaul of the health-care system.

This summer, as we hurtle toward health-care reform (we can debate the wisdom later of whether we're moving too fast; major health-care reform legislation appears to be coming this year, ready or not), it seems that every day, almost every hour, brings news of shifts and changes in the various legislative proposals based on whose spokesperson has the media's attention at the moment. With more than 3,000 health-care lobbyists working the halls of the Capitol with nearly $500 million a year to spend, it will be no surprise if whatever bill emerges is shot full of compromises. In the meantime, while the situation is still fluid, one person's hopes for:

    • a system that brings real competition to the health-insurance industry and forces it to pare its wasteful administrative costs that claim 20 cents of every dollar in premiums;

    • a system that requires that individuals participate in some form of health insurance and  provides an affordable option to do so, regardless of medical history;

    • a system that rewards best-practices and evidence-based medicine;

    • a fair and progressive reduction in the income-tax tax exclusion for employer-sponsored health insurance;

    • a system that ends the "lottery-winner" approach to medical malpractice awards without providing cover for physician incompetence.

It should be a fascinating summer in health care. By the time the leaves turn, this may well be settled and it will be time to get real.