TO THE EDITOR: THE NORTHFIELD NEWS THE U.S. HOUSE of Representatives has passed and sent to President Obama the health care reform bill previously approved by the Senate. The President is expected to sign the bill on Tuesday.

Eventually the President will also be signing a package of amendments to the bill after approval of those amendments by the House and Senate. Together, these two bills will begin the process of changing the American medical delivery system to one in which delivering health care to people who need it regains its status as the primary goal of the system, while profit by insurance companies, pharmaceutical companies and medical practices designed to “game” the system becomes secondary.

Most medical practices (including virtually all of those here in Vermont) are not designed to “game” the system. But evidence of the existence of such practices is clear.

Why else would it cost three times as much to get an MRI exam in Florida as it does in Portland, Oregon? Why else does it cost twice as much to provide care for Medicare recipients in poor, rural areas of Texas than it does in Rochester, Minnesota, home of the Mayo Clinic and its superb level of care?

It is clear that the legislation as enacted is an imperfect bill. In order to obtain passage in Congress, it was necessary to bargain away a more sweeping reform, leading to a system that will leave critics with much to complain about. But the combined proposals will establish two, clear principles upon which further reform can be based.

One is that availability of universal health care is an unavoidable requirement of any nation based on principles of fairness, equal opportunity and justice. Unequal access to health care is a clear violation of these principles.

The second is that the government has a role to play in ensuring that all people have access to health care. This does not mean that we are on our way to a “government run system” as the Republicans have charged. It does not even mean that we may wind up with a “single payer” system.

Other advanced industrial nations (Canada, Western European nations, Japan and Taiwan) have adopted a variety of models for delivering health care in an equitable fashion and at less cost than our existing system. We can learn from their experience.

One interesting example is provided by the Netherlands which originally included a “public option” in its health care model, but has now eliminated that feature after finding that the government can ensure reasonable costs through regulation and competition among private insurance companies and private service providers.

The medical delivery system that will exist after the signing of these two bills is not the end of the story. We have much to learn and much more remains to be done.

BRAD DENNY

Northfield