The quest for health care reform.(EDITORIAL)

As the 17th Surgeon General of the United States (2002-2006) and chairperson of the Partnership to Fight Chronic Disease (www.fight-chronicdisease.org), I have been working for nearly 2 years with the presidential candidates' policy teams to help ensure that health and health care were among their top policy considerations. Today, I continue that effort with President Obama's staff, focusing on a vision of health care reform.

First, we have to consider this task as one that will require a cultural transformation of our nation. Our current health care system is a "sick care" system with perverse incentives. We have scores of billing codes to pay providers to make you better once you get sick, but there are very few billing codes they can use to make a living if they want to keep you healthy. We need a paradigm shift that moves our nation to one that embraces health and wellness through appropriate prevention strategies, and builds an infrastructure that begins to reward health care providers who want to keep our citizens healthy.

That's not to say we still won't need surgeons, internists, gastroenterologists, and nephrologists. We certainly will need them. But we need to start this paradigm shift because the business case has been made: The disease and economic burden that we have upon us--we currently spend more than $2 trillion per year on health care, or 16% of our gross domestic product--is largely preventable. Chronic diseases account for 75% of our health care costs. Smoking, for instance, is the No. 1 preventable cause of death in the United States and the world. Cigarettes are the only product legally sold in the United States that, when used as directed, will kill you over time, yet we continue to sell them.

Then there's the problem of obesity, which is rampant in our society. Currently, 9 million children are overweight or obese, some of them with diabetes and hypertension. As ...