But for those who have seen the widespread and needless suffering caused by the dominant role of money in American health care, President Obama's clear commitment to change gives much cause for optimism. Currently, tens of millions of uninsured Americans lack adequate access to quality health services and uncounted millions more delay or decline needed care for financial reasons. The men and women leading the health reform process, particularly at the interface of the executive and legislative branches of the federal government, appear to have learned from past failures. Also of considerable significance, the new president is a consensus builder with roots as a community organizer and now applying his unprecedented grassroots-plus-online campaign model to the process of governance.

Access to care and related budgetary issues tend to dominate the debate, but they comprise only one part of the equation. In the long run, financial issues may prove less important than questions about which services are being delivered to those with newly increased access, as well as to those who already have access to health care but for whom it has failed to deliver health and wellness. Unless there are major changes in the health priorities of the nation, there will be no sustainable health care solutions. The stakes are extremely high.

This commentary focuses on four areas: universal coverage, prevention and health promotion, chiropractic (I am a chiropractic educator who was in private practice for 26 years), and complementary and alternative medicine.

A Right, Not a Privilege
For this journal's international readers, the fact that the United States remains the only industrialized nation without universal health coverage must seem truly bizarre. Health care costs are the leading cause of personal bankruptcies in the U.S., and fear of financial ruin dramatically compounds the stresses inherent in major illness. Appreciation of health care as a right rather than a privilege now appears to have reached critical mass in the U.S., several decades later than in most other nations. This alone would probably not prove sufficient as a driver of systemic change; the other new factor on the health reform landscape is that the competitive disadvantage for large American businesses, many of which spend vast amounts on their employees' health care, has passed a key tipping point in recent years. This had not yet occurred at the time of the failed Clinton health initiative in the 1990s.

The Primacy of Prevention
As the debate on health care reform heats up, one area of unanimous agreement stands out - people on all sides agree that it is far better to prevent illness than to treat disease after it takes root. The healing arts originated in response to the fundamental human need to relieve pain and suffering. Over time, the most insightful physicians and healers in all cultures developed the principles and practices of disease prevention and health promotion that we now increasingly recognize as the highest expression of the healing arts.