Health care reform is more than possible. It's easy if we want to do it.

After weeks of on-and-off discussions and of listening to people with various views, The Journal Times Editorial Board agreed on some basic points for reform in about 10 minutes, and this in a group whose members line the political spectrum from pretty much left to pretty much right. There were two main reasons why this happened so quickly.

First, we decided it is unwise to reinvent the whole system. What we have works even if it doesn't work as we wish, but trying to develop something from scratch would produce greater problems. There would be the general upset and confusion of trying to learn a new system, inequalities while rules are worked out, uncertain costs, and the ever present unintended consequences.

Second, we agreed on some basic systemic fixes to provide fairness and help control costs.

Before we go on, keep some numbers in mind for perspective. In 2007, United States spending on private health care was $7,290 per person. That is 2½ times more than the average per capita expenditure in the 30 developed nations of the Organization for Economic Cooperation and Development. Government health care expenditures in the United States (Medicare, Medicaid, and so on) were about $3,300 per person. The OECD average was about $2,100, and that includes nations such as the United Kingdom where government payments are the primary method of providing health care. What do we get for our money? The life expectancy for a child born in 2007 is 78 years. In the United Kingdom it's 80. In Switzerland it's 82.

Now let's go on to reforms.

Everyone should be in the insurance pool. In other words, no cherry-picking by insurers and no exclusion of people with pre-existing conditions. Insurance is a community idea: Everyone pays into a pool of money and then draws on it at time of need. The larger the risk pool, the lower the average cost for everyone. Also, no young people get to opt out, because the typical good health of one's 20s is no protection against an auto accident and its years of therapy or disability.

Pay for prevention. The system currently pays health care providers per procedure or office visit, so the way to maximize revenue is to see more people or do more procedures, which means less time spent with each patient even if some patients desperately need more time.

The system should pay for performance, called outcomes in medical parlance. We reward people and systems which maintain good health because the easiest and cheapest cure is to treat disease before it is out of control. We concentrate, for example, on managing diabetes so that it doesn't evolve into poor circulation and amputations, or kidney disease which requires a transplant. There also needs to be a safeguard here to prevent patients from being dumped in order to shore up a provider's statistics in the same way that insurers discard costly patients to keep up their profits.

This means investing more money in primary care, and it also means providing incentives for medical practices to adopt the best practices in the industry. These could include electronic medical records, and not prescribing drugs for which there are equally effective and less expensive alternatives.

You are responsible. A by-product of having everyone in the insurance pool is requiring people to pay more for unhealthy behavior. For example, we know that being overweight and smoking greatly increase the likelihood of future health problems, we know that there are any number of resources available to help people conquer these problems, and we know that some people will refuse all advice, warnings and offers of help. People who won't care for themselves should pay higher premiums to reflect the extra cost which they are likely to incur later in life. Others should not have to pay for their lack of concern.

Cost transparency. We can't manage our care or pay deductibles unless we know precisely how much care costs. For that reason, complete cost transparency must be required. A specific number may not be possible because of tests or the special needs of a patient, yet providers could still be required to provide at least a cost estimate just like those for car or home repairs.

Error transparency. Medical providers have been reluctant to admit how many mistakes they make, but this is part of measuring the quality of care. They should be required to report errors, which would be an incentive not to cut staff too much or to reform procedures.

Portability. People who change jobs or states should be able to take their health care with them. The best way to handle all of this would be to establish a national buying system so that insurance is not limited by state rules.

Basics plus. Insurers should be required to provide a basic package of care, emphasizing prevention, available to anyone such as the self-employed or very small businesses and paid for through tax credits. Because businesses use health care as a recruiting tool, they should be allowed to offer additional benefits.

There should be no penalty for efficiency. When Medicare reimbursement rates were set several years ago, the story goes, southeastern Wisconsin's rates were low because health care organizations here had been frugal in their practices. To put it another way: They were penalized for having been efficient. For any incentive system, therefore, areas of the country should not be rewarded for spending unwisely. They should be required to reduce their costs to the level of the most efficient providers.

Forget the extremes and myths, the "death panels" and grandiose schemes for which we have no money. Ignore the whining of people who held power for more than a decade yet did not act on health care reform, and ignore the assurances of people who, after being out of power, now want to remake the world in their image. These people are jockeying for short-term political gain, but to do so by risking the public health and the nation's economic capability is, frankly, repellent. The same goes for the broadcast media personalities. Health care is too important to be left to the demagoguery of the Limbaughs and the Olbermanns.

We can accomplish something real and worthwhile if we set aside our points of disagreement and work with what we already agree on, and with what we already have.