As  I reported Wednesday American voters have one main concern in the  upcoming general election for President of the United States. That  concern is to determine the direction in which citizens want the country  to proceed over the next 4 years.

1.  Do American voters want to continue the current road with increasing  involvement of the federal government in the lives of the American  people?

2.  Do American voters want less federal government involvement with more  of the decisions being left to the individuals and local/state  governments?

The  2nd most pressing issue I believe which will help Americans in deciding  the road to be traveled over the next 4 years is healthcare reform. The  cost of healthcare has continued to spiral out of control and is  continuing to climb even under measures already implemented under the  Affordable Care Act.

The  ACA is the signature domestic legislation of President Barack Obama and  is currently under debate and scrutiny by the Supreme Court of the  United States. A decision on the law's constitutionality or parts of the  law is not expected until late June or July.

Under  parts of the ACA already in effect many have already seen their  insurance premiums increase dramatically. Others have seen benefit in  allowing unmarried children to stay on their parents' insurance plans  until age 26. There have reportedly been savings for those in what is  called "the gap" in coverage as part of the Medicare Part D Prescription  Drug Plan. Others such as myself have seen up to 300% increases in  co-pays even for generic medications.

There  are many aspects of healthcare reform that must be taken. There are  myriad of steps to increase the proficiency and lessen the cost of  healthcare. An over-encompassing federal bill is not the answer. There  are too many parts and divisions that need to be tackled on an  individual basis.

Healthcare,  including the government-administered insurance program of Medicare,  would be better managed and costs controlled outside of federal control.  Each individual state is in a better position of crafting and  developing a healthcare program that is more beneficial and  cost-productive for the citizens in each state.

I  do believe that states should be allowed to setup and maintain local  state medical boards to review and consult with physicians  individualized treatment for patients in a common sense, medically  necessary basis with patient care the priority rather than arbitrary  decision based only on cost.

As  I said there are many factors that must be weighed. Requiring insuranc  companies or business to provide services or coverage at no cost makes  no sense unless the purpose is to do away with all insurance companies  and provide everything for free by the federal government. This is  unrealistic since the harm to the economy and the national debt would  make the Fall of Rome seem like just a scratch after being involved in  a10-car pile-up. We can't afford it.

Among the factors that must be considered are:

1. Preventive care and education pinpointed to a particular locale or region.

2. Ability for local state medical boards to converse and decide more patient centered care.

3. Education and more dialogue between patients and healthcare providers.

4.  To attract more Primary Care or General Practitioners offering to  provide medical training and education at public expense in exchange for  a commitment by the healthcare provider of 5-10 years of serving as a  PC or GP. Those who do not complete training must pay the taxpayers back  for the cost of education.

5.  Healthcare tort reform is an issue that should have been dealt with  decades ago and yet remains one of the leading causes of continuing cost  increases. Like a 2,000 pound rhinoceros wreaking havoc in an antique  store, the threat of a malpractice lawsuit with no realistic cap on  judgements is suffocating many healthcare providers. Many PCs and GPs  are electing the more lucrative specialty fields leaving a big gap in  the needed PCs and GPs just to pay for malpractice insurance.  Malpractice should be limited to verifiable or more-than-likely the case  in order to file suits and then after a review not just by lawyers, but  medical experts.

All  5 of these and many more also have an impact on the #1 issue - the  economy. These are not the only steps I believe must be taken, but just a  start in the right direction. Hopefully this report will also prompt  discussion and dialogue on healthcare and how the system can be  transformed.

I  have not even touched on such other areas of healthcare as research,  development, drug testing and more patient intensive healthcare  management.

From  the Cornfield, healthcare remains a major issue in this year's  presidential election no matter the decision the Supreme Court may make.  Healthcare continues to impact greatly the overall economy and economic  outlook.