As our nation confronts its greatest economic crisis since the 1930s, we have embarked on the second attempt in a generation to reform health care. Some might postpone that effort, but escalating costs are jeopardizing coverage for many families — and with premiums rising 120 percent in just the past 10 years, four times the increase in wages — the health and economic well-being of our nation demands action. Americans have long realized that their health needs will be greater and more costly later in life, but today more recognize that high costs and poor outcomes affect us all. Comprehensive health reform must be a primary objective.

We have learned from past efforts, and there is broad recognition that while we must reform and improve the system, a reform plan should build on the way coverage is purchased today — using the efficiency and bargaining power of groups, and often through purchase at the workplace.

So I am focused with my colleagues on fixing what doesn’t work. When one in four Americans this year will be either underinsured or without any coverage whatsoever, it is clear that reform must produce high-quality, affordable coverage. But coverage also must be seen as more than insurance against the unforeseen. We must engage individuals, health care providers and health plans to adopt a new proactive approach to health care that emphasizes preventing disorders, achieving early diagnosis, and wisely managing chronic conditions, so we reduce the burden of disease and spend health care dollars more effectively.

Some would have us address every possible health issue in reform, yet that could distract us from confronting the most critical issues. A core set of these are in fact interdependent parts of a working reform plan, and if not considered together, we may see reform fail. For example, if we are to provide guaranteed access to an affordable plan, do we also require a personal responsibility to carry coverage? Is reform a choice between the polar extremes of single payer and a minimally regulated and mandated private market, or is there a third way? These are in fact tough issues on which we must build consensus if this effort is to succeed.

As a member of the Senate Finance Committee, I am engaged not simply in tax and finance aspects of health care, but also in the federal health entitlements and programs upon which approximately one in three Americans rely. We are working to strengthen those and to change Medicare from emphasizing procedures to focusing on delivering better health. We recognize that with Americans receiving recommended care just over half the time, requiring that care would produce substantial benefits in both health and savings. Beyond that, it is critical to build our knowledge of comparative effectiveness so that every patient will receive the best care. By refashioning our payment system and making a vigorous effort to reduce fraud and waste, we can make substantial progress toward reform.

Though health entitlements must be strengthened, it is in private markets where the greatest access gaps have arisen. In our state health insurance markets, there is frequently little competition among insurers, few meaningful coverage choices and unfair rating rules that have led to adverse selection and unfair consumer treatment, effectively blocking millions from purchasing the coverage they need. In fact, fewer than half of the smallest businesses can now offer coverage to their employees, and today a family in my home state of Maine left to purchase an individual market plan can expect to face an annual premium more than $24,000.

The Small Business Health Options Program Act, which I introduced with Majority Whip Dick Durbin (D-Ill.) and Sen. Blanche Lincoln (D-Ark.), would allow the self-employed and small businesses — who constitute 52 percent of our nation’s uninsured — to access more affordable, quality coverage to address this crisis. The SHOP Act is supported by a diverse group of stakeholders, including the National Federation of Independent Business, National Association of Realtors, Service Employees International Union, Families USA and AARP. I am pleased that Finance Chairman Max Baucus (D-Mont.) has incorporated many of the principles of the SHOP Act into his proposals.

No matter what reforms we accomplish, substantial investments are required, including assistance to help those of limited means to purchase coverage. Yet as we face these costs, we must recognize that reform to enable universal coverage will not be sustainable if simply layered onto current spending, which is already two to three times greater in terms of gross domestic product than other highly developed nations. It is clear improving value is the first order of business, before revenues are considered. We must make those tough decisions.

The goal of comprehensive health reform is attainable, and it is one we must achieve.

Sen. Olympia Snowe (R-Maine) is a member of the Finance Committee.