Passing comprehensive health care reform will be difficult. We want Congress and the president to get the job done right, but the longer we wait, the more expensive it will become for all of us.

After the August recess AARP will continue working to build political support to fix our broken health care system. We're now at a critical part of the debate when tough choices must be made.

Driving the urgency is the reality that our health care system costs too much, wastes too much, and makes too many mistakes. In response to these concerns, AARP has developed six specific priorities for health reform — fair, common-sense solutions that will lower costs, improve quality and provide choices.

First, we have to make prescription drugs more affordable. Nearly one out of every five people in Medicare Part D has either delayed or has not filled a prescription because of its high cost — the biggest percentage for any insurance group. We can lower out-of-pocket costs by closing the Part D coverage gap sometimes referred to as the doughnut hole. The gap is particularly costly in Hawai'i, where the share of Part D enrollees caught in the doughnut hole reached 36 percent in 2007 — the highest figure in the country.

Second, we have to make drugs affordable for all generations. Today, half of all Americans say someone in their family has skipped pills, or postponed or cut back on needed medical care because it costs too much. That's a choice nobody should have to make. We can start by ending the drug companies' monopoly on brand name drugs, especially those used to treat serious diseases such as cancer and multiple sclerosis that can cost up to $10,000 per month.

Third, we must improve Medicare. In today's economy, millions of people in Medicare have seen their retirement savings shrink, and are spending, on average, 30 percent of their incomes on out-of-pocket health costs — including premiums for supplemental coverage. Their costs are six times greater than for people who have employer coverage.

We must protect patients' access to their doctors, and crack down on the wasteful spending, medical errors, and poor care that drive up costs and result in costly re-hospitalizations. In Hawai'i, more than 17 percent of discharged Medicare enrollees are readmitted within 30 days.

Fourth, to prevent avoidable re-hospitalizations and improve overall patient care, we must provide people in Medicare with a "follow-up care" benefit to help them safely transition to their homes after a hospital stay. Not only would this keep people healthier, it would eliminate extra $1,000 hospitalization co-pays for patients, reduce health care costs, and help people recover at home.

Fifth, we must guarantee access to affordable health care choices for Americans age 50 to 64 not covered through an employer. AARP is making the case that insurers can no longer deny coverage and charge higher rates based on age or health status.

It is all too common for people in the 50-64 age group to be in that situation — uninsured even if they're working, either because they work part time or are self-employed. As of March 2008, nearly 11 percent of Hawai'i's 50- to 64-year-olds were uninsured, a number that has certainly increased since then, given the economic downturn.

Finally, we need to give people independence and choice as they age. Eighty-nine percent of older Americans want to remain in their own homes and receive care right there if they need it. They should not be forced to get more costly care in a nursing home.

This is a major problem in Hawai'i. According to the 2009 Genworth Cost of Care Survey, Hawai'i's nursing homes are among the priciest in the nation. A private nursing home room in Honolulu costs more than $123,000 a year on average, almost two-thirds more than the $74,208 median, nationally. Making matters worse, there aren't enough beds. In 2007, Hawai'i had the highest nursing home occupancy rate in the country at 95 percent.

We need to change federal law to make it easier for states to provide older Americans and people with disabilities access to home and community-based services. States should get financial incentives to allow more people to get care at home.

Hawai'i is emblematic of the current imbalance: 83 percent of state Medicaid long-term-care spending for older people and people with disabilities goes to nursing homes. Only 17 percent goes to home and community based services.

It's time to break through the politics and gridlock and focus on the big issue of ensuring that all Americans have access to quality, affordable health care choices.

Join us in calling on Congress and the President to find common-sense solutions this year. The cost of doing nothing is simply too high.

Mae Mendelson is a Kailua resident and on the AARP National Board of Directors. She wrote this commentary for The Advertiser.