At a recent legislative hearing on health care reform, I was asked a difficult question: if we can’t do comprehensive health care reform, which should we do first – ensuring everyone has access to care, controlling the costs of health care or improving quality?

I think we should reject the premise of the question: that we must choose which problems we’ll address in these difficult times. Indeed, the very fact that our economy is in such dire straits provides an opportunity to tackle   more than one problem at a time.

The question also reflects a frustrating debate happening at the national level about whether President Obama is overreaching by including health care reform in his agenda and would he do better by focusing on stimulating the economy. The entire debate misses important points.

First, fixing health care is a priority. Health care was a top decision point for voters in the last election. Almost half of Americans report putting off needed health care, skipping treatments, not filling prescriptions, skipping doses, or cutting pills due to cost. We have to focus on our priorities. No one is suggesting that we stop the wars in Afghanistan and Iraq until the economy improves.

Second, health care costs are part of the economy, and we can’t fix the economy without fixing health care. Right now, health care consumes 16 percent of the US economy, far more than other countries, and that proportion is rising. The Business Roundtable just released a report describing how the problems with the US health care system have placed us at a significant global economic disadvantage. Polls confirm that voters see the fundamental relationship between health care costs and the economy

Third, we can do more than one thing at a time. Do the economists arguing against health care reform expect that the health policy wonks and planners in the administration will stop what they are doing and become auditors and bank regulators?

It is impossible to separate access to care, cost containment and quality. Access to care you can’t afford is irrelevant. Affordable insurance coverage with no participating providers is just a plastic card. And health care that doesn’t protect the quality of your health isn’t worth buying.

I understand that these are hard questions and even harder decisions. And that difficulty should never be an excuse to do nothing – something is better than nothing. But we’ve had a lot of little somethings and we are getting further behind. Massachusetts chose to focus first on access to care, mainly because they needed to hold onto $385 million in federal funds and that was what they were told to do. Massachusetts is now working to address cost and quality. Vermont and Maine wisely chose to do all three at the same time. It is going slowly, which is a good thing, but they are making extraordinary progress.

A state bureaucrat once stated in response to advocates arguing for investment in well-being, “We can’t afford any more of your savings.” I understand that sentiment; this is expensive and there may seem to be more pressing issues. It will cost a lot more than it would have if we had dealt with this in the early 90’s, the last time we had a similar opportunity to reform the US health care system. If we lose another opportunity, the cost will be astronomical next time. We can’t afford to do nothing and I refuse to choose between access, cost and quality.

Ellen Andrews is Executive Director of the CT Health Policy Project, a non-profit research and advocacy organization working to expand coverage to affordable, quality health care for all Connecticut residents. The Project provides policymakers with information about options for coverage and provides assistance to consumers struggling to access health care in Connecticut. www.cthealthpolicy.org, www.cthealthconsumer.com