As a pillar of New York's medical establishment, Dr. Milton Haynes, a physician specialist with strong Caribbean roots, can write chapter and verse about the delivery of care in the country.

So when the obstetrician and gynecologist who became one of the few Blacks to head the Medical Society of New York County, meaning Manhattan, came out early in the game for comprehensive health care reform, it was clear he was calling for radical surgery to a system that was badly broken.

The country's health care delivery system, perhaps the world's most sophisticated, is also one of the most expensive and wasteful. At the same time, it routinely denies quick and easy access to care to as many as 40 million people across the land, some of whom are immigrants from at least 180 countries—Dominicans, Antiguans, Bajans, Jamaicans, Guyanese, Trinidadians, St. Lucians and Vincentians among them.

That was why Dr. Haynes saw hope for a much better health care landscape in the passage of the sweeping reform package contained in HR 3962, a 2,000-page bill.

The measure, approved by a narrow margin of 220 to 215 in the House of Representatives less than a week ago, now faces a monstrous hurdle in the U.S. Senate where even some Democrats, members of the majority party, have doubts about its costs and implications for the government. We trust the upper chamber acts with speed while heeding the words of President Barack Obama, who has staked his reputation and his administration on health care reform.

Like most physicians or government officials, Dr. Haynes was quick to insist that a health care reform that didn't cover every area of the system was better than no package at all.

Clearly, it's better to take some action and then improve upon it than saying it's a case of all or nothing at all.

That sentiment was at the heart of an observation made by our President when he said "for years, we've been told that this couldn't be done…moments like this are why they sent us here," meaning the House of Representatives and the Senate.

As Caribbean immigrants across the land consider the rancorous debate that's engulfing the United States, some questions arise. At the top of the list is: How come a nation of such vast wealth and high levels of education is fighting over a plan designed to save millions of lives? The answer, of course, can be traced to a mix of politics and selfishness on the part of millions of affluent Americans, especially Republicans who seem more concerned about the size of the government than people's health and their life expectancy.

Next question: How will the House Bill, if enacted into law, affect the average West Indian in this country?

Undoubtedly the proposed changes would have a profound impact on immigrants, whether they are citizens, green card holders or undocumented aliens.

Take the case of people with moderate incomes. If the sweeping reforms become the law of the land, West Indians would benefit because:

• Their employers would be forced to provide them with health insurance coverage or face a tax penalty of almost 10 percent of their payroll.

• Those persons, for instance, who are poor and on Medicaid, the national health scheme for those with low incomes, would have expanded access to care.

• A national insurance exchange would be created that would allow people to shop for insurance coverage.

• The proposed public option, a government sponsored health insurance scheme, would open up the system to those persons who currently can't get care.

• Most people would be required to obtain health insurance.

• It would prevent insurance companies from declining to provide cover or even drop patients from their business if they have pre-existing conditions such as cancer, diabetes, hyper­tension, cardiovascular diseases and other ailments that are rampant in the Caribbean and among West Indians in the United States.

Back in the Caribbean, people who now walk into their neighborhood hospital and receive care at taxpayer's expense can't figure out why there is no comparable system of universal access to care, free at the point of delivery, in the United States. That's mainly what the big fight is about: universal access to care.

What's frightening for many Caribbean immigrants who have accumulated some resources during a lifetime of hard work is the prospect of becoming seriously ill in the United States. A catastrophic illness requiring a lengthy hospital stay can wipe out your meager finances in a matter of days, not even weeks or months, if you don't have insurance. That's because of the expensive nature of care and the defensive approach to medicine, which doctors and hospitals are forced to practice in order to avoid lengthy and costly law suits.

That explains why Dr. Haynes and others are calling for tort reform to limit the need for extra tests, often quite expensive, when patients turn to their primary care physicians or go to a hospital in New York.

The bottom line is that people must be able to receive effective care that would enable them to lead productive lives. And the health care reform package offers them that opportunity.