Two Israelis - Prof. Gabi Bin Nun and Dr. Osnat Luxenburg - are among the three non-Americans and nearly 60 Americans who have prepared a comprehensive health care reform plan for the US, The Jerusalem Post has learned. Among the leaders of the voluntary professional forum, which began about 18 months ago, is Dr. Ezekiel ("Zeek") Emanuel, who was named US President Barack Obama's White House health care policy adviser just a few weeks ago. Emanuel is a prominent breast cancer expert and was, until his new appointment, a bioethics specialist at the US National Institutes of Health. As Emanuel is a brother of Obama's chief of staff, Rahm Emanuel (both brothers were born in the US to former Israelis), their recommendations are expected to form the basis for major modifications in US health insurance. Some Washington journalists have compared the capable Emanuel brothers to the Kennedy brothers, as US president John F. Kennedy appointed his brother Robert F. Kennedy to be his attorney-general in 1961. Bin Nun is a former Health Ministry director-general and is now with Ben-Gurion University's department of health systems management. Luxenburg currently heads the Health Ministry's medical technologies administration. They were invited by Ezekiel Emanuel - who was then at Stanford University - to join the forum about six months ago. The third non-US expert is octogenarian Dr. Louis van de Ven at Erasmus University in the Netherlands, while all the other team members are leading American experts - many of them Jews. Called the Fresh-Thinking Project (www.fresh-thinking.org), the team comprised physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives. They held workshops to discuss the issues and formulate their recommendations. This week, they published an article summarizing their recommendations in the Annals of Internal Medicine journal under the title "Towards a 21st-Century Health Care System: Recommendation for Health Care Reform." A huge 16 percent of the US Gross Domestic Product is spent on American health care, but some 40 million residents still lack health insurance. While the poor get Medicaid and pensioners get Medicare health insurance coverage, the 40 million fall between the cracks. Many of them are unemployed or not offered adequate or any health insurance by their employer; as health insurance is usually part of employment benefits, they are forced to go to hospital emergency rooms for care only when they are very ill. Now the economic catastrophe in the US and the high number of unemployed means that many Americans have lost their work-tied health insurance or cannot afford health care on their own. Bin Nun told the Post on Thursday that he thought the forum would influence US health policy, which would be forced to reform its system. "I believe they will keep private health insurance providers - unlike Israel's system, which has four public health funds - but they will establish universal health insurance and a standard basket of health care, which we Israelis have. The existing US system is terribly wasteful," he said, adding that "I believe they will also adopt a single electronic medical record for all Americans." According to Bin Nun, the report relates to three health care issues - how to provide all Americans with access to a standard benefits package; how to deliver care, using outcome measures to guide payment; and how to simplify the administrative function and the quality of services. Their proposals include establishing a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions; simplifying and rationalizing federal and state laws and regulations to facilitate organizational innovation, support care coordination and streamline financial and administrative functions; and creating a national health database with the participation of all payers, delivery systems and others who own health care data. In addition, the team recommended identifying revenue sources - including a cap on the tax exclusion of employer-based health insurance - subsidizing health care coverage with the goal of insuring all Americans; creating state or regional insurance exchanges to pool risk so Americans without access to employer-based or other group insurance could obtain a standard benefits package; and creating a health coverage board to determine and periodically update the affordable standard benefits package. They also urged the replacement of the current fee-for-service payment system with one that encourages and rewards innovation in the efficient delivery of quality care. Payments, they said, should be linked to improving patient outcomes, reducing racial and other disparities in outcomes, increasing efficiency and moderating the growth in the cost of care. The Fresh-Thinking Project, they concluded, "demonstrates that despite diverse backgrounds and interests, people can agree on fundamental elements that will provide a solid foundation for a health care system. The essence of these elements is the reform and modernization of how we both finance and deliver health care to ensure real value - better quality care and improved health of Americans at sustainable growth in costs."