The Washington State Insurance Commissioner recently reported that more than 1 million Washington residents do not have health insurance.

As a consequence, Tri-City hospitals provided $53.1 million in unpaid health care in 2010. Despite this situation, all Republican presidential candidates have vowed the repeal of the Affordable Care Act, derisively referred to as Obamacare, primarily due to its mandate for all citizens to carry health insurance.

It is widely accepted that the cost of health care in general, and Medicare and Medicaid in particular, are rising at an unsustainable rate, but there is strong opposition to any change in these popular programs.

How does a person sort through the rhetoric and slogans to reach an informed decision regarding health care that takes into account the tradeoffs necessary to address these problems in a comprehensive manner?

My recommendation is to compare the claims against personal experience to see if they stand up.

Three years ago, I was diagnosed with prostate cancer. The Tri-City Cancer Center referred me to Seattle for radiation seed implants but followup care is provided at TCCC.

Treatment was covered by my Battelle health insurance at the Pacific Northwest National Lab. While co-payments and deductibles resulted in out-of-pocket costs, given my financial position, they were not significant. This would not have been the case for someone living from paycheck to paycheck.

In April 2009, I moved to the United Kingdom when I became the managing director of the National Nuclear Laboratory. While I maintained my Battelle health insurance, I was also automatically enrolled in the much-maligned U.K. health service.

I would routinely go to the local surgery for health care. I never experienced any delays in appointments, my chosen doctor was very responsive and prescriptions were free since I was over 60 (about $11 per prescription for younger patients).

In April 2010, I began experiencing shortness of breath after minimal exertion. My U.K. doctor sent me to the local hospital for some tests. Upon arrival at the hospital I didn't have to sign any papers as all my information was included in my electronic records and all costs would be covered by national health insurance -- circumstances that greatly reducing administrative costs.

After initial tests, the doctors decided to have me admitted to the hospital. By morning, doctors had agreed on the tests needed, discovered numerous, large blood clots in my lungs and prescribed treatment. I had been evaluated, admitted, diagnosed and released (at my own request) within 24 hours.

While elective treatments can take time in the U.K., my experience was that urgent medical care is swift and effective.

Due to the blood clots and the onset of back problems, I retired from Battelle at the end of 2010 and returned home to the Tri-Cities. Unfortunately my back continued to deteriorate, resulting in spine fusion surgery at Kadlec Regional Medical Center in early November 2011.

I am very fortunate to have my retiree's health insurance, as private insurance would probably not have been reasonably available because of my pre-existing condition of prostate cancer. Had I not been vested in Battelle's health insurance, retirement would not have been an option.

Given my personal experiences and recognition of the financial burden that similar medical problems can cause for those less fortunate, I have come to the following conclusions:

-- The Affordable Care Act provides improved access to health care for all citizens, including those with pre-existing conditions. Its mandate for health insurance is similar to Medicare and fairly has everyone contributing to health care costs. It should be strengthened and expanded, not repealed.

-- All health care cost, including Medicare and Medicaid, must be reduced. One way of doing this, as provided for in the Act, is to have qualified physicians determine the effectiveness of various treatments. This process works effectively in the UK but is scornfully referred to by some in the U.S. as death panels. I would much rather have qualified doctors make these recommendations with transparency and oversight, than having insurance companies make them on a one-to-one basis.

-- Costs could be further reduced by tort reform that would address the expense of unnecessary tests and ineffective treatments approved solely as a defensive measure to protect against potential lawsuits. I firmly believe that most doctors have the knowledge and desire to prescribe what is best for their patients. Safeguards against abuse should be available that do not penalize the vast majority of conscientious physicians.

-- Ultimately, I would like to see basic universal health care provided to all citizens, just as Medicare provides today for senior citizens. Additional services and care could still be available to those able and willing to buy supplemental health insurance. Everyone should have access to health care with the emphasis on good health rather than treatment.

I believe that the quality of health care in the U.S. is second to none, and we continue to lead the world in new treatments and procedures.

Unfortunately, the availability of this world-class care is limited, with many unable to access or pay for these services. With shared sacrifice by those who can afford it, and compassion for those who cannot, we can build upon the Affordable Care Act and provide everyone health care they can live by.

* Mike Lawrence worked at the Department of Energy and the Pacific Northwest Laboratory before his retirement. He lives in West Richland.