NORTH LIBERTY – The current state of health care delivery in America is so grim that U.S. Sen. Tom Harkin no longer uses the word “care” in reference to reform.

“We need health reform,” the Democrat told the roughly 200 individuals who gathered at an AARP forum in North Liberty on Saturday. “I don’t say that we need health care reform because you can’t reform something you don’t already have. We don’t have a health care system in America. We have a sick care system.”

Harkin said the World Health Organization ranks the U.S. health care system 37th in the world, on par with Serbia. Despite the fact that the U.S. spends twice as much per capita on health care as European countries, he explained, Americans face twice the number of chronic diseases.

“We spend 95 cents of every dollar on treating illnesses and conditions after they occur,” he said. “In other words, we’ve been neglecting wellness and disease prevention. That’s the bad news. The good news is that right now I think that we have a chance to make a dramatic change.”

Although Congress is not always known for its ability to act swiftly, Harkin said President Obama “is adamant” that health reform be complete by October of this year. In addition, Harkin is optimistic, if not fully confident, that the deadline will be met.

“What we are doing is marking up our bill … during the last two weeks of June,” Harkin said. “We plan to be done with it before the July Fourth recess. We will come back after July 4 and will be on the floor of the U.S. Senate in July with both the finance bill, which basically covers Medicare and Medicaid and the taxing part of it, and our bill, the health bill. We plan to have it done before the August recess. It will go to conference during August and September so that it can be done in October.

“And I’m telling you, we cannot fail in this. We have got to get it done.”

President Barack Obama invoked the same sense of urgency on health reform during his weekly radio address, released Saturday. That drew criticism from Iowa’s other senator, Republican Chuck Grassley, via the social messaging site Twitter. Grassley complained that Obama had “nerve” to tell Congress to deliver on health care while he was off “sight seeing” in Paris. Obama is on an oversees trip that took him to Egypt, where he delivered a major address intended for muslim nations; Germany, where he visited the site of a Nazi concentration camp; and France, where he observed the anniversary of D-Day with other world leaders.

Harkin said that because the country has come together in what describes as “a critical mass,” comprehensive reform is much more of a certainty now than it was during discussions during the 1990s.

“I want to impress upon you: We aren’t dancing around the edges,” he said. “What we are planning on doing will change the very fabric – the very fabric – of how we do health in America. It’s not just changing medicine, but it is changing the kind of medicine we do.”

Despite a recently published column by Grassley listing reasons for his opposition to a public plan option, Harkin confidently proclaimed that the reform will contain such an option, and that it will be national. Harkin also lamented the fact that single payer was not on the table despite his personal support and the growing support of the majority of Americans for that option.

Noting that there is not enough support in Washington to pass a single-payer system, Harkin said that “there are a lot of things the majority of Americans support that Congress won’t do.” Harkin also praised members of the audience who carried signs calling for a single-payer system, saying that one of the major reasons that a public plan is now a real possibility is due in large part to their advocacy.

Although members of the audience grumbled during the question-and-answer portion of the forum when Harkin indicated full implementation of such sweeping change could take several years, panel member Cathy Glasson, state president of the Service Employees International Union, pointed to the nation’s looming nursing crisis as evidence of why reform will take time.

“I don’t think people are considering [the shortage of nurses and other health care professionals] in relation to reform of our nation’s health care system,” said Glasson, who has worked for more than two decades as a registered nurse. “We are going to be adding between 47 to 52 million currently uninsured individuals into the system. If we don’t have the qualified professionals to care for the influx of those folks, we are going to have a major disaster on our hands.”

Harkin also wanted to assure those in attendance that existing low federal reimbursement rates that have been negatively impacting Iowa hospitals and health care professionals will be revamped during the course of reform.

“Our Iowa doctors, nurses and professionals have a lot to be proud of,” Harkin said. “I don’t know how many more studies we need from the Commonwealth Fund and Dartmouth and others ranking Iowa in the top places nationally for providing quality health care delivery. But our current reimbursement system is based on volume, not quality. Well, if you reimburse on volume, you get volume. But if you start reimbursing on quality, you’ll get quality.”