ANALYSIS: 3 health care problems could shape the next decade as much as medicine

— -- This is the first article in a five-part series.

When it comes to health care in the U.S., I have no idea what’s going to happen in the next five years — but I think I know what’s going to happen in 10 years.

That sweeping prediction stems from several decades of reporting on health care issues as medical editor for ABC News from 1984 to 2009. During that time, I slowly became aware of the fact that health care policy decisions were becoming as important as new medical discoveries in shaping the health of Americans.

One episode in particular opened my eyes to the idea that maybe we Americans could learn from other countries — and that American health care had some serious problems.

My discovery happened in the early 1990s when then-anchor Peter Jennings asked me to do a four-minute report for "World News" comparing the U.S. and Canadian health care systems, a contrast very much in the news then — and now.

4:42

May 1, 1990: Health care in the US vs. health care in Canada

Medical editor Tim Johnson visits and compares two families dealing with their country's health care on both sides of the U.S.-Canada border.

We came up with an idea that turned out to be dramatically informative. We asked family practice organizations in New York state and right across the border in Ontario, Canada, to pick a two-doctor family practice. We then asked each practice to pick a young family with two kids.

First, we went to a small town south of Buffalo, New York. The two doctors in the practice there were outstanding; smart and caring. But, my first shock came when I learned they employed several full-time people to do nothing but bill the many insurance companies with which they had to deal.

Read articles in this series:

Part 2: ANALYSIS: Health care spending reforms are critical to change the system
Part 3: ANALYSIS: Health care quality will improve for all, if we have a federal watchdog
Part 4: ANALYSIS: Health care should be a right, but the US doesn't have a system
Part 5: ANALYSIS: The 2 options for US health care likely to emerge in the next decade

My second shock came when we interviewed the young family they had picked. The father, a self-employed logger, earned slightly too much to qualify for Medicaid, but too little to afford health insurance. So while his wife was delivering their youngest child, during labor, he spent several hours in the business office working out a long-term payment plan.

Across the border in Canada, we interviewed two wonderful family doctors in a suburb of Toronto. When I asked about their billing process, they didn’t even understand the question at first. Finally, they pointed out that all their billing was done by a woman who came in just 10 hours a week because the form was the same for everyone, since the only insurer was the government, the "single payer."

And when I asked the young father they had picked about his experience when his child was recently born, he also did not understand my question. He finally explained that when his wife went into labor, he simply showed the hospital their government health insurance card — given to all Canadian citizens at the time of birth. The father said they then "whisked us upstairs" — words I have never forgotten.

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I came back from that experience deeply shaken. The comparison between the families in New York and Ontario was startling. In one, the birth of a baby produced a financial crisis and deep anxiety; in the other, the assurance that basic health care would always be available without financial worry stood in vivid contrast.

Since then I have studied the problems with American health care, read widely and interviewed many experts. I have come to realize that, while many Americans have access to the best health care in the world, almost 30 million have no health insurance. I have learned that there are three crucial problems that need to be addressed by any so-called "health care reform" proposal. They are cost control, quality assurance and affordable access.

So remember those three words: COST, QUALITY and ACCESS. In the next essays, I will examine these three problems — and then tell you what I believe is going to happen in 10 years.

This is the first of a five-part series. Read other articles in the series below:

Part 2: ANALYSIS: Health care spending reforms are critical to change the system
Part 3: ANALYSIS: Health care quality will improve for all, if we have a federal watchdog
Part 4: ANALYSIS: Health care should be a right, but the US doesn't have a system
Part 5: ANALYSIS: The 2 options for US health care likely to emerge in the next decade

Dr. Tim Johnson was the chief medical editor for ABC News from 1984 to 2009.