President Barack Obama has backed away from his demand that Congress approve health-care reform before its August recess, but that should not delay the goal indefinitely. Most Americans understand the need for universal health care but want assurance that it will be affordable and will strengthen rather than weaken the economy.

Those are the legitimate concerns of some Republicans — others are cheering unabashedly for the reform's defeat — and conservative Democrats. Governors from both parties also fear that the package will include another “;unfunded mandate”; in the form of expanded Medicaid, the state and federal insurance program for the poor, and that states will be required to pick up the increased cost.

The concept of employer-based health insurance at the core of the overhaul should be acceptable. Hawaii has shown the effectiveness of such a system for full-time employees since 1975; only 10 percent of Hawaii residents are uninsured. Employer-based coverage now is prevalent in states where it is not required.

However, the White House points out that average family premiums in Hawaii have increased by 56 percent in this decade alone, and one in five middle-income families spend more than 10 percent of their income on health care.

Health care for the typical American family costs $15,000 a year, including employee contributions, which is $6,500 more than that spent per family by other wealthy countries, whose families have better health.

“;The fact that we spend all this money and don't have better outcomes than other countries is a sign of how poorly we're doing,”; says Dr. Alan Garber of Stanford University. “;We should be doing better.”;

A key part of the legislation is creation of a panel of experts to propose fair payment rates for health care. President Obama cites the system at the Cleveland Clinic, which pays doctors salaries rather than rewarding them and hospitals for each additional service, removing the incentive for doctors to perform work that is unnecessary.

More than 45 million Americans now lack health insurance, and the cost of providing it to them is estimated at $1 trillion over the next decade. Some of that — two-thirds by some estimates — could come from cost-saving reforms for Medicare and other federal programs.

For the remainder, Obama said at last week's news conference that he would be open to a surcharge on the income of Americans making at least $1 million a year or to taxing employer-provided health benefits.

Obama said he will oppose “;a proposal that is primarily funded through taxing middle-class families,”; but those families will want assurance that they will not bear the brunt of that cost.