On the cusp of Obama’s inauguration, it’s hard not to get excited about the potential for health care reform in America. After all, some promising issues were touted during the campaign: affordable health insurance for all Americans, investment in electronic medical records and biomedical research, and increased focus on disease prevention and disease management, to name a few.

As a resident of Massachusetts, whose universal health insurance law has made us the state with the lowest uninsured rate in the country, it’s been especially interesting to see the successes and the inevitable complications of implementing this type of reform.

Obviously I think the most important thing we need to do is make sure people have access to health insurance. There are many, many reasons to support this notion, but I can’t help going to the most personal: As you know if you’re familiar with this blog, I am a patient with multiple chronic diseases—lifelong, progressive diseases that require constant care and maintenance. Even with reasonably good insurance a significant portion of our budget goes to health care expenses, and most of our major life decisions are made around issues of health outcomes and health insurance.

Ask me to try and live without the insurance that makes this possible, and everything else I’ve worked for in my life crumbles. That’s no way to ensure a sound economy, let alone a positive health status or a reasonable quality of life.

It’s not surprising, then, that beyond increasing access to health insurance what matters most to me is how we approach chronic disease in this country. Preventive medicine and wellness initiatives are hugely important, especially in terms of preventing and treating costly diseases like type 2 diabetes, obesity, and related health problems. From a health perspective and a financial perspective, this makes so much sense, and I hope the measures proposed during the campaign come to fruition.

But there’s more to this notion of preventing and managing chronic disease that demands attention. Consider that one in 12 Americans live with autoimmune disease, or that 25 million Americans live with more than 600,000 rare diseases and you begin to understand the scope of existing chronic illness in this country.

What matters to me are policies that make it affordable to maintain existing chronic illnesses and help prevent disease progression. For example, in terms of my ability to work, contribute to society, and minimize cost and use of resources, I am much a much cheaper patient when I can get the medications and routine physical therapy I need to try and prevent serious lung infections than I am when I am an inpatient.

For patients like me, health care that covers our nebulizer medications, certain IV therapies, or chest physiotherapy not only keep us out of costly hospitalizations in the short term, but they lessen the damage to our lungs that can mean massively expensive problems down the road.

Like so much about chronic illness, the universals here are much more significant than the personal details—whether it’s degenerative arthritis, multiple sclerosis, etc, being able to take the appropriate medications and access the treatments we need to stay healthier and remain productive contributors to society is so important.

Above all, it just makes so much sense…which is though I have a healthy dose of skepticism, I am cautiously optimistic about where we’re going in terms of health care reform.