Healthcare Reform

The debate over health care reform in the United States centers around questions of access, efficiency, quality, and sustainability. The mixed public-private health care system in the US is the most expensive in the world, with the US spending more on health care, both as a proportion of gross domestic product (GDP) and on a per capita basis, than any other nation.Current estimates put U.S. health care spending at approximately 16% of GDP. In 2007, the U.S. spent a projected $2.26 trillion on health care, or $7,439 per person. Health care costs are rising faster than wages or inflation, and the health share of GDP is expected to continue its historical upward trend, reaching 19.5 percent of GDP by 2017.

The U.S. is the only wealthy, industrialized nation that does not have a universal health care system, according to the Institute of Medicine of the National Academy of Sciences. Americans without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people.

International comparisons that could lead to conclusions about the quality of the health care received by Americans are inconclusive and subject to debate. The US lags other wealthy nations in such measures as infant mortality and life expectancy, but some argue that these differences have little to do with the structure of its health care system. Other comparisons indicate that the US system performs better on some measures, such as responsiveness and higher cure rates for serious illnesses such as cancer.

Whether a government-mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic, with Americans divided along party lines in their views of the US health system and what should be done to improve it. Reform proposals include restructuring the private health insurance market, employer "pay or play" requirements, premium subsidies to help individuals purchase health insurance, increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices.