The state of US health-care reform.

摘要

In the weeks before US President George W Bush's annual State of the Union address, rumours abounded that he would use the speech to propose bold new initiatives to reform the USA's troubled health-care system. The problems plaguing the world's most expensive health-care system are not new. Costs continue to spiral, far outpacing inflation, and now consume 16% of the US gross domestic product. This is far more than is spent by any other developed nation, all of which achieve equal or better health-care outcomes. The rising costs are forcing employers to cut benefits or to shift costs to workers by offering plans with higher deductibles and requiring higher out-of-pocket co-payments. Some are dropping coverage altogether. The number of uninsured, most of whom are low-income workers and their families, continues to climb and is now estimated to be 45 million, roughly one in seven Americans. Many more are underinsured.Given these and other problems, it seemed natural that the President would use the Stateof the Union address to propose ways to reform the system. So it came as a surprise when he dedicated only two short paragraphs of his speech to health care and did little more than tout three old and rather shopworn initiatives. He again promised to promote the use of electronic records and information technology. He again asked Congress to change US medical malpractice laws to cap damages. And he again pushed health-savings accounts (HSAs).