Health Care Reform: An Introduction. CRS Report for Congress. April 14, 2009

摘要

Health care reform has emerged as an issue in the 111th Congress, driven by growing concern about widely discussed problems. Three predominant concerns involve coverage, cost and spending, and quality. Commonly cited figures indicate that more than 45 million people have no insurance, which can limit their access to care and their ability to pay for the care they receive. Costs are rising for nearly everyone, and the country now spends over $2.2 trillion, more than 16% of gross domestic product (GDP), on health care services and products, far more than other industrialized countries. For all this spending, the country scores but average or somewhat worse on many indicators of health care quality. These concerns raise significant challenges. Each of the concerns is more complex than might first appear, which increases the difficulty of finding solutions. Insurance coverage and access to health care are not the same, and it is possible to have one without the other. Having coverage does not ensure that one can pay for care, nor does it always shield one from significant financial loss in the case of serious illness. Similarly, high levels of spending may be partly attributable to the countrys wealth, while rising costs, though difficult for many, may primarily mean that less money is available for other things. Solutions to these concerns may conflict with one another. Health care reform proposals will likely rekindle debate over perennial issues in American health care policy. These include whether insurance should be public or private; whether employment-based insurance should be strengthened, weakened, or left alone; what role states might play; and whether Medicaid should be folded into new insurance arrangements. Whether changes to Medicare should occur at the same time may also be considered. Concerns about coverage, cost and spending, and quality are likely to be addressed within the context of these issues.