The debate over health care reform in the United States centers on questions of a right to health care, access, fairness, the quality achieved for the high sums spent, and the sustainability of expenditures that have been rising faster than the level of general inflation and the growth in the economy. It is now clear that medical debt is the principal cause of bankruptcy in the United States.

 The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation. A greater portion of gross domestic product (GDP) is spent on health care in the U.S. than in any other United Nations member state except for East Timor (Timor-Leste). A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.
According to the Institute of Medicine of the National Academy of Sciences, the United States is the “only wealthy, industrialized nation that does not ensure that all citizens have coverage”. Whether a federal government-mandated system of universal health care should be implemented in the US remains a hotly debated political topic, with Americans divided along party lines in their views regarding whether a new public health plan should be created and administered by the federal government. Those in favor of government-guaranteed universal health care argue that the large number of uninsured Americans creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality. Opponents of government mandates or programs for universal health care argue that people should be free to opt out of health insurance. Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government.
In spite of the amount spent on health care in the US, a 2008 report by the Commonwealth Fund ranked the United States last in the quality of health care among the 19 compared countries. Other comparisons conclude that the US system performs better in some areas, such as responsiveness and higher cure rates for some serious illnesses such as cancer.
Costs
Current estimates put spending on health care in the US at approximately 16% of GDP. In 2007, an estimated $2.26 trillion was spent on health care in the United States, 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. As a proportion of GDP, government health care spending in the United States is larger than in most other large western countries.On top of that, there is substantial expenditure paid from private insurance. A recent study found that medical expenditure was the cause for 60% of all personal bankruptcy in the United States. According to Dr. David Himmelstein of Harvard University who helped author the study, “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy…for middle-class Americans, health insurance offers little protection…”
The US spends more on health care per capita than any other UN member nation.[2] It also spends a greater fraction of its national budget on health care than Canada, Germany, France, or Japan. In 2004 the US spent $6,102USD per person on health care, 92.7% more than any other G7 country, and 19.9% more than Luxembourg, which, after the US, had the highest spending in the Organisation for Economic Co-operation and Development (OECD).Although the US Medicare coverage of prescription drugs began in 2006, most patented prescription drugs are significantly more costly in the US than in most other countries. Factors involved are the absence of government price controls, enforcement of intellectual property rights limiting the availability of generic drugs until after patent expiration, and the monopsony purchasing power seen in national single-payer systems[citation needed]. Some US citizens obtain their medications, directly or indirectly, from foreign sources, to take advantage of lower prices.
The US system already has substantial public components. Of every dollar spent on health care in the US, 45 cents comes from some level of government. The federal Medicare program covers the elderly and some people with disabilities, the federal-state Medicaid program provides coverage to some of the poor, the State Children’s Health Insurance Program (SCHIP) extends coverage to low-income families with children, Native Americans are covered while on the reservation, merchant seamen are covered by the Public Health System, and retired railway workers and military veterans are also covered by the government.[21] Government also affects private sector medicine through licensing and regulatory barriers to entry into health professions.
Health care spending in the U.S. is also highly concentrated. In 1996, 5% of the population accounted for more than half of all costs.
Uninsured
Main article: Uninsured in the United States
People in the US without health insurance coverage at some time during 2007 totaled 15.3% of the population, or 45.7 million people. This number decreased slightly from 47 million in 2006 due to increased publicly sponsored coverage and that about 300,000 more people are now covered in Massachusetts, which implemented the Massachusetts health care reform law in 2007. It is estimated that the current economic downturn and rising unemployment rate likely will have caused the number of uninsured to grow by at least 2 million in 2008.
Comparisons with other health care systems
The cost and quality of care in the United States are frequently the two major issues of discussion. While cost comparisons are relatively easy, the reasons for higher costs in the US and quality measures are frequently subject to debate.
The World Health Organization (WHO), in 2000, ranked the US health care system 37th in overall performance, right next to Slovenia, and 72nd by overall level of health (among 191 member nations included in the study). Despite larger spending, the United States has only slightly better infant mortality rate (6.30)and life expectancy (78.14) than the European Union (6.38 and 77.32). However, David Hogberg, a political scientist, has written that infant mortality and life expectancy are not accurate ways to compare the U.S. health care system to others.
For example, the US CDC suggests that higher rates of infant mortality in the US are “due in large part to disparities which continue to exist among various racial and ethnic groups in this country, particularly African Americans”. Some studies claim the data collected regarding infant mortality and life expectancy do not lend themselves to fair comparison.
Another metric used to compare the quality of health care across countries is Years of potential life lost (YPLL, also abbreviated PYLL). By this measure, the United States comes third last in the OECD for women (beating Mexico and Hungary) and fifth last for men (also beating Poland and Slovakia), according to OECD data (see YPLL for a table). Yet another measure is Disability-adjusted life year (DALY); again the United States fares relatively poorly. According to Jonathan Cohn, health care scholars prefer these more “finely tuned” statistical measures for international comparisons in place of the relatively “crude” infant mortality and life expectancy.
Access to advanced medical treatments and technologies is greater than in most other developed nations and waiting times may be substantially shorter for treatment by specialists.
Employer-provided health insurance receives uncapped tax benefits. According to OECD, it “encourages the purchase of more generous insurance plans, notably plans with little cost sharing, thus exacerbating moral hazard”. Various health care analysts have asserted that market failure occurs in health care markets,but some have suggested that it is a result of too much government involvement rather than too little.Consumers want unfettered access to medical services; they also prefer to pay through insurance or tax rather than out of pocket. These two needs create cost-efficiency challenges for health care. Some studies have found no consistent and systematic relationship between the type of financing of health care and cost containment.
The consumers of health care often lack basic information compared to the medical professionals they buy it from, and fully informed choices (particularly in emergencies) are often implausible. Meanwhile, health insurance companies and care providers also suffer from information asymmetry, as patients are almost always more aware of their particular family histories and risky behaviors than the firms are. Price theory dictates that the risk cost associated with this lack of information gets passed on to consumers. Demand is likely to be inelastic. The medical profession potentially may set rates that are well above ideal market value, and they are controlled by licensing requirements, with some degree of monopoly or oligopoly control over prices. Monopolies are made more likely by the variety of specialists and the importance of geographic proximity. Private insurers have been perhaps the only stabilizing force, as they pay a contractually fixed cost for a given procedure. With no more than one or two heart specialists or brain surgeons to choose from, competition for patients between such experts is limited, so contractually pre-arranged pricing helps reduce supply-limited pricing.
Increased use of preventive care is often suggested as a way of reducing health care spending. Research suggests, however, that in most cases prevention does not produce significant long-term cost savings. Preventive care is typically provided to many people who would never become ill, and for those who would have become ill, it is partially offset by the health care costs during additional years of life.
Reforming or restructuring the private health insurance market is often suggested as a means for achieving health care reform in the US. Insurance market reform has the potential to increase the number of Americans with insurance, but is unlikely to significantly reduce the rate of growth in health care spending.[43] Careful consideration of basic insurance principles is important when considering insurance market reform, in order to avoid unanticipated consequences and ensure the long-term viability of the reformed system.According to one study conducted by the Urban Institute, if not implemented on a systematic basis with appropriate safeguards, market reform has the potential to cause more problems than it solves.
Since most Americans with private coverage receive it through employer-sponsored plans, many have suggested employer “pay or play” requirements as a way to increase coverage levels. However, research suggests that current pay or play proposals are limited in their ability to increase coverage among the working poor. These proposals generally exclude small firms, do not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall compensation costs to employers.
Premium subsidies to help individuals purchase their own health insurance have also been suggested as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market are sensitive to price. Estimates of the demand elasticity in this market vary, but generally fall in the range of -0.3 to -0.1. It appears that price sensitivity varies among population subgroups and is generally higher for younger individuals and lower income individuals. However, research also suggests that subsidies alone are unlikely to solve the uninsured problem in the US.
A report published by the Commonwealth Fund in December 2007 examined 15 federal policy options and concluded that, taken together, they had the potential to reduce future increases in health care spending by $1.5 trillion over the next 10 years. These options included 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. The authors based their modeling on the effect of combining these changes with the implementation of universal coverage. The authors concluded that there are no magic bullets for controlling health care costs, and that a multifaceted approach will be needed to achieve meaningful progress.[48] The Congressional Budget Office has concluded that increased use of health information technology alone is unlikely to significantly reduce overall health care spending unless it is combined with broader measures to reduce costs.
Common arguments for and against a national health care system
Common arguments by supporters of universal health care systems include:
In most cases, people have little influence on whether or not they will contract an illness. Consequently, illness may be viewed as a fundamental part of what it means to be human and, as such, access to treatment for illness should be based on acknowledgement of the human condition, not the ability to pay. Therefore, healthcare may be viewed as a fundamental human right itself or as an extension of the right to life. 
Since people’s access to universal health care is affordable, they are more likely to seek preventative care which, in the long run, lowers their overall healthcare expenditure by focusing treatment on small, less expensive problems before they become large and costly.
A universal healthcare system allows for a larger capital base (all Americans) than can be offered by individual, competing free market insurers (policyholders only) without violating antitrust laws. A larger capital base “spreads out” the cost of a payout among more people, lowering the cost to the individual.
Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.
In most free-market situations, the consumer of health care is entirely in the hands of a third party who has a direct personal interest in persuading the consumer to spend money on health care in his or her practice. The consumer is not able to make value judgments about the services judged to be necessary because he or she may not have sufficient expertise to do so. This, it is claimed, leads to a tendency to over produce. In socialized medicine, hospitals are not run for profit and doctors work directly for the community and are assured of their salary. They have no direct financial interest in whether the patient is treated or not, so there is no incentive to over provide. When insurance interests are involved this furthers the disconnect between consumption and utility and the ability to make value judgments.  Others argue that the reason for over production is less cynically driven but that the end result is much the same.
The profit motive in medicine values money above public benefit.For example, pharmaceutical companies have reduced or dropped their research into developing new antibiotics, even as antibiotic-resistant strains of bacteria are increasing, because there’s less profit to be gained there than in other drug research. Those in favor of universal health care posit that removing profit as a motive will increase the rate of medical innovation.
Paul Krugman and Robin Wells say that in response to new medical technology, the American health care system spends more on state-of-the-art treatment for people who have good insurance, and spending is reduced on those lacking it.
The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.
Wastefulness and inefficiency in the delivery of health care would be reduced.[81] A single payer system could save $286 billion a year in overhead and paperwork.Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of U.S. health care spending. It might only take one government agent to do the job of two health insurance agents. According to one estimate roughly 50% of health care dollars are spent on healthcare, the rest go to various middlemen and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which money is spent on health care.
About 60% of the U.S. health care system is already publicly financed with federal and state taxes, property taxes, and tax subsidies – a universal health care system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers.
Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal health care system over the current U.S. system America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times, according to the Commonwealth Fund.
A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.
The Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.
In countries in Western Europe with public universal health care, private health care is also available, and one may choose to use it if desired. Most of the advantages of private health care continue to be present, see also Two-tier health care.
Universal health care and public doctors would protect the right to privacy between insurance companies and patients.
Public health care system can be used as independent third party in disputes between employer and employee.
A study of hospitals in Canada found that death rates are lower in private not-for-profit hospitals than in private for-profit hospitals.
Common arguments by opponents of universal health care systems include:

Health care is not a right. As such, it is not the responsibility of government to provide health care.
Universal health coverage does not in practice guarantee universal access to care. Many countries offer universal coverage but have long wait times or ration care.
The federal Emergency Medical Treatment and Active Labor Act requires hospitals and ambulance services to provide emergency stabilization to anyone regardless of citizenship, legal status or ability to pay.
Eliminating the profit motive will decrease the rate of medical innovation.It slows down innovation and inhibits new technologies from being developed and utilized. This simply means that medical technologies are less likely to be researched and manufactured, and technologies that are available are less likely to be used.Publicly-funded medicine leads to greater inefficiencies and inequalities.  Opponents of universal health care argue that government agencies are less efficient due to bureaucracy.Universal health care would reduce efficiency because of more bureaucratic oversight and more paperwork, which could lead to fewer doctor-patient visits.  Advocates of this argument claim that the performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.Converting to a single-payer system could be a radical change, creating administrative chaos.Countries with health systems based on greater government control tend to have more obstacles to care, such as long wait times, rationing and restrictions on the choice of doctors. Universal health care would result in increased wait times, which could result in unnecessary deaths.Data on liver and heart transplants suggest that access to transplants (especially the sickest patients) and outcomes are as among the best in the world. The extra spending in the US is cost effective if expected life span increases by only about half a year as a result.
Unequal access and health disparities still exist in universal health care systems.
The problem of rising health care costs is occurring all over the world; this is not a unique problem created by the structure of the US system.
Universal health care suffers from the same financial problems as any other government planned economy. It requires governments to greatly increase taxes as costs rise year over year. Universal health care essentially tries to do the economically impossible.Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates. As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare’s spending. The Washington Post reported in July 2008 that Medicare had “paid as much as $92 million since 2000″ for medical equipment that had been ordered in the name of doctors who were dead at the time. Medicare’s administrative expense advantage over private plans is less than is commonly believed. Large market-based public program such as the Federal Employees Health Benefits Program and CalPERS can provide better coverage than Medicare while still controlling costs as well.
National health systems tend to be more effective as they incorporate market mechanisms and limit centralized government control.
Some commentators have opposed publicly-funded health systems on ideological grounds, arguing that public health care is a step towards socialism and involves extension of state power and reduction of individual freedom.
The right to privacy between doctors and patients could be eroded if government demands power to oversee the health of citizens.
Universal health care systems, in an effort to control costs by gaining or enforcing monopsony power, sometimes outlaw medical care paid for by private, individual funds.

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