Congressional Research Service. Health Care Reform: An Introduction. by Bob Lyke. CRS Report R40517. July 29, 2009. [Full Text (pdf)]
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. For example, by one statistical measure, far more than 45 million people face the risk of being uninsured for short time periods, yet by another, substantially fewer have no insurance for long periods. 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 country’s 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. For example, expanding coverage to most of the uninsured would likely drive up costs (as more people seek care) and expand public budgets (since additional public subsidies would be required). Cutting costs may threaten initiatives to improve quality.