A second concern is cost and spending. Costs are a particular source of anxiety for families that are planning for retirement or where someone is seriously ill. National health care spending now likely exceeds $2.5 trillion, more than 17% of the gross domestic product (GDP). The three concerns raise significant challenges. For one thing, each is more complex than might first appear, which makes it difficult to find solutions, or at least simple or uniform solutions. Second, solutions to the three concerns may conflict with one another. Under many scenarios, for example, providing coverage to the 45 million uninsured would likely drive up costs (as more people seek care) and expand public budgets (since public subsidies would be required to help them get insurance). Other challenges involve significant stakeholder interests that reform might threaten, including those of insurers, hospitals and other health care facilities, and doctors and other providers, many of whom have substantial investments in present arrangements. In addition, if debates over the Clinton plan are still a guide, some people may be uneasy about moving from an imperfect but known system to something that is potentially better but untried. It focuses on the three predominant concerns just mentioned—coverage, cost and spending, and quality—and some of the legislative issues within which they likely will be debated, including the scope of reform (particularly whether Medicare and Medicaid should be included); the choice between public and private coverage; whether employment-based insurance should be strengthened, weakened, or left alone; and what role states might play. The report does not attempt to identify, let alone discuss, all the relevant concerns about health care in the United States, even though others may also be important and will likely contribute to the complexity of the reform debate. The report may be updated to include other health care reform issues as the debate in Congress unfolds. The number indicates that more than 45 million people are likely to be uninsured over a short time period, even if many have coverage at some point. Coverage is not the same as access, and it is possible to have one without the other. Having coverage also does not ensure that one can pay for care. Quality

Despite spending more on health care than other industrialized countries, the United States scores only average or somewhat worse on many quality of care indicators. As Congress considers what to do about health care quality, a number of issues have arisen, including the following:
whether quality improvements should be pursued for their own sake, regardless of whether they promise to save money, whether it is possible to improve the quality of care without reorganizing and restructuring health care delivery systems, whether preventive care should have a significant role in improving quality, relative to acute or chronic care services, whether the evidence-base is adequate for guiding quality improvement efforts, or whether the way research is organized, financed, and carried out needs to be changed, and whether employers and other entities that are not health care providers can play a role in improving health outcomes. ( H.R. The Cost of Reform

The cost of reform and how to pay for it have become important issues in the current debate. Congressional Proposals

The committees of jurisdiction for health care have prepared comprehensive reform proposals. The Senate HELP Committee approved a measure on July 15 (Affordable Health Choices Act), whereas the Senate Finance Committee has not yet released a proposal, though earlier it provided a range of policy options and many of its debates have been publicized. 3200 , a coordinated measure by three House committees (Education and Labor, Ways and Means, and Energy and Commerce), was approved by the first two committees with some variations on July 17 and by Energy and Commerce on July 31.
Health care reform is a major issue in the 111th Congress, driven by growing concern about millions of people without insurance coverage, continual increases in cost and spending, and quality shortcomings. Commonly cited figures indicate that more than 45 million people have no insurance, which can limit their access to care and ability to pay for the care they receive. Costs are rising for nearly everyone, and the country now likely spends over $2.5 trillion, more than 17% 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, and many may not get appropriate standards of care.
These concerns raise significant challenges. Each 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. Other challenges include addressing the interests of stakeholders that have substantial investments in present arrangements and the unease some people have about moving from an imperfect but known system to something that is potentially better but untried. How much reform might cost and how to pay for it is also an issue.
Health care reform proposals 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 is also being considered. Concerns about coverage, cost and spending, and quality are likely to be addressed within the context of these issues.
The committees of jurisdiction for health care have prepared comprehensive reform proposals. The Senate HELP Committee approved a measure on July 15 (Affordable Health Choices Act), whereas H.R. 3200, a coordinated measure by three House committees (Education and Labor, Ways and Means, and Energy and Commerce), was approved by the first two committees with some variations on July 17 and by Energy and Commerce on July 31. The Senate Finance Committee has no draft available to the public, though it has released policy option documents and many of its debates have been publicized. More than a dozen other comprehensive bills have also been introduced.
This report does not discuss or even try to identify all of the concerns about health care in the United States that are prompting calls for reform. Other concerns may also be important, at least to some, and will likely contribute to the complexity of the reform debate. The report may be updated to include other health care reform issues as the debate in Congress unfolds.