††††††††††† The health care reform debate in the United States has been a political issue for many years, focusing upon increasing coverage, decreasing the cost and social burden of healthcare, insurance reform, and the philosophy of its provision, funding, and government involvement. Following the election of President Obama, whose election included a promise to accomplish reform, legislation passed both houses of the U.S. Congress in late 2009. The House passed the Senate bill and a package of fixes in a Reconciliation bill in March 2010.

††††††††††† The United States has one of the highest healthcare costs in relation to the size of the economy throughout the world. It is estimated that over 50 million U.S. citizens go without insurance coverage. On top of this, millions of citizens from the Baby Boomer era are approaching retirement age. All of this is combined with significant annual increases in healthcare costs per person will place enormous budgetary strain on U.S. state and federal governments. The long-term health of the U.S. federal government is primarily related to whether healthcare costs can be brought under control.

††††††††††† Various general and specific reform strategies are under debate in the Congress and media. One major reform that is being proposed is to change doctorsí incentives. Currently, doctors are usually paid for the services that they provide instead of a salary. This provides incentive to raise the costs of the services they provide.

††††††††††† Also, a reform of the insurance business has been discussed. The debate has involved certain insurance industry practices such as the placing of caps on coverage, the high level of co-pays even for essential services such as preventative procedures, the refusal of many insurers to cover pre-existing conditions or adding premium loading for these conditions. One proposal being made is to fine larger employers who do not provide a minimum standard of health care insurance. Some proposals include a choice of a not-for-profit insurer modeled after Medicare. Democratic legislators have largely supported the proposed reform efforts, while Republicans have criticized the government option or expanded regulation of healthcare.

††††††††††† Recently, the Patient Protection and Affordable Care Act was signed into law. The legislation focuses on reforming certain aspects of the health insurance industry. These reforms include increasing coverage for pre-existing conditions, expanding insurance to millions of Americans, and mandating an increase in total national medical expenditure.