Health Care Reform: BBC's Q & A

US President Barack Obama made reform of the American healthcare system his top priority when he entered the White House.

He has pledged to get a reform bill passed this year.

Lawmakers in Congress have been finding it difficult to agree on a bill to implement reform, but the president's supporters received a major boost when the House of Representatives passed its bill on 7 November. BBC reports on US Health Care in a Q & A.

How is the US healthcare system currently structured?

Unlike other developed countries, the US does not have a universal system of healthcare coverage.

It is up to individuals to obtain health insurance. Most Americans obtain coverage through their employers, but others sign up for private insurance schemes.

Under the terms of most coverage plans, members pay regular premiums, but they are sometimes also required to pay part of the cost of their treatment (known in the US as a deductible) before the insurer covers the expense. The amount they pay varies according to their plan.

Does the US government provide health coverage for anyone?

Yes. Americans aged 65 or over can sign up for the government-run Medicare scheme, and low-income parents, children, pregnant women and people with certain disabilities are eligible for the government-administered Medicaid programme.

The US government also runs the State Children's Health Insurance Program (S-Chip), which provides coverage to children whose parents are on modest incomes, but not poor enough to qualify for Medicaid.

Military veterans are also provided healthcare by a government-run scheme.

So what are the problems with the US system?

Healthcare costs for individuals are rising dramatically.

Premiums for employer-provided schemes have risen four times faster than wages, and are now double their cost nine years ago.

The percentage of employees with an annual deductible greater than $1,000 increased from 1% to 18% between 2000 and 2008.

As a nation, the US spent some $2.2tn (£1.34tn) on healthcare in 2007. That amounts to 16.2% of GDP, nearly twice the average of other OECD countries.

What are the effects of rising health costs?

The rising individual costs mean that more and more people in America are unable to afford health insurance. Tens of millions of Americans do not have insurance, and millions more are deemed "under-insured" - their coverage is inadequate for their needs.

When someone without insurance (or with inadequate cover) falls ill, they are obliged to pay their medical costs out of their own pocket.

Half of all personal bankruptcies in the US are at least partially the result of medical expenses.

Rising costs also mean the government is spending more and more on Medicare and Medicaid.

US government spending on the two schemes is projected to rise from 4% of GDP in 2007 to 7% in 2025 and 12% in 2050, making rising healthcare costs one of the biggest contributing factors to the spiralling US budget deficit.

How many people in America do not have health insurance?

The US census bureau estimates that 46.3 million people in America, out of a population of 300 million, were uninsured in 2008.

Supporters of healthcare reform often use this figure as evidence that the system is failing too many Americans and needs to change.

Some opponents, however, say the figure is misleading as it includes illegal immigrants, Americans who earn over $50,000 a year and Americans who are eligible for Medicaid or S-Chip who could get coverage if they wanted to. It also includes people who may have been temporarily in between jobs, and therefore only briefly without coverage.

The census bureau confirms that the 46.3 million figure includes 9.2 million non-citizens, and 18 million people who earn over $50,000 a year.

But backers of reform insist that - aside from illegal immigrants, who would not be covered under any of the plans for reform proposed by congress or the White House - many of the 46.3 million uninsured people would indeed benefit from an overhaul, and that it is therefore a meaningful figure to cite.

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