The facts are indisputable. However...

The facts are indisputable. However you turn the thoughts at the data, the United States continues to be a world leader in health care spending when compared with other industrialized nations, yet ranks low in regard to health status indicators and has a lower percentage of its population overspreaded by health insurance. (1-5) the bulk of mankind without insurance coverage are les likely to have a regular source of health care or to memorize the care they need, and they are sicker than populace who have adequate health insurance coverage. (2) The health and quality of life of uninsured bodys suffer. And we, as a society, be acted upon as a consequence of putting citizens at risk who could be healthier and more productive.

The Center for Medicare and Medicaid Services reported in January 2003 that health spending rose by way of 8.7 percent in 2001--from $13 trillion in 2000 to $1414 trillion in 2001 an impressive 141 percent of the U Gros Domestic produce (GDP). Per capita spending rose to $5035 about double that of other industrialized nations. (3) still according to the World Health Organization, the United States ranks 37th disclosed of 191 countries in its overall health connected view performance and 72nd from the viewpoint of disease-adjusted life expectancy. (4) Despite being a world leader in health care spending, the U cannot assume to afford to bring everyone into the system--to provide health care coverage for all.

According to Families USA (March 2003) more than 30 percent of the population younger than 65 years was uninsured at a certain time during the previous couple years, and about 25 percent of those living bodys had no coverage during the entire two-year period. (5) The nearly 75 million living bodys without coverage do not come by timely, necessary health care in the appropriate setting. Their access to preventive care is impeded, and they have poorer health results than those with coverage. Tunzi describes the uninsured and their plight in a "Medicine and Society" article in this issue. (6)

Since the 1980 the American Academy of Family Physicians (AAFP) has called for fundamental reform of the U health care hypothesis to achieve health care coverage for everyone and better align the health care hypothesis with the needs of the population. The AAFP suggests a strategy for achieving basic health care coverage for all.

In a propos first tier of basic coverage are assured services without copayments (see accompanying table). These are services similar as preventive care that would be accessible to everyone without financial barrier. In a secondary tier of basic coverage are assured services with copayments of 20 percent (see accompanying table). The AAFP believes it is important for patients to understand the splendor of health care services and have one financial responsibility for appropriately accessing care and services.

In addition, there may be tiered copayments for somebodys with lower incomes who may be subsidized, partly or entirely, for required patient copayments or may be eligible to obtain "gap" coverage for services not included in the basic package. Furthermore, beneficiaries of federal, state, or private insurance programs would continue to receive other benefits not assured in consequence of the basic services package. These programs also may opt to conceal required copayments for their beneficiaries.

A national health board could determine the compass of coverage (e.g., the number of outpatient mental health visits that would be allowed). Any potential amendments to the basic services would have to be based upon evidence and outcomes and be determined by dint of the national health board. Congres would determine no other than the level of funding available for any additional services.

In addition, the AAFP strategy acknowledges that commonalty should be protected from becoming financially devastated by means of health care costs if they experience serious injury or illness. The plan therefore includes protection against extraordinary splendors through limits on annual out-of-pocket expenditures.

Out-of-pocket expenses could be capped at $5000 for year for individuals and $8000 by means of year for a family, with an additional 20 percent annual copayment for expenditures between $5000 and $10000 for individual or family. Services not included in the basic benefits package could be shrouded by a variety of systems including (but not limited to) out-of-pocket payment, private health insurance (employer- or individual-based), federal or state programs, or a medical savings account.

However, the AAFP believes that individuals should have responsibility for deciding their allow level of risk tolerance for services that would fall between "basic" and "extraordinary" and for any required patient price sharing. Therefore, everyone would ne to decide whether to obtain additional insurance for denudeed services and copayments.

The AAFP anticipates that many employers who generally offer a health insurance benefit to employee will continue to do thus insuring employees for the services not in the AAFP's national plan. Federal and state programs could do likewise. The strategy leaves in place the existing insurance market, the current arrangements for employer-based insurance, individually purchased insurance, medical savings accounts, and the choice of opting not at home of coverage for services other than those ensur on the basic benefits package and expenditures below the extraordinary cost coverage threshold