System: Employer-based private coverage, with an under-regulated private insurance market, and
government-subsidized public plans for the poor, elderly, and disabled
Reform: The United States has the rare distinction of being both one of the world's richest countries and having one of its least-functional health care systems.
Americans spend around one in every six dollars on healthcare. But, in aggregate, they're not getting much bang for their buck. People in the United States are as likely to die from diseases like lung cancer as citizens in all OECD countries - which, on average, spend less than half as much per capita. Some 47 million lack any health insurance coverage. An estimated 600,000 people file for bankruptcy every year because they cannot pay their medical expenses. Indeed, the United States is the only rich country without universal coverage.
The U.S. government has repeatedly tried to create a more coherent plan and to make sure more Americans are insured. Reformers have scored piecemeal victories -- such as the 1997 creation of the State Children's Health Insurance Plan, or Massachusetts' recent implementation of universal coverage.
But for the most part, the history of health reform in the United States has been a history of failure. The last attempt at comprehensive reform -- the 1993 bill derided as "HillaryCare," during the administration of Bill Clinton -- floundered in Congress. Since then, costs and premiums have doubled, a lower percentage of employers offer coverage, and millions more are uninsured.
Efforts at healthcare reform have tended to be derailed by partisan politics -- and last week, Senate Republican Jim DeMint promised to make the issue President Barack Obama's "Waterloo." But with Democrats in the White House and enjoying a Senate supermajority, healthcare reform looks more likely to pass now than at any other time in recent history. Let's just hope it works this time.