Health care reforms proposed during the Obama administration

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pay bonuses to hospitals that improve patient results after heart failure, pneumonia, and surgery. There’s a program that would impose financial penalties on institutions with high rates of infections transmitted by health-care workers. Still another would test a system of penalties and rewards scaled to the quality of home health and rehabilitation care. Other experiments try moving medicine away from fee-for-service payment altogether. A bundled-payment provision would pay medical teams just one thirty-day fee for all the outpatient and inpatient services related to, say, an operation. This would give clinicians an incentive to work together to smooth care and reduce complications. One pilot would go even further, encouraging clinicians to band together into “Accountable Care Organizations” that take responsibility for all their patients’ needs, including prevention—so that fewer patients need operations in the first place. These groups would be permitted to keep part of the savings they generate, as long as they meet quality and service thresholds. The bill has ideas for changes in other parts of the system, too. Some provisions attempt to improve efficiency through administrative reforms, by, for example, requiring insurance companies to create a single standardized form for insurance reimbursement, to alleviate the clerical burden on clinicians. There are tests of various kinds of community wellness programs. The legislation also continues a stimulus-package program that funds comparative-effectiveness research—testing existing treatments for a condition against one another—because fewer treatment failures should mean lower costs.

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Arizona to about 96 percent in Alabama. In 31 of the 39 states supplying market share information, the top carrier had a market share of a third or more. The five largest carriers in the small group market, when combined, represented three quarters or more of the market in 34 of the 39 states supplying this information, and they represented 90 percent or more in 23 of these states. Thirty-six of the 44 states supplying information on the top carrier identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier, and in all but 1 of the remaining 8 states, a BCBS carrier was among the five largest carriers. The median market share of all the BCBS carriers in the 38 states supplying this information was about 51 percent, with a range of less than 5 percent in Vermont and Wisconsin and more than 90 percent in Alabama and North Dakota...the median market share of all the BCBS carriers in 38 states reporting this information in 2008 was about 51 percent, compared to the 44 percent reported in 2005 and the 34 percent reported in 2002 for the 34 states supplying information in each of these years."

1366:. This relates to moral arguments for health care reform, framing healthcare as a social good, one that is fundamentally immoral to deny to people based on economic status. The motivation behind healthcare reform in response to the medical-industrial complex also stems from issues of social inequity, promotion of medicine over preventative care. The medical-industrial complex, defined as a network of health insurance companies, pharmaceutical companies, and the like, plays a role in the complexity of the US insurance market and a fine line between government and industry within it. Likewise, critiques of insurance markets being conducted under a capitalistic, free-market model also include that medical solutions, as opposed to preventative healthcare measures, are promoted to maintain this medical-industrial complex. Arguments for a market-based approach to health insurance include the Grossman model, which is based on an ideal competitive model, but others have critiqued this, arguing that fundamentally, this means that people in higher socioeconomic levels will receive a better quality of healthcare. 412: 738:

accounted for 43 percent of total spending, while the costliest 25 percent...accounted for fully 85 percent of spending...These high-cost beneficiaries, compared with beneficiaries in the bottom 75 percent in terms of their spending, were slightly older, more likely to suffer from chronic conditions, such as coronary artery disease and diabetes, and more likely to die in a given year." Such concentration offers opportunities to focus on key ailments and treatment approaches. Peter Orszag wrote in May 2011: "The truth is that constraining future health care costs will require a variety of approaches, but in particular it will mean improving the information that providers have about their patients and best practices, and the incentives that providers are given to deliver better care, especially in expensive cases."

1380:–Healthways Well–Being conducted a survey and found that the uninsured rate is going down. 13.4 percent of U.S. adults are uninsured in 2014. This is a decrease from the percentage at 17.1 percent in January 2014 and translates to roughly 10 million to 11 million individuals who gained coverage. The survey also looked at the major demographic groups and found each is making progress towards getting health insurance. However, Hispanics, who have the highest uninsured rate of any racial or ethnic group, are lagging in their progress. Under the new health care reform, Latinos were expected to be major beneficiaries of the new health care law. Gallup found that the biggest drop in the uninsured rate (2.8 percentage points) was among households making less than $ 36,000 a year. 427: 782:

combined, represented three-quarters or more of the market in 19 of the 34 states supplying information, and they represented more than 90 percent in 7 of these states. Twenty-five of 37 states supplying information identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier offering health insurance in the small group market, and in all but one of the remaining 12 states, a BCBS carrier was among the five largest. The median market share of all the BCBS carriers in the 34 states supplying information was about 34 percent, with a range from about 3 percent in Vermont to about 89 percent in North Dakota; in 9 of these states BCBS carriers combined for half or more of the market."

536:

system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention. Gawande argued that dramatic improvements and savings in the delivery system will take "at least a decade." He recommended changes that address the over-utilization of healthcare; the refocusing of incentives on value rather than profits; and comparative analysis of the cost of treatment across various healthcare providers to identify best practices. He argued this would be an iterative, empirical process and should be administered by a "national institute for healthcare delivery" to analyze and communicate improvement opportunities.

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the part of service providers (mainly doctors and hospitals) to process payments. For example, the Cleveland Clinic, considered a low-cost, best-practices hospital system, has 1,400 billing clerks to support 2,000 doctors. Further, the insurance companies have their own overhead functions and profit margins, much of which could be eliminated with a single payer system. Economist Paul Krugman estimated in 2005 that converting from the current private insurance system to a single-payer system would enable $ 200 billion per year in cost savings, primarily via insurance company overhead. One advocacy group estimated savings as high as $ 400 billion annually for 2009 and beyond.

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has reported that $ 13.5 billion of processed Medicare fee-for-service claim payments for fiscal year 1999 may have been improperly paid for reasons that ranged from inadvertent error to outright fraud and abuse." Fewer than 5% of Medicare claims are audited. CBO reported in October 2014 that it is difficult to quantify healthcare fraud related to government programs. CBO reported that: "According to HHS, since 2009 the HEAT Medicare task force has filed criminal and civil charges against more than 1,700 defendants who falsely billed the Medicare program for more than $ 5.5 billion." However, false billing is a partial measure of fraud, as much of it is undetected.

544:

to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices. The authors based their modeling on the effect of combining these changes with the implementation of universal coverage. The authors concluded that there are no magic bullets for controlling health care costs, and that a multifaceted approach will be needed to achieve meaningful progress.

556: 870:

of small awards, offsetting any reduction in large awards. A New York study found that only 1.5% of hospital negligence led to claims; moreover, the CBO observed that "health care providers are generally not exposed to the financial cost of their own malpractice risk because they carry liability insurance, and the premiums for that insurance do not reflect the records or practice styles of individual providers but more-general factors such as location and medical specialty." Given that total liability is small relative to the amount doctors pay in malpractice insurance premiums, alternative mechanisms have been proposed to reform malpractice insurance.

442: 1417:

countries ranging from $ 3,365 (Argentina) to $ 27,810 (Australia). An MRI averaged $ 1,121 in the U.S. versus $ 280 in France. The reasons for these differences are driven by higher prices per unit of service, rather than a higher volume of usage. In other countries, governments intervene more forcefully in setting prices. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they're set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

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to $ 147 billion. The CDC identified a series of expensive conditions more likely to occur due to obesity. The CDC released a series of strategies to prevent obesity and overweight, including: making healthy foods and beverages more available; supporting healthy food choices; encouraging kids to be more active; and creating safe communities to support physical activity. An estimated 25.6% of U.S. adults in 2007 were obese, versus 23.9% in 2005. State obesity rates ranged from 18.7% to 30%. Obesity rates were roughly equal among men and women. Some have proposed a so-called "

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gives politicians enormous power to dictate the content of every American's health plan – a power that health care providers inevitably capture and use to increase the required level of insurance" and state that providers were successful in persuading legislators to include an additional 16 benefit mandates in the required benefit package during the first three years after the coverage mandate was enacted. They also say that by prohibiting the use of health status in pricing, the Massachusetts law "further increase premiums for the young and healthy" and, as the result of

400: 1247:

doctors feared malpractice suits if they refused; and doctors and hospitals wanted to maximize revenues. One study indicated that changing incentives may have reduced cost growth. From 2006 to 2010, the share of workers with deductibles exceeding $ 1,000 grew from 10 percent to 27 percent. Increased out-of-pocket expenses have made patients and physicians more cost conscious. Further, a combination of prior notification, higher patient co-payments and restrained reimbursements may have contributed to slowing cost growth.

759:, which is a series of budgetary reforms. His January 2010 version of the plan includes the transition of Medicare to a voucher system, meaning individuals would receive a voucher which could be used to purchase health insurance in the private market. This would not affect those near retirement or currently enrolled in Medicare. A series of graphs and charts summarizing the impact of the plan are included. Economists have both praised and criticized particular features of the plan. The CBO also partially scored the bill. 632: 320: 1618:. 2 bar charts: For both: From bottom menus: Countries menu > choose OECD. Check box for "latest data available". Perspectives menu > Check box to "compare variables". Then check the boxes for government/compulsory, voluntary, and total. Click top tab for chart (bar chart). For GDP chart choose "% of GDP" from bottom menu. For per capita chart choose "US dollars/per capita". Click fullscreen button above chart. Click "print screen" key. Click top tab for table, to see data. 946:

are excluded from individual income and payroll taxes. Although both theory and evidence suggest that workers ultimately finance their employment-based insurance through lower take-home pay, the cost is not evident to many workers...If transparency increases and workers see how much their income is being reduced for employers’contributions and what those contributions are paying for, there might be a broader change in cost-consciousness that shifts demand.

1358:

because of lack of medical care were estimated in a 1997 analysis to be nearly 100,000 per year. A study of the effects of the Massachusetts universal health care law (which took effect in 2006) found a 3% drop in mortality among people 20–64 years old - 1 death per 830 people with insurance. Other studies, just as those examining the randomized distribution of Medicaid insurance to low-income people in Oregon in 2008, found no change in death rate.

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denouncing the whole concept." According to the article, however, "ealth-policy experts . . .say there is a good reason for the mandate." Proposed reforms would prohibit health insurers from denying coverage to individuals with pre-existing medical conditions. Insurers said that, to keep premiums from rising for everyone, it is necessary for healthier people to pay into the insurance pools to balance out the cost of these higher cost individuals.

1437:

Gibbs said President Obama is supportive of importing drugs, provided safety concerns related to the drugs can be addressed. This is because drugs manufactured outside the country may be held to different standards. According to Bloomberg News, drugmakers agreed in June 2009 to contribute $ 80 billion over 10 years, largely to help the elderly afford medicines, in return for staving off other profit-endangering proposals such as drug importation.

709:" to provide incentives for healthier behavior, either by levying the tax on products (such as soft drinks) that are thought to contribute to obesity, or to individuals based on body measures, as they do in Japan. A study released in October, 2010 had a similar cost estimate, of $ 168 billion, nearly 17% of U.S. medical costs. This is an estimated $ 2,400 per obese person. The study was performed by researchers at Cornell and Emory universities. 982:

6.1% of the variation is attributable to the combination of benefit design and plan type (e.g., PPO, HMO, etc.). The employer's industry and regional variations in health care cost explain part of the variation, but most is unexplained. The researchers conclude ". . . that analysts should not equate high-cost plans with Cadillac plans, . . . ithout appropriate adjustments, a simple cap may exacerbate rather than ameliorate current inequities"

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restrictions in cases where quality of life cannot be improved. He also recommended that a budget be established for government healthcare expenses, through establishing spending caps and pay-as-you-go rules that require tax increases for any incremental spending. He has indicated that a combination of tax increases and spending cuts will be required. All of these issues would be addressed under the aegis of a fiscal reform commission.

596:, as corporations pay for benefits rather than wages. Bloomberg reported in January 2013: "If there’s a consensus among health economists about anything, it’s that employer-provided health benefits come out of wages. If health insurance were cheaper, or the marketplace were structured so that most people bought health coverage for themselves rather than getting it with their jobs, people would be paid more and raises would be higher." 921:'If you're just coming in to have your blood pressure checked and your pulse taken, you really don't need to see a doctor, and you might not need to see a nurse, either,' says David Barrett, president and CEO of the Lahey Clinic in Burlington, Mass. "There are three-stripe military sergeants with two-year degrees who can provide excellent primary care. There's absolutely no reason to force all primary-care providers to have an M.D." 1086:, said that a coverage mandate would not be necessary within a single-payer system and that even within the context of current system she was "troubled by the notion of an individual mandate." She described the Massachusetts mandates as "a windfall for the insurance industry" and wrote, "Premiums are rising much faster than income, benefit packages are getting skimpier, and deductibles and co-payments are going up." 564:

and Germany (both at 11.6% of GDP). The United States spent $ 8,233 on health per capita in 2010, two-and-a-half times more than the OECD average of $ 3,268 (adjusted for purchasing power parity). Following the United States were Norway and Switzerland which spent over $ 5,250 per capita. Americans spent more than twice as much as relatively rich European countries such as France, Sweden and the United Kingdom.

900:

2% of medical school graduates choose primary care as a career. An amendment to the Senate health bill includes $ 2 billion in funds over 10 years to create 2,000 new residency training slots geared toward primary care medicine and general surgery. Writing in Forbes, a physician argued that this is a "tiny band-aid at best," advocating full loan repayments and guaranteed positions upon graduation.

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Price Waterhouse advanced several strategies for addressing the nursing shortage, including developing more public-private partnerships, federal and state-level grants for nursing students and educators, creating healthy work environments, using technology as a training tool, and designing more flexible roles for advanced practice nurses given their increased use as primary care providers.

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were incurred by the smoking group. However, because of differences in life expectancy (life expectancy at age 20 was 5 years less for the obese group, and 8 years less for the smoking group, compared to the healthy-living group), total lifetime health spending was greatest for the healthy-living people, lowest for the smokers, and intermediate for the obese people."

376:. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others. 669:

malpractice/tort reform. He described how the U.S. faced a cost problem with agriculture, with nearly 40% of household disposable income absorbed by food costs in 1900. With a central oversight panel (the U.S.D.A.) and many pilot programs, the U.S. was able to vastly improve the productivity of its food production and reduce these costs over time. He wrote:

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counterparts; U.S. clinicians are more likely to fear litigation which may be due to the teaching of defensive strategies which are reported more often in U.S. teaching programs. Counting both direct and indirect costs, other studies estimate the total cost of malpractice "is linked to" between 5% and 10% of total U.S. medical costs.

1067:, drives more comprehensive health plans out of the market. The conclusion they draw is that "he most sweeping provision . . . is an 'individual mandate' that makes health insurance compulsory. Massachusetts shows that such a mandate would oust millions from their low-cost health plans and force them to pay higher premiums." 1012:

never receive the services. These costs appear on the Medicare statements provided to Medicare card holders. The program pays out over $ 430 billion per year via over 1 billion claims, making enforcement challenging. Its enforcement budget is "extremely limited" according to one Medicare official. U.S. Attorney General

1047:

current pay or play proposals are limited in their ability to increase coverage among the working poor. These proposals generally exclude small firms, do not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall compensation costs to employers.

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the IMAC) that facilitate such change over time. And ultimately, without a structure in place to help contain health care costs over the long term as the health market evolves, nothing else we do in fiscal policy will matter much, because eventually rising health care costs will overwhelm the federal budget.

1007:

reported that $ 54 billion in "improper payments" were made to Medicare ($ 24B), Medicaid ($ 18B) and Medicaid Advantage ($ 12B) during FY2009. This was 9.4% of the $ 573 billion spent in these categories. GAO reported in 2000: "The Department of Health and Human Services’ Office of Inspector General

877:

Administration and members of Congress; CBO concluded that "the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency." Empirical data and reporting have since shown that some

869:

Others have argued that even successful tort reform might not lead to lower aggregate liability. For example, the current contingent fee system skews litigation towards high-value cases while ignoring meritorious small cases; aligning litigation more closely with merit might thus increase the number

857:

put medical malpractice costs at 2 percent of U.S. health spending and "even significant reductions" would do little to reduce the growth of health care expenses. A 2009 CBO report estimated that approximately $ 54 billion could be saved over ten years by limiting medical malpractice lawsuits. A tort

781:

number of licensed carriers in the small group market per state was 28, with a range from 4 in Hawaii to 77 in Indiana. The median market share of the largest carrier was about 33 percent, with a range from about 14 percent in Texas to about 89 percent in North Dakota. The five largest carriers, when

712:

However, in contrast to yearly costs, lifetime costs can be highest among healthy people, who live longer. One study in the Netherlands indicated that: "Until the age of 56, yearly health costs were highest for obese people and lowest for healthy-living people. At older ages, the highest yearly costs

642:

refers to when a patient overuses a doctor or to a doctor ordering more tests or services than may be required to address a particular condition effectively. Several treatment alternatives may be available for a given medical condition, with significantly different costs yet no statistical difference

614:

Their support of the IMAC proposal underscores what most serious health analysts have recognized for some time: that moving toward a health system emphasizing quality rather than quantity will require continual effort, and that a key objective of legislation should be to put in place structures (like

571:

The Centers for Medicare and Medicaid Services reported in 2013 that the rate of increase in annual healthcare costs has fallen since 2002. However, costs per capita continue to rise. Per capita cost increases have averaged 5.4% annually since 2000. Costs relative to GDP have risen from 13.8% in 2000

1416:

provides a comparative annual survey of costs for drugs, devices and medical services across countries. According to their 2013 report, the U.S. pays considerably more than other countries in 22 of 23 categories. For example, the average cost of a hip replacement in the U.S. was $ 40,364, with other

1246:

During 2009, Medicare spent $ 11.7 billion for medical imaging, such as CT scans and MRI's. From 2005 to 2009, usage of scans grew at an annual rate of 14%, but may have slowed since due to a combination of changing incentives and saturation of usage. Initially, demanding patients insisted on scans;

1229:

determined that some 31 percent of U.S. health care dollars, or more than $ 1,000 per person per year, went to health care administrative costs. Other estimates are lower. One study of the billing and insurance-related (BIR) costs borne not only by insurers but also by physicians and hospitals found

1038:

Reforming or restructuring the private health insurance market is often suggested as a means for achieving health care reform in the U.S. Insurance market reform has the potential to increase the number of Americans with insurance, but is unlikely to significantly reduce the rate of growth in health

1011:

According to CBS News, Medicare fraud accounts for an estimated $ 60 billion in Medicare payments each year, and "has become one of, if not the most profitable, crimes in America." Criminals set up phony companies, then invoice Medicare for fraudulent services provided to valid Medicare patients who

899:

The American Academy of Family Physicians predicts a shortage of 40,000 primary care doctors (including family practice, internal medicine, pediatrics and obstetrics/gynecology) by 2020. The number of medical students choosing the primary care specialty has dropped by 52% since 1997. Currently, only

865:

explained why tort reform was omitted from the Congressional health care reform bills then under consideration: "When you go to pass a really enormous bill like that, the more stuff you put in it, the more enemies you make, right?...And the reason tort reform is not on the bill is because the people

797:

argued that allowing interstate competition would create a "race to the bottom," in which "he states with the weakest regulations – for example, those that allow insurance companies to deny coverage to victims of domestic violence – would set the standards for the nation as a whole. The result would

704:

reported that approximately 9% of healthcare costs in 1998 were attributable to overweight and obesity, or as much as $ 92.6 billion in 2002 dollars. Nearly half of these costs were paid for by the government via Medicare or Medicaid. However, by 2008 the CDC estimated these costs had nearly doubled

673:

Medicare and Medicaid currently pay clinicians the same amount regardless of results. But there is a pilot program to increase payments for doctors who deliver high-quality care at lower cost, while reducing payments for those who deliver low-quality care at higher cost. There’s a program that would

535:

further distinguished between the delivery system, which refers to how medical services are provided to patients, and the payment system, which refers to how payments for services are processed. He argued that reform of the delivery system is critical to getting costs under control, but that payment

496:

described aspects of the Obama administration's strategy during an interview: "In order to help contain cost growth over the long term, we need a new health care system that has digitized information...in which that information is used to assess what’s working and what’s not more intelligently, and

1436:

Congressional proponents argue that drugs manufactured overseas by U.S. companies could be imported and purchased more cheaply in the U.S. Drug manufacturers argue that certain foreign countries have price controls, which they recoup by charging higher prices in the U.S. Whitehouse spokesman Robert

1216:

The payment system refers to the billing and payment for medical services, which is distinct from the delivery system through which the services are provided. The over 1,300 U.S. health insurance companies have different forms and processes for billing and reimbursement, requiring enormous costs on

1093:

reported that the number of people seeking emergency room care and the cost of emergency room visits increased after the 2006 mandates went into effect (comparing 2005 to 2007). The number of visits increased by 7% during that period, while costs rose by 17%. State officials cautioned that it was

920:

wrote: "Lately, some policymakers have argued that instead of having a primary-care doctor, more people—especially young, healthy patients with simple medical needs—should see a nurse or physician assistant who administers routine care and kicks more complex problems up to a doctor when they arise.

849:

lawsuits are a major driver of medical costs. A 2005 study estimated the cost around 0.2%, and in 2009 insurer WellPoint Inc. said "liability wasn’t driving premiums." A 2006 study found neurologists in the United States ordered more tests in theoretical clinical situations posed than their German

817:

Gawande argued: "Our fee-for-service system, doling out separate payments for everything and everyone involved in a patient’s care, has all the wrong incentives: it rewards doing more over doing right, it increases paperwork and the duplication of efforts, and it discourages clinicians from working

543:

in December 2007 examined 15 federal policy options and concluded that, taken together, they had the potential to reduce future increases in health care spending by $ 1.5 trillion over the next 10 years. These options included increased use of health information technology, research and incentives

1192:

has concluded that increased use of health information technology has great potential to significantly reduce overall health care spending and realize large improvements in health care quality providing that the system is integrated. The use of health IT in an unintegrated setting will not realize

1110:

wrote: "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States." There is also disagreement as to whether federal

1098:

reported that Massachusetts had "the most expensive family health insurance premiums in the country." Premiums in Massachusetts increased by 40 percent from 2003 to 2008, compared to a national average increase of 33%. The report did not break out the amount of the increase since 2006, but as the

967:

Employer-provided health insurance receives uncapped tax benefits. According to the OECD, it "encourages the purchase of more generous insurance plans, notably plans with little cost sharing, thus exacerbating moral hazard". Consumers want unfettered access to medical services; they also prefer to

945:

One factor perpetuating inefficiencies in health care is a lack of clarity regarding the cost of health insurance and who bears that cost, especially employment-based health insurance. Employers’ payments for employment-based health insurance and nearly all payments by employees for that insurance

563:

Health spending accounted for 17.6% of GDP in the United States in 2010, down slightly from 2009 (17.7%) and by far the highest share in the OECD, and a full eight percentage points higher than the OECD average of 9.5%. Following the United States were the Netherlands (at 12.0% of GDP), and France

981:

in December 2009 found that high-cost health plans do not provide unusually rich benefits to enrollees. The researchers found that only 3.7% of the variation in the cost of family coverage in employer-sponsored health plans is attributable to differences in the actuarial value of benefits. Only

903:

Physicians wrote a NYT Op Ed in May 2011 stating that doctors typically graduate with an average of $ 155,000 in debt from Medical school, with over 80% owing debt of some type. This drives some doctors into higher paying specialties as opposed to primary care. As specialists, they prescribe more

825:

One option involves an integrated series of healthcare providers charging a premium or flat fee to patients to participate in the network, rather than a fee for each individual service. This modifies the doctor's incentive from ordering more services to solving the problem efficiently (i.e., more

609:

President Obama has proposed an "Independent Medicare Advisory Panel" (IMAC) to make recommendations on Medicare reimbursement policy and other reforms. Comparative effectiveness research would be one of many tools used by the IMAC. The IMAC concept was endorsed in a letter from several prominent

1357:

There are health losses from insufficient health insurance. A 2009 study found more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance. More broadly, estimates of the total number of people in the United States, whether insured or uninsured, who die

1333:

estimated that 16 million U.S. adults were underinsured in 2003. The underinsured were significantly more likely than those with adequate insurance to forgo health care, report financial stress because of medical bills, and experience coverage gaps for such items as prescription drugs. The study

1062:

has asserted that the Massachusetts law forcing everyone to buy insurance has increased costs: "Premiums are growing 21 to 46 percent faster than the national average, in part because Massachusetts' individual mandate has effectively outlawed affordable health plans." They say that "the mandate

1016:

said in an interview: "Clearly more auditing needs to be done and it needs to be done in real time." The Obama administration is providing Medicare with an additional $ 200 million to fight fraud as part of its stimulus package, and billions of dollars to computerize medical records and upgrade

985:

Premium tax subsidies to help individuals purchase their own health insurance have also been suggested as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market are sensitive to price. It appears that price sensitivity varies among population

911:

The American Association of Colleges of Nurses cited studies estimating that a shortage of registered nurses would reach 230,000 by 2025 as America ages, with over 135,000 open positions during 2007. An additional 30% more nurses would have to graduate annually to keep up with demand. A study by

453:

A variety of specific types of reform have been suggested to improve the United States health care system. These range from increased use of health care technology through changing the anti-trust rules governing health insurance companies and tort-reform to rationing of care. Different overall

1284:

According to 2009 World Bank statistics, the U.S. had the highest healthcare costs relative to the size of the economy (GDP) in the world, even though estimated 50.2 million citizens (approximately 15.6% of the September 2011 estimated population of 312 million) lacked insurance. In March 2010,

881:

One option proposed includes specialized healthcare courts rather than the jury system. Such courts exist in other disciplines. In administrative health courts, an expert judge would decide cases based on best medical practice, writing an opinion that is subject to appeal to an appellate health

789:

reported in 2008 (using 2007 data for the most part) the following statistics: "The median number of licensed carriers in the small group market per state was 27. The median market share of the largest carrier in the small group market was about 47 percent, with a range from about 21 percent in

1399:

An estimated 3%–10% of all health care expenditures in the U.S. are fraudulent. In 2011, Medicare and Medicaid made $ 65 billion in improper payments (including both error and fraud). Government efforts to reduce fraud include $ 4.2 billion in fraudulent payments recovered by the Department of

1233:

Advocates of "single-payer" argue that shifting the U.S. to a single-payer health care system would provide universal coverage, give patients free choice of providers and hospitals, and guarantee comprehensive coverage and equal access for all medically necessary procedures, without increasing

1046:

Since most Americans with private coverage receive it through employer-sponsored plans, many have suggested employer "pay or play" requirements as a way to increase coverage levels (i.e., employers that do not provide insurance would have to pay a tax instead). However, research suggests that

1054:

reported that while requirements to purchase health insurance were central to proposals in both the House and Senate, these coverage mandates were "under fire from both ends of the political spectrum, with some liberals saying the penalties are too harsh for those who refuse and conservatives

687:

proposals state that most of its savings would be from providing preventative care to the uninsured. Canadian physicians, who provide universal health care including preventative care, found that they could lower their total health care expenditures by 40% simply by increasing appropriate and

668:

Gawande wrote that Obamacare contains a variety of pilot programs that may have a significant impact on cost and quality over the long-run, although these have not been factored into CBO cost estimates. He stated these pilot programs cover nearly every idea healthcare experts advocate, except

1628:

Emanuel, Ezekiel; Tanden, Neera; Altman, Stuart; Armstrong, Scott; Berwick, Donald; de Brantes, François; Calsyn, Maura; Chernew, Michael; Colmers, John; Cutler, David; Daschle, Tom; Egerman, Paul; Kocher, Bob; Milstein, Arnold; Oshima Lee, Emily; Podesta, John D.; Reinhardt, Uwe; Rosenthal,

1159:

Rationing by price means accepting that there is no triage according to need. Thus in the private sector it is accepted that some people get expensive surgeries such as liver transplants or non life-threatening ones such as cosmetic surgery, when others fail to get cheaper and much more cost

1155:

has also argued that some form of rationing is inevitable and desirable considering the state of U.S. finances and the trillions of dollars of unfunded Medicare liabilities. He estimated that 25–33% of healthcare services are provided to those in the last months or year of life and advocated

821:

Gawande quoted one surgeon who stated: "We took a wrong turn when doctors stopped being doctors and became businessmen." Gawande identified various revenue-enhancing approaches and profit-based incentives that doctors were using in high-cost areas that may have caused the over-utilization of

737:

The CBO reported in May 2005: "Medicare spending is highly concentrated, with a small number of beneficiaries accounting for a large proportion of the Medicare program's annual expenditures. In 2001, the costliest 5 percent of beneficiaries enrolled in Medicare's fee-for-service (FFS) sector

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During April 2012, nine physician groups identified 45 tests that were commonly used but that provided no proven benefits to patients or could actually be harmful. This was done at the urging of a Dr. Howard Brody, who published this recommendation in a 2010 article. The nine groups (medical

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The cost of insurance has been a primary motivation in the reform of the US healthcare system, and many different explanations have been proposed in the reasons for high insurance costs and how to remedy them. One critique and motivation for healthcare reform has been the development of the

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too early to determine if the state's new coverage mandate had failed to reduce the emergency room use, but several physicians and policymakers said that it was unlikely that a coverage mandate alone could solve the problems of emergency room crowding and overuse. In August 2009

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President and CEO Denis Cortese has advocated an overall strategy to guide reform efforts. He argued that the U.S. has an opportunity to redesign its healthcare system and that there is a wide consensus that reform is necessary. He articulated four "pillars" of such a strategy:

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argues that U.S. healthcare is rationed, based on income, type of employment, and pre-existing medical conditions, with nearly 46 million uninsured. He argues that millions of Americans are denied coverage or face higher premiums as a result of pre-existing medical conditions.

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Massachusetts reforms are often taken as a model for national reform, "advocates on various sides of the issue said the report underscores the urgency of including cost controls in any large-scale federal or state overhaul." Karen Davenport, director of health policy at the

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are avoidable or wasted. This included: unnecessary services ($ 210 billion annually); inefficient delivery of care ($ 130 billion); excess administrative costs ($ 190 billion); inflated prices ($ 105 billion); prevention failures ($ 55 billion), and fraud ($ 75 billion).

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President Obama further described his plan in a September 2009 speech to a joint session of Congress. His plan mentions: deficit neutrality; not allowing insurance companies to discriminate based on pre-existing conditions; capping out of pocket expenses; creation of an

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care spending. Careful consideration of basic insurance principles is important when considering insurance market reform, in order to avoid unanticipated consequences and ensure the long-term viability of the reformed system. According to one study conducted by the

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Proponents of health care reform argue that moving to a single-payer system would reallocate the money currently spent on the administrative overhead required to run the hundreds of insurance companies in the U.S. to provide universal care. An often-cited study by

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of the highest medical costs are now in states where tort reform had already caused malpractice premiums and lawsuits to drop substantially; unnecessary and injurious procedures are instead caused by a system "often driven to maximize revenues over patient needs."

651:(CBO), the cost of healthcare per person in the U.S. also varies significantly by geography and medical center, with little or no statistical difference in outcome. Comparative effectiveness research has shown that significant cost reductions are possible. Former 1234:

overall spending. Shifting to a single-payer system, by this view, would also eliminate oversight by managed care reviewers, restoring the traditional doctor-patient relationship. Among the organizations in support of single-payer health care in the U.S. is

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In addition, the number of employers who offer health insurance has declined and costs for employer-paid health insurance are rising: from 2001 to 2007, premiums for family coverage increased 78%, while wages rose 19% and prices rose 17%, according to the

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pay through insurance or tax rather than out of pocket. These two needs create cost-efficiency challenges for health care. Some studies have found no consistent and systematic relationship between the type of financing of health care and cost containment.

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The annual rate of cost increases slowed during 2010 and 2011. The causes are disputed, ranging from recession-related delays in visiting doctors to more long-term trends in moderating insurance premiums and reduced spending on structures and equipment.

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expensive treatments. About $ 2.5 billion/year would be required to make Medical school free, which the writers estimated at one-thousandth the total annual healthcare costs. Making medical school free would help address the shortage in their view.

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have each separately noted that health care rationing is not a choice, but an economic necessity. All health care resources are finite and have to be allocated in some way or other. The issue is which way is the most sensible way to do it.

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have found that the United States spends more per-capita than other similarly developed nations but falls below similar countries in various health metrics, suggesting inefficiency and waste. In addition, the United States has significant

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court. There would also be a requirement of full disclosure by hospitals, and all facts would be fed back into the health care system so providers learn from their mistakes. Such an approach has been opposed by trial lawyer lobbyists.

1171:(R-IA) makes similar arguments claiming for example that people like the late Senator Edward Kennedy received health care in the U.S. that would have been denied in countries which have government controlled health care, a claim that 696:

would cost much less. However, preventive care is typically provided to many people who would never become ill, and for those who would have become ill, it is partially offset by the health care costs during additional years of life.

1024:, citing approximately $ 110 billion in unauthorized payments of all types, including Medicare and Medicaid. President Obama has directed his administration to reduce these payments by $ 50 million annually by 2012, less than 1%. 1334:

found that underinsurance disproportionately affects those with lower incomes — 73% of the underinsured in the study population had annual incomes below 200% of the federal poverty level. However, a study published by the

1103:, has argued that "before making coverage mandatory, we need to reform the health insurance market, strengthen public health insurance programs, and finance premium subsidies for people who can’t afford coverage on their own." 5183: 907:

The U.S. had 2.3 doctors per 1,000 people in 2002, ranking 52nd. Germany and France had approximately 3.4 and ranked in the top 25. The OECD average in 2008 was 3.1 doctors per 1,000 people, while the U.S. had 2.4.

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One application of healthcare technology is the creation of registries or databases to relate treatments to outcomes. Useful treatments could be identified and those less useful could be avoided to reduce costs.

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effective care such as prenatal care, which could save the lives of many fetuses and newborn children. Some places, like Oregon for example, do explicitly ration Medicaid resources using medical priorities.

1392:, asserted that 20% to 30% of health care spending is waste. He listed five causes for the waste: (1) overtreatment of patients, (2) the failure to coordinate care, (3) the administrative complexity of the 1296:

are reaching retirement age, which combined with significant annual increases in healthcare costs per person will place enormous budgetary strain on U.S. state and federal governments, particularly through

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stated: "Nearly thirty percent of Medicare's costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level of low-cost areas."

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spending (Medicaid provides long-term care for the elderly poor). Maintaining the long-term fiscal health of the U.S. federal government is significantly dependent on healthcare costs being controlled.

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that the current exclusion of insurance premiums from compensation represents a $ 200 billion subsidy for the private insurance industry and that it would likely not exist without it. In November 2009,

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Deductibles (the amount a person pays before insurance begins to cover claims) have risen sharply. Workers must pay a larger share of their own health costs, and generally forces them to spend less; and

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for individuals and small businesses; tax credits for individuals and small companies; independent commissions to identify fraud, waste and abuse; and malpractice reform projects, among other topics.

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Both Mayo Clinic CEO Dr. Denis Cortese and Surgeon/Author Atul Gawande have argued that such panel(s) will be critical to reform of the delivery system and improving value. Washington Post columnist

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subgroups and is generally higher for younger individuals and lower income individuals. However, research also suggests that subsidies alone are unlikely to solve the uninsured problem in the U.S.

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in outcome. Such scenarios offer the opportunity to maintain or improve the quality of care, while significantly reducing costs, through comparative effectiveness research. According to economist

5449:"Key Issues in Health Reform: The federal government’s role in financing and delivering health care; Lowering the rate of growth of Medicare spending; Advance care planning for serious illness," 5976: 4758: 430: 5425:"Public Health Insurance Plan: Should some uninsured Americans be able to enroll in a newly created, publicly administered health plan as the nation works to expand health insurance coverage?" 858:

reform package that includes caps on jury awards of $ 500,000 for punitive damages and $ 250,000 for "pain and suffering" damages would lower liability insurance premiums by about 10 percent.

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Some conservatives advocate free market reforms such as breaking up state monopolies on insurance and licensing and allowing consumers to purchase health insurance licensed by other states.

6696: 5603: 1167:(R-GA) argued that the reform plans supported by President Obama expand the control of government over healthcare decisions, which he referred to as a type of healthcare rationing. Senator 261: 473:

outlined his strategy for reform. He mentioned electronic record-keeping, preventing expensive conditions, reducing obesity, refocusing doctor incentives from quantity of care to quality,

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healthcare. He contrasted this with lower-cost areas that used salaried doctors and other techniques to reward value, referring to this as a "battle for the soul of American medicine."

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The proportion of workers with employer-sponsored health insurance enrolled in a plan that required a deductible climbed to about three-quarters in 2012 from about half in 2006.

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Patients that are fully insured have no financial incentive to minimize the cost when choosing among alternatives. The overall effect is to increase insurance premiums for all.

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336, no. 11 1997) "concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDs."

208: 97: 1687: 896:, cardiologist Arthur Feldman cited various studies that indicate the U.S. is facing a "critical" shortage of doctors, including an estimated 1,300 general surgeons by 2010. 5718: 5728: 5365: 692:

can incur over half a million dollars in hospital bills in a few months, which must be borne by all other health care consumers, when the same diagnosis at stage one with

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Medicaid recipients could also be provided with tax credits or subsidies to purchase their own private insurance, reducing incentives for them to remain in the program.

6783: 5693: 5688: 5683: 5437:"Health Insurance Reforms: Should there be a new federal law and regulations to broaden coverage and make the market work better for individuals and small businesses?" 5673: 3029:

Roland Brilla; Stefan Evers; Angela Deutschländer; Katja Elfriede Wartenberg (2006). "Are neurology residents in the United States being taught defensive medicine?".

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for treatment of conditions rather than specific services, better identifying and communicating the most cost-effective treatments, and reducing defensive medicine.

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The U.S. is facing shortages of doctors and nurses that are projected to grow worse as America ages, which may drive up the price of these services. Writing in

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lists Medicare as a "high-risk" government program due to its vulnerability to improper payments. Estimates of Medicare fraud or "improper payments" vary. The

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Establish mechanisms for improving the healthcare service delivery system over the long-term, which is the primary means through which value would be improved.

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Doctors are typically paid for services provided rather than with a salary. This provides a financial incentive to increase the costs of treatment provided.

387:, which originated in the Senate and was later passed by the House of Representatives in amended form on March 21, 2010 (with a vote of 219–212). President 8300: 6579: 5214: 352: 178: 8388: 8222: 6616: 2719: 91: 3771: 7156: 7014: 3637: 1669: 964:

estimated that taxing employer-provided health insurance (which is presently exempt from tax) would add $ 215 billion per year to federal tax revenue.

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One July 2012 proposal advocated that consumers of healthcare always have "skin in the game" such that their costs rise as more services are provided.

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that BIR among insurers, physicians, and hospitals in California represented 20–22% of privately insured spending in California acute care settings.

7210: 7183: 6500: 85: 5328: 3253: 8468: 7558: 7518: 5854: 5387: 4714: 4139: 1564:. Click the sources tab under the chart for info on the countries, healthcare expenditures, and data sources. See the later version of the chart 497:

in which we’re paying for quality rather than quantity while also encouraging prevention and wellness." He also argued for bundling payments and

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Politicians on the right tend to be fearful of democratically elected governments becoming involved in rationing decision. Former House Speaker

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Health insurance premiums for employer-provided family coverage 1999–2014. The 3% increase in 2014 was tied for lowest over the 16-year period.

7366: 6284: 5771: 3833:""Health Care Fraud: Schemes to Defraud Medicare, Medicaid and Private Health Insurers" U.S. Government Accountability Office, July 2000 (PDF)" 3704: 1315: 1256: 1043:, if not implemented on a systematic basis with appropriate safeguards, market reform has the potential to cause more problems than it solves. 866:

who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. That is the plain and simple truth."

218: 3453: 8175: 7580: 6816: 6023: 5492: 4353: 2850:"GAO-09-363R Private Health Insurance: 2008 Survey Results on Number and Market Share of Carriers in the Small Group Health Insurance Market" 2667: 2189: 1431: 57: 20: 2054: 1719: 1175:

magazine said was "dangerous" and went on to say that "The reality is that America, like Britain, already makes extensive use of rationing.

7198: 6795: 6611: 6552: 6135: 6093: 5849: 5844: 5839: 5834: 5829: 5824: 5819: 5814: 5809: 5804: 3401: 3095: 2693: 1281:(Medicaid provides free long-term care to the elderly poor). The fiscal and human impact of these issues have motivated reform proposals. 8322: 8165: 8060: 7805: 7543: 6663: 6574: 6316: 6301: 6183: 1453: 5406: 4469: 8148: 7663: 7658: 7648: 7021: 6750: 5998: 5733: 4204: 4189: 2131: 384: 172: 103: 3279: 2969: 683:

Increased use of preventive care (e.g., regular doctor visits) is one way of reducing health care spending. Official budget scores of

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care to more cost-efficient care). The provider network would also purchase insurance for catastrophic (extremely high cost) cases.

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During February 2010, President Obama updated his reform proposal, with modifications to the bills that had passed as of that time.

8364: 8160: 7653: 7141: 7081: 6641: 6296: 6188: 6038: 5663: 4556: 3181: 1235: 411: 5145:. How Money, Power, and the Pursuit of Self-Interest Have Imperiled the American Dream. Cornell University Press. pp. 39–77. 4799: 4727: 1783: 8270: 8243: 8202: 8197: 8170: 8100: 7987: 7783: 7590: 7178: 7002: 6900: 6532: 462: 4677: 4275: 4013: 8371: 8080: 7763: 7668: 7498: 7446: 7407: 6974: 6969: 6823: 6760: 6713: 6691: 6656: 6311: 6167: 4157: 116: 39: 2641: 2592: 1289:

commented that the high costs paid by U.S. companies for their employees' health care put them at a competitive disadvantage.

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signed the reforms into law on March 23, 2010. Reuters and CNN summarized the reforms and the year in which they take effect.

8187: 8075: 7945: 7849: 7758: 7682: 7227: 7193: 6208: 6198: 6193: 6051: 6046: 5910: 5875: 4326: 3570: 1809: 5413:"Individual Mandate: Congress is now weighing different versions of a requirement that individuals obtain health insurance," 5240: 1579: 623:

has also recommended that President Obama engage someone like Cortese to have a more active role in driving reform efforts.

8383: 8280: 8217: 8207: 8090: 7881: 7844: 7773: 7605: 7570: 7121: 6851: 6584: 6355: 6306: 6279: 6203: 6162: 5553: 5465: 5460: 4825: 4252: 3966: 2457: 2210:"Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis" 1886: 1553: 4963:

Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Bor, David H.; Himmelstein, David U. (2009).

4826:"Health Insurance Premiums Rise 6.1% In 2007, Less Rapidly Than In Recent Years But Still Faster Than Wages And Inflation" 4092: 8473: 8339: 8327: 8265: 8022: 7513: 7412: 7009: 6668: 6564: 6448: 3031: 2619: 3864: 3832: 3293: 2983: 2405: 2259: 2106: 806:

Critics have argued that the healthcare system has several incentives that drive costly behavior. Two of these include:

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societies) developed the lists after months of analyses and reviews of the medical literature by expert committees. The

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Several studies have attempted to explain the reduction in the rate of annual increase. Reasons include, among others:

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Higher unemployment due to the 2008–2012 recession, which has limited the ability of consumers to purchase healthcare;

426: 8354: 8334: 8285: 8275: 8143: 8065: 8042: 8002: 7866: 7856: 7733: 7708: 7615: 7595: 7073: 6863: 6589: 5971: 5618: 5485: 5158: 5114: 5058: 4969: 3790: 3363: 1629:

Meredith; Sharfstein, Joshua; Shortell, Stephen; Stern, Andrew; Orszag, Peter R.; Spiro, Topher (September 6, 2012).

1261: 1941: 1325:. Even for those who are employed, the private insurance in the US varies greatly in its coverage; one study by the 1111:

mandates would be constitutional, and state initiatives opposing federal mandates may lead to litigation and delay.

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reported in 2002 (using 2000 data) the following statistics regarding insurance competition in state markets: "The

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Standard Option. One indicator of the consequences of Americans' inconsistent health care coverage is a study in

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that concluded that half of personal bankruptcies involved medical bills, although other sources dispute this.

726:

editorial board wrote: "Eliminating needless care is not rationing. It is sound medicine and sound economics."

4633:"The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals" 2578: 8128: 7992: 7908: 7839: 7810: 7748: 7638: 7610: 7254: 6626: 6519: 5757: 4908: 3993: 3768: 1470: 498: 2069: 929: 8423: 8416: 8349: 8212: 8095: 8017: 8007: 7861: 7822: 7778: 7738: 7695: 7643: 7575: 7548: 7508: 7486: 7295: 7109: 7056: 6989: 6846: 6802: 6730: 6651: 6569: 6380: 6244: 6073: 5981: 5789: 5478: 4787: 3769:

Medicare: More Effective Screening and Stronger Enrollment Standards Needed for Medical Equipment Suppliers

2313: 1862:

Cathy Schoen, Stuart Guterman, Anthony Shih, Jennifer Lau, Sophie Kasimow, Anne Gauthier, and Karen Davis,

1100: 555: 5292: 3662: 2752: 8344: 8295: 8110: 8012: 7935: 7817: 7713: 7538: 7523: 7461: 7096: 7051: 6858: 6740: 6594: 4462: 3711: 1532: 1266: 1189: 1107: 938: 854: 701: 648: 251: 5341: 3728: 3257: 3007: 1238:(PNHP), an organization of some 17,000 American physicians, medical students, and health professionals. 8248: 8118: 7950: 7930: 7918: 7728: 7718: 7400: 7305: 6918: 6908: 6435: 6430: 6420: 6415: 5937: 4301: 4011:"The Economics of "Pay or Play" Employer Mandates: Who Gets What From Employer "Pay or Play" Mandates," 3231: 2900: 2275:"In the Balance: Some Candidates Disagree, but Studies Show It's Often Cheaper To Let People Get Sick," 1841: 798:

be to afflict the afflicted, to make the lives of Americans with pre-existing conditions even harder."

4436: 3028: 2027: 441: 7827: 7133: 6938: 6933: 6495: 5949: 5698: 5608: 5518: 4731: 2383:"CDC-Recommended Community Strategies and Measurements to Prevent Obesity in the U.S.- July 24, 2009" 1484: 700:

Preventing obesity and overweight conditions presents a significant opportunity to reduce costs. The

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Washington Post-Ezra Klein-21 graphs that show America’s health-care prices are ludicrous-March 2013

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How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?

4140:"Bay State health insurance premiums highest in country: Rein in health costs, Massachusetts urged," 3701: 8463: 8458: 7940: 7320: 7290: 7285: 7275: 7041: 6997: 6838: 6599: 6385: 6249: 6063: 6003: 5538: 4894: 4605: 3460: 1343: 1335: 1322: 1298: 1274: 1075: 1033: 256: 4580: 4361: 4227: 3489: 2671: 2186: 1864:"Bending the Curve: Options for Achieving Savings and Improving Value in the U.S. Health Spending" 1726: 688:

reducing inappropriate preventative care measures. A single uninsured cancer patient diagnosed at

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Washington Post-Ezra Klein-Why an MRI costs $ 1,080 in America and $ 280 in France-March 15, 2013

4600: 4043: 3724: 1401: 1388:

In December 2011 the outgoing Administrator of the Centers for Medicare & Medicaid Services,

1211: 1051: 972: 446: 419: 296: 3619: 3405: 3074: 2431: 2138: 1987:

Centers for Medicare and Medicaid Services-Statistics, Trends and Reports-Retrieved June 9, 2013

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Focus on value, which he defined as the ratio of quality of service provided relative to cost;

8085: 7768: 6883: 6440: 6405: 6400: 6343: 6326: 6056: 5653: 5049:

Craig, David M. (January 1, 2014). "Health Care as a Social Good". In CRAIG, DAVID M. (ed.).

4850: 4637: 4466: 4117:"ER visits, costs in Mass. climb: Questions raised about healthcare law's impact on overuse," 1400:

Justice and the FBI in 2012, longer jail sentences specified by the Affordable Care Act, and

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Health insurance premiums paid on behalf of workers are increasingly offsetting compensation.

684: 458: 273: 153: 5342:"Bloomberg-McCain Charges Democrats Pandering to Drugmakers on Import Ban-December 11, 2009" 5215:"Republicans Darkest Fears Realized: ACA Causes Number of Uninsured to Drop Across All Ages" 4527: 3788:

Medicare Fraud and Abuse: DOJ Continues to Promote Compliance with False Claims Act Guidance

2874: 8437: 7565: 7439: 7330: 6708: 6140: 6120: 6068: 6018: 5959: 5890: 5598: 5588: 5533: 5528: 324: 268: 147: 8: 7977: 7893: 7703: 7419: 7104: 6735: 5932: 5573: 3868: 3742:""High-Risk Series: An Update" U.S. Government Accountability Office, January 2009 (PDF)" 3350: 2511:"Lifetime medical costs of obesity: prevention no cure for increasing health expenditure" 2382: 2291:"CDC Home Page-Economic Consequences of Overweight and Obesity-Retrieved October 6, 2009" 2277: 1960: 892: 835: 399: 5141:

Ehrenreich, John (January 1, 2016). "The Health of Nations". In Ehrenreich, John (ed.).

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costs (insurance and lawsuits, for example) are significant and should be addressed via

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Cathy Schoen; Michelle M. Doty; Sara R. Collins; Alyssa L. Holmgren (June 14, 2005).

4674: 4656: 4183: 4010: 3684: 3566: 3048: 2542: 2241: 1873: 1650: 1561: 1326: 1064: 540: 4936: 4164: 4039: 2596: 2290: 1630: 1565: 7876: 7723: 7429: 7249: 6259: 6100: 6083: 6078: 5917: 5146: 4986: 4978: 4916: 4860: 4646: 4552: 4143: 4120: 4064: 3676: 3646: 3598: 3402:"American Association of Colleges of Nurses-Fact Sheet-Retrieved September 7, 2009" 3159: 3044: 3040: 2777: 2645: 2532: 2522: 2231: 2221: 1642: 1611: 1377: 1270: 1168: 1095: 1090: 693: 644: 5013:

A 1997 study carried out by Professors David Himmelstein and Steffie Woolhandler (

4330: 3454:"Long-Term Budget Outlook and Options for Slowing the Growth of Health Care Costs" 3060: 1813: 1269:

and significant impending unfunded liabilities from its aging demographic and its

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Centers for Medicare and Medicaid Services-National Health Expenditure Data-2012

4829: 3963: 3808:""White House Reports Billions of Improper Payments in 2009" CNN, November 2009" 8055: 7955: 7338: 6473: 6463: 6458: 6453: 6125: 5988: 5922: 5452: 5440: 5428: 5416: 5401: 5018: 4070: 3934: 3667: 3562: 1894: 1756: 1692: 1389: 1330: 1286: 1059: 977: 941:

has described how the tax treatment of insurance premiums may affect behavior:

874: 689: 631: 620: 527: 306: 5470: 5150: 4888: 4651: 4632: 3680: 3108: 8452: 7036: 6336: 6145: 5780: 5372: 5068: 4982: 4828:(Press release). Kaiser Family Foundation. September 11, 2007. Archived from 3428: 3134: 2694:"Washington Post-Robert Samuelson-Paul Ryan's Lonely Challenge-February 2010" 1164: 1079: 961: 5124: 3865:"Medical Fraud a Growing Problem: Medicare Pays Most Claims Without Review," 3839: 873:

In 2004, the CBO studied restrictions on malpractice awards proposed by the

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In August 2009, physician and former Democratic National Committee Chairman

7343: 7315: 6370: 5000: 4928: 4874: 4865: 4852: 4693: 4660: 4074: 4006: 3688: 3586: 3554: 3294:"Feldman-Washington Post-Ten Things I Hate About Healthcare Reform-Sept 09" 3052: 2953:"Beyond Obamacare: How to Fix Our Enormous, Inefficient Health-Care System" 2849: 2825: 2546: 2361:"WebMD-Retrieved October 6, 2009-Obesity Costs U.S. $ 147 billion per year" 2245: 2226: 1654: 1293: 1140: 1133: 950: 794: 656: 532: 493: 470: 388: 5466:

CBO-Key Issues in Analyzing Major Health Insurance Proposals-December 2008

4920: 4245: 3787: 3741: 1646: 845:

How much these costs are is a matter of debate. Philip Howard argued that

7620: 7151: 6488: 6390: 6130: 5993: 5749: 5366:

Time Magazine-Steven Brill-Why Medical Bills Are Killing Us-February 2013

4715:

Washington Post-Samuelson-Curbing the Costs of High-Tech Health-July 2012

4302:"NYT-Leonhardt-Healthcare Rationing Rhetoric Overlooks Reality-June 2009" 3729:"Subsidies and the Demand for Individual Health Insurance in California," 2901:"NYT-Leonhardt-In Health Reform, A Cancer Offers and Acid Test-July 2009" 1376:

Another concern is the rate of uninsured people in the US. In June 2014,

1017:

networks, which should assist Medicare in identifying fraudulent claims.

1013: 862: 846: 839: 504: 4788:

http://www.economist.com/media/globalexecutive/coming_gen_storm_e_02.pdf

4596: 3882: 3661:

Gabel, Jon; Pickreign, Jeremy; McDevitt, Roland; Briggs, Thomas (2009).

2644:. Roadmap.republicans.budget.house.gov. January 26, 2011. Archived from 1752:"Remarks by the President to a Joint Session of Congress-September 2009" 1615: 635:

Medicare spending per person varied significantly across states in 2006.

6483: 6289: 6115: 6110: 6028: 2406:"Washington Post-U.S. Obesity Epidemic Continues to Grow-July 17, 2008" 610:

healthcare policy experts, as summarized by OMB Director Peter Orszag:

5402:

Slate's online guide to the health care reform bill. – By Timothy Noah

4467:"Evidence on the Costs and Benefits of Health Information Technology," 2487: 1956:"Washington Post-Sarah Kliff-Healthcare spending slowdown-August 2012" 829: 461:

reported in September 2012 that approximately $ 750B per year in U.S.

7972: 7965: 5051:

Health Care as a Social Good: Religious Values and American Democracy

3907: 2800:"Newt Gingrich-LAT Times-Healthcare Rationing-Real Scary-August 2009" 2484:"CNN-Obesity Care May Cost Twice Previous Estimates-October 15, 2010" 1557: 4500: 1921:"OECD-Health Data 2012-How Does the United States Compare-June 2012" 1533:"CNN-Timeline-When Healthcare Reform Will Affect You-March 23, 2010" 6155: 6105: 4950: 4501:"Newsweek-The Hospital That Could Cure Healthcare-December 7, 2009" 4276:"NYT-President Obama-Why We Need Healthcare Reform-August 15, 2009" 4087: 4085: 4083: 4066:

Massachusetts' Obama-like Reforms Increase Health Costs, Wait Times

4034: 4032: 4030: 4028: 4026: 3915: 3641: 3603: 3590: 1302: 1278: 916: 4906: 2620:"Bloomberg-Orszag-Cost Sharing is No Way to Fix Medicare-May 2011" 1554:

Link between health spending and life expectancy: US is an outlier

706: 437:). 11.2% for Canada in 2022. 16.6% for the United States in 2022. 4962: 4327:"Peter G. Peterson on Charlie Rose-July 3, 2009-About 17 min in" 4080: 4023: 3702:"The Price Sensitivity of Demand for Nongroup Health Insurance," 3376:"Forbes-Bruce Bartlett-Health Care Costs & Reform-July 2009" 2720:"Forbes-Bartlett-Paul Ryan's Budgetary Holy Grail-February 2010" 2668:"Roadmap for America's Future-Charts & Graphs-February 2010" 2509:

van Baal PH, Polder JJ, de Wit GA, et al. (February 2008).

885: 5391: 5107:

To Live and Die in America: Class, Power, Health and Healthcare

5025:, Vicente Navarro, September 2003. Retrieved September 10, 2009 3964:"Health Insurance Market Reforms: What They Can and Cannot Do," 3958: 3956: 3902: 3900: 3898: 3896: 3541:"Economic Survey of the United States 2008: Health Care Reform" 3075:"CNN-Tort reform could save $ 54 billion,CBO Report Says-Oct 9" 2458:"WSJ-Another Thing Big in Japan-Measuring Waistlines-June 2008" 1670:"How the U.S. Health-Care System Wastes $ 750 Billion Annually" 778: 572:

to 17.9% by 2009, but remained at that level in 2010 and 2011.

403:

Life expectancy vs healthcare spending of rich OECD countries.

4853:"Insured But Not Protected: How Many Adults Are Underinsured?" 3987:'Fundamentals of Insurance: Implications for Health Coverage," 3008:"Bloomberg-Malpractice Lawsuits are Red Herring in Obama Plan" 4887:

Dale Yamamoto, Tricia Neuman and Michelle Kitchman Strollo,

3953: 3893: 3660: 2132:"Peter Diamond-Healthcare and Behavioral Economics-May 2008" 1627: 374:

health care reforms proposed during the Obama administration

4587:, America's Health Insurance Plans, has some 1,300 members. 3946: 3930:"Whitehouse-Improper Payments Elimination and Recovery Act" 3642:"Do I have a "Cadillac Plan"? An Explainer health care FAQ" 2826:"GAO-Letter to Honorable Christopher "Kit" Bond-March 2002" 2091: 1906: 1887:"President Obama's Plan – February 2010-Whitehouse Website" 1769: 1705: 1603: 1118:

upheld the individual mandate provision as Constitutional.

1058:

Arguing against requiring individuals to buy coverage, the

746: 4907:

Himmelstein DU, Warren E, Thorne D, Woolhandler S (2005).

3559:

Crisis of Abundance: Rethinking How We Pay for Health Care

2927:"Atul Gawande – Testing, Testing-New Yorker-December 2009" 501:, which reward doctors for teamwork and patient outcomes. 422:. $ 6,319 for Canada in 2022. $ 12,555 for the US in 2022. 2972:

RCP-Roth-The High Cost of Medical Malpractice-August 2009

2875:"Paul Krugman-Afflicting the Afflicted-February 25, 2010" 786: 774: 5175: 4951:"An Economic Analysis of the Consumer Bankruptcy Crisis" 4111: 4109: 4107: 3663:"Taxing Cadillac Health Plans May Produce Chevy Results" 3620:"Congress Is Split on Effort to Tax Costly Health Plans" 3490:"NYT-Singer-Why We Must Ration Healthcare-July 15, 2009" 2055:"What Republicans Misunderstand About Health-Care Costs" 1810:"Denis Cortese Interview on Charlie Rose Show-July 2009" 1631:"A Systemic Approach to Containing Health Care Spending" 1580:"America's inefficient health-care system: another look" 1178: 379:

The first of these reform proposals to be passed by the

3618:

Herszenhorn, David M.; Robert Pear (October 12, 2009).

4577: 4354:"Time Magazine-Ethics: Rationing Medical Care-Sept 09" 3912:

CBS-60 Minutes-Medicare Fraud-A $ 60 Trillion Business

3617: 2670:. Roadmap.republicans.budget.house.gov. Archived from 2207: 2067: 1784:"Charlie Rose-Peter Orszag Interview-November 3, 2009" 1022:

Improper Payments Elimination and Recovery Act of 2010

1020:

During July 2010, President Obama signed into law the

765: 4630: 4619:

Costs of Health Administration in the U.S. and Canada

4104: 4059: 4057: 4055: 4053: 3727:, Jose J. Escarce, Kanika Kapur, and Jill M. Yegian, 3429:"Newsweek-The Doctor Won't See You Now-February 2010" 3320:"Forbes-The Doctor Drought-Marc Siegel-December 2009" 1241: 626: 4134: 4132: 4130: 3797:, GAO Report to Congressional Committees, April 2002 3533: 2508: 1425: 4487:"Smart Health-Care Strategy Hidden in 'Cliff' Deal" 4384:"LA Times-Gingrich-Healthcare Rationing-Real Scary" 3280:"Costly Medicare Mistakes You Can't Afford to Make" 2165:"Gawande-Testing, Testing-New Yorker-December 2009" 1688:"Remarks by the President to the AMA-June 15, 2009" 1106:Addressing the issue when it was proposed in 1994, 830:

Medical malpractice liability costs and tort reform

5105:Chernomas, Robert; Hudson, Ian (January 1, 2013). 4909:"Illness and injury as contributors to bankruptcy" 4759:"Buffett says economy recovering but at slow rate" 4050: 3857: 3351:"Opinion | Why Medical School Should Be Free" 2314:"WSJ-Cost of Treating Obesity Soars-July 28, 2009" 2000:"Slowdown in Rise of Healthcare Costs May Persist" 1404:—volunteers trained to identify and report fraud. 1309: 971:Some have proposed an "excise tax" for high cost ' 732: 5290: 5241:"Rate of uninsured Americans is dropping: Gallup" 5232: 4621:, Woolhandler, et al., NEJM 349(8) Sept. 21, 2003 4127: 3098:RCP-Roundtable on Health Reform Costs-August 2009 2642:"Republican Website-Roadmap for America's Future" 2057:. January 14, 2013 – via www.bloomberg.com. 1342:(PPO) plan in 2007 was more generous than either 8450: 7184:Native American recognition in the United States 5184:"SURVEY: UNINSURED RATE DROPS; HEALTH LAW CITED" 5053:. Georgetown University Press. pp. 85–120. 4800:"Charlie Rose-Peter Orszag Interview Transcript" 4597:"The Health Care Crisis and What to Do About It" 4489:. January 8, 2013 – via www.bloomberg.com. 3927: 2981: 2185:Physicians for a National Health Program (2008) 1835: 1833: 1831: 1599: 1597: 1471:"House sends health care overhaul bill to Obama" 1183: 801: 5500: 5267:"Health Official Takes Parting Shot at 'Waste'" 5181: 5104: 4040:"Insurance Mandates Draw Flak From Both Sides," 3591:"Health Care Financing, Efficiency, and Equity" 3515:"The Economist-Stemming the Tide-November 2009" 3426: 3349:Bach, Peter B.; Kocher, Robert (May 28, 2011). 2107:"Washington Post-Paging Dr. Reform-August 2009" 592:Increasing healthcare costs also contribute to 4631:Kahn JG, Kronick R, Kreger M, Gans DN (2005). 4077:on August 27, 2009 (accessed October 16, 2009) 3483: 3481: 1446: 1338:in 2008 found that the typical large employer 1316:Health insurance coverage in the United States 1257:Health care reform debate in the United States 716: 604: 449:, compared amongst various first world nations 7581:Greenhouse gas emissions by the United States 5765: 5486: 5407:Washington Post's Ezra Klein on Health Reform 5036:"Study calls wide Mass. coverage a lifesaver" 4965:"Health Insurance and Mortality in US Adults" 4624: 2572: 2570: 2432:"NYT-Leonhardt-The Way We Live-Fat Tax-Aug 9" 2208:Hogg, W.; Baskerville, N; Lemelin, J (2005). 1842:"The New Yorker-The Cost Conundrum-June 2009" 1828: 1594: 1432:Prescription drug prices in the United States 886:Addressing the shortage of doctors and nurses 353: 21:Healthcare reform debate in the United States 5461:President's Proposal Summary – February 2010 4818: 4020:Employment Policies Institute, November 2007 3731:Health Services Research 39:5 (October 2004) 3256:. CBSNews.com. March 5, 2009. Archived from 1997: 1571: 1485:"CNN-Obama Signs Health Bill-March 23, 2010" 1407: 179:Health Care and Education Reconciliation Act 5182:ALONSO-ZALDIVAR, RICARDO (March 10, 2014). 4203:Seelye, Katharine Q. (September 26, 2009). 3611: 3478: 3364:NationMaster.com-Retrieved December 4, 2009 3001: 2999: 2997: 2593:"CBO-High Cost Medicare Beneficiaries-2005" 2025: 5779: 5772: 5758: 5493: 5479: 5206: 5140: 4673:Physicians for a National Health Program. 4253:"Supreme Court upholds individual mandate" 4073:, Reprint of article that appeared in the 3348: 3154: 3152: 2567: 1991: 1499: 418:. Public and private spending. US dollars 385:Patient Protection and Affordable Care Act 360: 346: 7194:Federally recognized Alaska Native tribes 4990: 4864: 4719: 4650: 4528:"Krugman-One Nation, Uninsured-June 2005" 4299: 3602: 2898: 2536: 2526: 2429: 2235: 2225: 2068:Peter Orszag, Director (August 4, 2009). 2019: 1577: 1454:House passes historic healthcare overhaul 1348:Federal Employees Health Benefits Program 1227:Canadian Institute for Health Information 1128:Healthcare rationing in the United States 994: 975:' insurance plans. A study published in 818:together for the best possible results." 741: 5381:) is being considered for deletion. See 4557:Physicians for a National Health Program 4408: 4093:"Should Health Insurance Be Mandatory?," 3005: 2994: 2563:. April 9, 2012 – via NYTimes.com. 2403: 2104: 1414:International Federation of Health Plans 1236:Physicians for a National Health Program 1205: 1151:Former Republican Secretary of Commerce 928: 747:Privatize Medicare with a voucher system 678: 630: 554: 515:Pay for and align incentives with value; 454:strategies have been suggested as well. 440: 425: 410: 398: 7245:List of counties and county equivalents 5388:Health Care Reform in the United States 5291:Phipps, Jennie L. (February 21, 2013). 4859:. Suppl Web Exclusives: W5–289–W5–302. 4525: 3229: 3206: 3149: 2946: 2944: 2924: 2872: 2778:"Cato-A Free Market can fix healthcare" 2617: 2561:"Opinion | Do You Need That Test?" 2162: 1839: 1262:International comparisons of healthcare 1196: 8469:Healthcare reform in the United States 8451: 5339: 5238: 5212: 5136: 5134: 5100: 5098: 4202: 4188:: CS1 maint: archived copy as title ( 3487: 2950: 2746:"CBO-Ryan Roadmap Letter-January 2010" 2579:"Opinion | A Choice, Not a Whine" 2576: 2481: 1396:, (4) burdensome rules and (5) fraud. 5753: 5474: 5340:Jensen, Kristin (December 11, 2009). 5048: 5019:The Inhuman State of U.S. Health Care 4915:. Suppl Web Exclusives: W5–63–W5–73. 4667: 4351: 4273: 4225: 3765:U.S. Government Accountability Office 3585: 3553: 3547: 3427:Mary Carmichael (February 25, 2010). 2311: 2082:from the original on February 3, 2017 1505: 1179:Better usage of healthcare technology 469:During a June 2009 speech, President 5264: 4756: 4409:Cummings, Jeanne (August 22, 2009). 4226:Davey, Monica (September 28, 2009). 3636: 3630: 3184:. Physiciansnews.com. Archived from 2941: 2618:Bratton, William J. (May 24, 2011). 2455: 2430:Leonhardt, David (August 12, 2009). 2258:Nicholas Kristof (October 17, 2012) 1667: 1121: 1027: 989: 445:Health spending per capita, in US$ 5131: 5095: 4725: 3962:Linda J. Blumberg and Len Nichols, 3032:Clinical Neurology and Neurosurgery 2873:Krugman, Paul (February 25, 2010). 2105:Ignatius, David (August 20, 2009). 1547: 1074:opinion blog "Room for Debate" the 766:Insurance company antitrust reforms 123:America's Affordable Health Choices 13: 4802:. November 3, 2009. Archived from 4413:. Dyn.politico.com. Archived from 4300:Leonhardt, David (June 17, 2009). 3928:Katelyn Sabochik (July 22, 2010). 3326:. December 4, 2009. Archived from 2982:Philip K. Howard (July 31, 2009). 2456:Wang, Shirley S. (June 13, 2008). 2404:Reinberg, Steven (July 17, 2008). 1608:Health resources - Health spending 1383: 1242:Reduce costs of imaging technology 627:Comparative effectiveness research 117:Affordable Health Care for America 79:Social Security Amendments of 1965 14: 8485: 6590:Director of National Intelligence 5385:to help reach a consensus. › 5359: 5265:Pear, Robert (December 3, 2011). 4970:American Journal of Public Health 4329:. Charlierose.com. Archived from 4274:Obama, Barack (August 15, 2009). 4207:. Prescriptions.blogs.nytimes.com 2951:Howard, Philip K. (May 7, 2012). 2899:Leonhardt, David (July 7, 2009). 2482:Stobbe, Mike (October 15, 2010). 1938:"OECD Health Data 2012-June 2012" 1812:. Charlierose.com. Archived from 1668:Fung, Brian (September 7, 2012). 1578:Kenworthy, Lane (July 10, 2011). 1426:Importation of prescription drugs 1292:Further, an estimated 77 million 663: 599: 372:There were a number of different 6746:Government Accountability Office 5614:Saint Vincent and the Grenadines 5432:Policy Brief, November 10, 2009. 5333: 5322: 5311: 5284: 5258: 5213:Easley, Jason (March 10, 2014). 5042: 5028: 5007: 4956: 4943: 4900: 4881: 4844: 4792: 4781: 4750: 4708: 4686: 4612: 4590: 4570: 4545: 4519: 4493: 4479: 4455: 4429: 4402: 4376: 4345: 4319: 4293: 4267: 4219: 4196: 4150: 4095:"Room for Debate" opinion blog, 3999: 3979: 3921: 3230:Gawande, Atul (August 1, 2011). 3207:Gawande, Atul (August 1, 2011). 3006:Nussbaum, Alex (June 16, 2009). 2925:Gawande, Atul (August 1, 2011). 2260:"Scott’s Story and the Election" 2163:Gawande, Atul (August 1, 2011). 1840:Gawande, Atul (August 1, 2011). 1082:, former editor-in-chief of the 1001:Government Accountability Office 550: 416:Total healthcare cost per person 329: 318: 5444:Policy Brief, October 21, 2009. 5420:Policy Brief, January 13, 2010. 5015:New England Journal of Medicine 4526:Krugman, Paul (June 13, 2005). 3875: 3825: 3800: 3781: 3778:, GAO-05-656 September 22, 2005 3758: 3734: 3717: 3695: 3654: 3579: 3507: 3488:Singer, Peter (July 19, 2009). 3446: 3420: 3394: 3368: 3357: 3342: 3312: 3286: 3272: 3246: 3223: 3200: 3174: 3127: 3101: 3089: 3067: 3022: 2975: 2963: 2918: 2892: 2866: 2842: 2818: 2792: 2770: 2738: 2712: 2686: 2660: 2634: 2611: 2585: 2553: 2502: 2475: 2449: 2423: 2397: 2375: 2353: 2331: 2305: 2283: 2267: 2252: 2201: 2179: 2156: 2124: 2098: 2075:Office of Management and Budget 2061: 2047: 1980: 1948: 1930: 1913: 1879: 1856: 1802: 1776: 1744: 1712: 1680: 1661: 1635:New England Journal of Medicine 1506:Smith, Donna (March 19, 2010). 1452:Noam N. Levey and Janet Hook, " 1420: 1340:preferred provider organization 1310:Insurance cost and availability 1084:New England Journal of Medicine 1005:Office of Management and Budget 733:Address expensive chronic cases 8389:Separation of church and state 6605:National Reconnaissance Office 6548:President of the United States 5456:Policy Brief, August 20, 2009. 5239:Howell, Tom (March 10, 2014). 4728:"World Health Statistics 2009" 3045:10.1016/j.clineuro.2005.05.013 2577:Brooks, David (July 3, 2012). 2312:Mckay, Betsy (July 28, 2009). 1621: 1582:. Consider the Evidence (blog) 1525: 1477: 1463: 582:Rising out-of-pocket payments; 499:accountable care organizations 405:US average of $ 10,447 in 2018 199:Obama administration proposals 1: 5370: 3994:American Academy of Actuaries 2984:"Health Reform's Taboo Topic" 2028:"Healthcare Costs and Budget" 1440: 1250: 1184:Automation of patient records 924: 802:Reform of doctor's incentives 6751:Government Publishing Office 6219:Technological and industrial 5739:United States Virgin Islands 5501:Healthcare in North America 5293:"How big is Medicare fraud?" 5038:. Boston Globe. May 5, 2014. 4953:, 99 NWU L. Rev. 1463 (2005) 4857:Health Affairs Web Exclusive 4765:. SFGate.com. Archived from 4757:Funk, Josh (March 1, 2010). 4352:Elson, John (May 15, 1989). 3595:NBER Working Paper No. 13881 2780:. Cato.org. October 21, 2009 2528:10.1371/journal.pmed.0050029 2214:BMC Health Services Research 1101:Center for American Progress 757:Roadmap for America's Future 16:Proposed health care reforms 7: 8223:Women's reproductive health 7189:Federally recognized tribes 7052:Public utilities commission 6956:Public Health Service Corps 6859:Code of Federal Regulations 6741:Congressional Budget Office 6595:Central Intelligence Agency 6501:Water supply and sanitation 5928:Declaration of Independence 4463:Congressional Budget Office 4038:Janet Adamy and Greg Hitt, 3712:Congressional Budget Office 2187:"Single Payer System Cost?" 1193:all the projected savings. 1190:Congressional Budget Office 939:Congressional Budget Office 855:Congressional Budget Office 717:Eliminate unnecessary tests 702:Centers for Disease Control 649:Congressional Budget Office 605:Independent advisory panels 394: 10: 8490: 8474:Presidency of Barack Obama 7401:Red states and blue states 7306:City commission government 7301:Council–manager government 4583:November 11, 2009, at the 4472:February 19, 2012, at the 4016:November 26, 2007, at the 2486:. NBC News. Archived from 2070:"OMB Director Orszag-IMAC" 1429: 1364:medical–industrial complex 1313: 1254: 1209: 1125: 1031: 647:and research cited by the 539:A report published by the 431:Health spending by country 286:Third-party payment models 98:Medicare Modernization Act 18: 8410: 8236: 8109: 8041: 7694: 7690: 7681: 7629: 7494: 7485: 7381: 7352: 7329: 7268: 7235: 7226: 7169: 7157:Comparison of governments 7132: 7095: 7072: 6988: 6968: 6899: 6837: 6759: 6682: 6540: 6531: 6527: 6518: 6240: 6231: 6176: 6136:Post-Cold War (1991–2008) 5977:drafting and ratification 5950:Articles of Confederation 5863: 5797: 5788: 5714:Saint Pierre and Miquelon 5632: 5506: 5151:10.7591/9781501703591-004 4732:World Health Organization 4652:10.1377/hlthaff.24.6.1629 3969:January 12, 2015, at the 3707:October 12, 2011, at the 3681:10.1377/hlthaff.2008.0430 3543:. OECD. December 9, 2008. 2595:. Cbo.gov. Archived from 2293:. Cdc.gov. March 28, 2011 2192:December 6, 2010, at the 1998:Annie Lowrey (May 2013). 1408:International comparisons 834:Critics have argued that 242:Health insurance exchange 8176:Prescription drug prices 7296:Mayor–council government 7286:Coterminous municipality 7276:Consolidated city-county 7042:Agriculture commissioner 6692:House of Representatives 6600:National Security Agency 6250:Contiguous United States 5734:Turks and Caicos Islands 5459:President Barack Obama, 5383:templates for discussion 4983:10.2105/AJPH.2008.157685 4895:Kaiser Family Foundation 4606:New York Review of Books 3793:August 24, 2006, at the 3353:– via NYTimes.com. 2581:– via NYTimes.com. 2341:. Cdc.gov. March 3, 2011 2026:Yuval Levin (May 2013). 1336:Kaiser Family Foundation 1323:Kaiser Family Foundation 1076:single-payer health care 1034:Health insurance mandate 325:United States portal 142:American Health Care Act 41:Healthcare reform in the 30:This article is part of 8261:Criticism of government 7606:Social welfare programs 7199:State-recognized tribes 6184:Outline of U.S. history 5896:Continental Association 4763:San Francisco Chronicle 4675:"What is Single Payer?" 4476:Pub. No. 2976, May 2008 4044:The Wall Street Journal 4005:Richard Burkhauser and 3725:Melinda Beeuwkes Buntin 3077:. CNN. October 12, 2009 2462:The Wall Street Journal 2318:The Wall Street Journal 1720:"Summary of Obama Plan" 1402:Senior Medicare Patrols 1212:Single-payer healthcare 488:In November 2009, then- 8323:Environmental movement 8166:Health insurance costs 8061:Educational attainment 7586:Federal Reserve System 7544:Science and technology 7047:Insurance commissioner 6585:Intelligence Community 6280:minor outlying islands 6043:Civil rights movement 5664:British Virgin Islands 5169:10.7591/j.ctt1h4mjdm.6 4866:10.1377/hlthaff.w5.289 4680:June 16, 2009, at the 4576:The trade association 3985:Uninsured Work Group, 3774:June 23, 2008, at the 2227:10.1186/1472-6963-5-20 2033:National Review Online 1869:March 4, 2016, at the 1223:Harvard Medical School 1114:On June 28, 2012, the 995:Address Medicare fraud 948: 934: 742:Market-based solutions 694:preventative screening 676: 636: 617: 560: 450: 438: 435:Gross domestic product 423: 408: 381:United States Congress 336:Health care portal 292:All-payer rate setting 247:Nationalized insurance 209:Reform advocacy groups 8149:Immigrant health care 7664:Transportation safety 7659:Transportation policy 7649:Public transportation 6719:President pro tempore 6575:Executive departments 6344:National Park Service 5999:Territorial evolution 5604:Saint Kitts and Nevis 5143:Third Wave Capitalism 4921:10.1377/hlthaff.w5.63 4913:Health Aff (Millwood) 4638:Health Aff (Millwood) 3188:on September 28, 2011 3096:Realclearpolitics.com 1732:on September 10, 2009 1657:– via CrossRef. 1647:10.1056/NEJMsb1205901 1535:. CNN. March 23, 2010 1487:. CNN. March 23, 2010 1430:Further information: 1314:Further information: 1206:Payment system reform 943: 932: 853:A 2004 report by the 755:(R) has proposed the 685:universal health care 679:Preventive strategies 671: 634: 612: 558: 459:Institute of Medicine 444: 429: 414: 402: 262:Canadian vs. American 154:Healthy Americans Act 8318:Environmental issues 7983:Political ideologies 7882:Indigenous languages 7082:List of legislatures 6879:separation of powers 6580:Independent agencies 6506:World Heritage Sites 6141:September 11 attacks 6064:Spanish–American War 6004:Mexican–American War 5960:Confederation period 5891:Continental Congress 5188:The Associated Press 4417:on February 27, 2012 4364:on November 22, 2009 3640:(October 14, 2009). 3182:"Physiciansnews.com" 2970:Realclearmarkets.com 2758:on February 16, 2012 2674:on December 19, 2011 1197:Treatment registries 1050:In October 2009 the 148:Medicare for All Act 8161:Health care finance 7654:Rail transportation 7420:Imperial presidency 7142:State constitutions 7087:List of legislators 7037:Auditor/Comptroller 7010:Lieutenant governor 6736:Library of Congress 6627:Diplomatic Security 6270:Indian reservations 5933:American Revolution 5619:Trinidad and Tobago 5514:Antigua and Barbuda 4806:on January 11, 2012 4553:"PNHP-Single Payer" 4507:. November 26, 2009 4170:on January 21, 2012 4063:Michael F. Cannon, 3889:. October 20, 2014. 3869:The Washington Post 3845:on January 26, 2021 3813:. November 18, 2009 3521:. November 19, 2009 3466:on December 3, 2011 3408:on October 11, 2011 3330:on January 23, 2013 3300:. September 6, 2009 3298:The Washington Post 2988:The Washington Post 2726:. February 12, 2010 2700:. February 12, 2010 2698:The Washington Post 2648:on January 30, 2010 2599:on January 27, 2012 2410:The Washington Post 2278:The Washington Post 2144:on December 2, 2011 2111:The Washington Post 1961:The Washington Post 1790:on January 11, 2012 1760:. September 9, 2009 1616:10.1787/8643de7e-en 1556:. May 26, 2017. By 1052:Wall Street Journal 893:The Washington Post 836:medical malpractice 173:Affordable Care Act 160:Health Security Act 8271:affirmative action 8244:Capital punishment 8203:Poverty and health 8198:Physician shortage 8171:Health care prices 8101:Standard of living 7784:standard of living 7591:Financial position 7218:Hawaiian home land 7206:Indian reservation 7179:Tribal sovereignty 7022:Secretary of state 6891:United States Code 6807:Territorial courts 6779:Associate Justices 6664:Inspector generals 6151:War in Afghanistan 6014:Reconstruction era 5881:Stamp Act Congress 5554:Dominican Republic 4532:The New York Times 4306:The New York Times 4280:The New York Times 4232:The New York Times 4098:The New York Times 4047:, October 10, 2009 3976:, November 1, 1995 3918:, October 25, 2009 3723:M. Susan Marquis, 3494:The New York Times 3260:on August 10, 2003 2905:The New York Times 2879:The New York Times 2436:The New York Times 2005:The New York Times 1944:on April 13, 2012. 1394:health care system 1116:U.S. Supreme Court 956:The New York Times 935: 637: 561: 483:insurance exchange 451: 439: 433:. Percent of GDP ( 424: 409: 219:Insurance coverage 129:Baucus Health Bill 8446: 8445: 8406: 8405: 8402: 8401: 8372:National security 8081:Income inequality 7961:Statue of Liberty 7764:income inequality 7677: 7676: 7669:Trucking industry 7481: 7480: 7477: 7476: 7408:Foreign relations 7396:Electoral College 7377: 7376: 7165: 7164: 7117:District attorney 6964: 6963: 6791:Courts of appeals 6514: 6513: 6227: 6226: 6168:COVID-19 pandemic 6121:Feminist Movement 5967:American frontier 5886:Thirteen Colonies 5747: 5746: 5636:other territories 5194:on March 10, 2014 4977:(12): 2289–2295. 4832:on March 29, 2013 4599:By Paul Krugman, 4443:. August 20, 2009 4390:. August 16, 2009 4388:Los Angeles Times 4333:on March 19, 2012 4147:, August 22, 2009 3947:National Archives 3638:Beam, Christopher 3572:978-1-930865-89-1 3115:. August 26, 2009 2806:. August 16, 2009 2804:Los Angeles Times 2092:National Archives 1968:on March 12, 2016 1907:National Archives 1874:Commonwealth Fund 1816:on March 22, 2012 1770:National Archives 1706:National Archives 1562:Our World in Data 1473:. March 22, 2010. 1460:(March 22, 2010). 1458:Los Angeles Times 1327:Commonwealth Fund 1153:Peter G. Peterson 1122:Rationing of care 1065:adverse selection 1028:Coverage mandates 990:Government action 541:Commonwealth Fund 475:bundling payments 463:health care costs 370: 369: 150:(2021, H.R. 1976) 44: 8481: 8426: 8419: 8306:African American 8188:Health insurance 8076:Household income 7946:National symbols 7877:American English 7850:Federal holidays 7759:household income 7692: 7691: 7688: 7687: 7492: 7491: 7430:Anti-Americanism 7354:Special district 7281:Independent city 7250:County executive 7233: 7232: 7027:Attorney general 6986: 6985: 6975:Federal District 6558:Executive Office 6538: 6537: 6529: 6528: 6525: 6524: 6285:populated places 6265:federal enclaves 6260:federal district 6238: 6237: 6101:American Century 6084:Great Depression 6079:Roaring Twenties 6039:Women's suffrage 5918:Halifax Resolves 5911:Founding Fathers 5906:military history 5871:Pre-colonial era 5795: 5794: 5774: 5767: 5760: 5751: 5750: 5704:Saint Barthélemy 5634:Dependencies and 5507:Sovereign states 5495: 5488: 5481: 5472: 5471: 5354: 5353: 5351: 5349: 5337: 5331: 5326: 5320: 5315: 5309: 5308: 5306: 5304: 5288: 5282: 5281: 5279: 5277: 5262: 5256: 5255: 5253: 5251: 5245:Washington Times 5236: 5230: 5229: 5227: 5225: 5210: 5204: 5203: 5201: 5199: 5190:. Archived from 5179: 5173: 5172: 5138: 5129: 5128: 5102: 5093: 5092: 5086: 5082: 5080: 5072: 5046: 5040: 5039: 5032: 5026: 5011: 5005: 5004: 4994: 4960: 4954: 4947: 4941: 4940: 4904: 4898: 4897:, September 2008 4885: 4879: 4878: 4868: 4848: 4842: 4841: 4839: 4837: 4822: 4816: 4815: 4813: 4811: 4796: 4790: 4785: 4779: 4778: 4776: 4774: 4769:on March 6, 2010 4754: 4748: 4747: 4745: 4743: 4734:. Archived from 4726:WHO (May 2009). 4723: 4717: 4712: 4706: 4705: 4703: 4701: 4690: 4684: 4671: 4665: 4664: 4654: 4628: 4622: 4616: 4610: 4609:, March 23, 2006 4594: 4588: 4574: 4568: 4567: 4565: 4563: 4549: 4543: 4542: 4540: 4538: 4523: 4517: 4516: 4514: 4512: 4497: 4491: 4490: 4483: 4477: 4459: 4453: 4452: 4450: 4448: 4433: 4427: 4426: 4424: 4422: 4406: 4400: 4399: 4397: 4395: 4380: 4374: 4373: 4371: 4369: 4360:. Archived from 4349: 4343: 4342: 4340: 4338: 4323: 4317: 4316: 4314: 4312: 4297: 4291: 4290: 4288: 4286: 4271: 4265: 4264: 4262: 4260: 4249: 4243: 4242: 4240: 4238: 4223: 4217: 4216: 4214: 4212: 4200: 4194: 4193: 4187: 4179: 4177: 4175: 4169: 4163:. Archived from 4162: 4154: 4148: 4144:The Boston Globe 4136: 4125: 4124:, April 24, 2009 4121:The Boston Globe 4113: 4102: 4089: 4078: 4061: 4048: 4036: 4021: 4003: 3997: 3983: 3977: 3960: 3951: 3950: 3944: 3942: 3925: 3919: 3904: 3891: 3890: 3879: 3873: 3863:Carrie Johnson, 3861: 3855: 3854: 3852: 3850: 3844: 3838:. Archived from 3837: 3829: 3823: 3822: 3820: 3818: 3812: 3804: 3798: 3785: 3779: 3762: 3756: 3755: 3753: 3751: 3746: 3738: 3732: 3721: 3715: 3699: 3693: 3692: 3658: 3652: 3651: 3634: 3628: 3627: 3615: 3609: 3608: 3606: 3587:Glied, Sherry A. 3583: 3577: 3576: 3551: 3545: 3544: 3537: 3531: 3530: 3528: 3526: 3511: 3505: 3504: 3502: 3500: 3485: 3476: 3475: 3473: 3471: 3465: 3459:. Archived from 3458: 3450: 3444: 3443: 3441: 3439: 3424: 3418: 3417: 3415: 3413: 3404:. Archived from 3398: 3392: 3391: 3389: 3387: 3372: 3366: 3361: 3355: 3354: 3346: 3340: 3339: 3337: 3335: 3316: 3310: 3309: 3307: 3305: 3290: 3284: 3283: 3276: 3270: 3269: 3267: 3265: 3250: 3244: 3243: 3241: 3239: 3227: 3221: 3220: 3218: 3216: 3204: 3198: 3197: 3195: 3193: 3178: 3172: 3171: 3169: 3167: 3156: 3147: 3146: 3144: 3142: 3131: 3125: 3124: 3122: 3120: 3105: 3099: 3093: 3087: 3086: 3084: 3082: 3071: 3065: 3064: 3026: 3020: 3019: 3017: 3015: 3003: 2992: 2991: 2979: 2973: 2967: 2961: 2960: 2948: 2939: 2938: 2936: 2934: 2922: 2916: 2915: 2913: 2911: 2896: 2890: 2889: 2887: 2885: 2870: 2864: 2863: 2861: 2859: 2854: 2846: 2840: 2839: 2837: 2835: 2830: 2822: 2816: 2815: 2813: 2811: 2796: 2790: 2789: 2787: 2785: 2774: 2768: 2767: 2765: 2763: 2757: 2751:. Archived from 2750: 2742: 2736: 2735: 2733: 2731: 2716: 2710: 2709: 2707: 2705: 2690: 2684: 2683: 2681: 2679: 2664: 2658: 2657: 2655: 2653: 2638: 2632: 2631: 2629: 2627: 2615: 2609: 2608: 2606: 2604: 2589: 2583: 2582: 2574: 2565: 2564: 2557: 2551: 2550: 2540: 2530: 2506: 2500: 2499: 2497: 2495: 2490:on July 30, 2020 2479: 2473: 2472: 2470: 2468: 2453: 2447: 2446: 2444: 2442: 2427: 2421: 2420: 2418: 2416: 2401: 2395: 2394: 2392: 2390: 2379: 2373: 2372: 2370: 2368: 2357: 2351: 2350: 2348: 2346: 2335: 2329: 2328: 2326: 2324: 2309: 2303: 2302: 2300: 2298: 2287: 2281: 2271: 2265: 2256: 2250: 2249: 2239: 2229: 2205: 2199: 2183: 2177: 2176: 2174: 2172: 2160: 2154: 2153: 2151: 2149: 2143: 2137:. Archived from 2136: 2128: 2122: 2121: 2119: 2117: 2102: 2096: 2095: 2089: 2087: 2065: 2059: 2058: 2051: 2045: 2044: 2042: 2040: 2023: 2017: 2016: 2014: 2012: 1995: 1989: 1984: 1978: 1977: 1975: 1973: 1964:. Archived from 1952: 1946: 1945: 1940:. Archived from 1934: 1928: 1927: 1925: 1917: 1911: 1910: 1904: 1902: 1891: 1883: 1877: 1860: 1854: 1853: 1851: 1849: 1837: 1826: 1825: 1823: 1821: 1806: 1800: 1799: 1797: 1795: 1786:. Archived from 1780: 1774: 1773: 1767: 1765: 1748: 1742: 1741: 1739: 1737: 1731: 1725:. Archived from 1724: 1716: 1710: 1709: 1703: 1701: 1684: 1678: 1677: 1665: 1659: 1658: 1625: 1619: 1601: 1592: 1591: 1589: 1587: 1575: 1569: 1551: 1545: 1544: 1542: 1540: 1529: 1523: 1522: 1520: 1518: 1503: 1497: 1496: 1494: 1492: 1481: 1475: 1474: 1467: 1461: 1450: 1271:social insurance 1169:Charles Grassley 1096:the Boston Globe 1091:the Boston Globe 645:Peter A. Diamond 362: 355: 348: 334: 333: 332: 323: 322: 321: 40: 27: 26: 8489: 8488: 8484: 8483: 8482: 8480: 8479: 8478: 8464:2010s in health 8459:2000s in health 8449: 8448: 8447: 8442: 8429: 8422: 8415: 8398: 8384:Opioid epidemic 8301:Native American 8281:intersex rights 8232: 8228:Life expectancy 8218:Medical deserts 8208:Race and health 8105: 8091:Personal income 8037: 7941:National anthem 7774:personal income 7739:Economic issues 7673: 7625: 7473: 7373: 7362:School district 7348: 7331:Minor divisions 7325: 7264: 7222: 7161: 7147:Statutory codes 7128: 7091: 7068: 6978: 6973: 6960: 6895: 6852:civil liberties 6833: 6824:Other tribunals 6803:District courts 6755: 6714:current members 6697:current members 6678: 6612:Law enforcement 6510: 6223: 6172: 6163:Great Recession 6034:Progressive Era 6024:Native genocide 5955:Perpetual Union 5943:Treaty of Paris 5901:United Colonies 5859: 5784: 5778: 5748: 5743: 5637: 5635: 5628: 5502: 5499: 5386: 5362: 5357: 5347: 5345: 5338: 5334: 5327: 5323: 5316: 5312: 5302: 5300: 5297:Retirement Blog 5289: 5285: 5275: 5273: 5263: 5259: 5249: 5247: 5237: 5233: 5223: 5221: 5211: 5207: 5197: 5195: 5180: 5176: 5161: 5139: 5132: 5117: 5109:. Pluto Books. 5103: 5096: 5084: 5083: 5074: 5073: 5061: 5047: 5043: 5034: 5033: 5029: 5012: 5008: 4961: 4957: 4948: 4944: 4905: 4901: 4886: 4882: 4849: 4845: 4835: 4833: 4824: 4823: 4819: 4809: 4807: 4798: 4797: 4793: 4786: 4782: 4772: 4770: 4755: 4751: 4741: 4739: 4738:on May 25, 2009 4724: 4720: 4713: 4709: 4699: 4697: 4692: 4691: 4687: 4682:Wayback Machine 4672: 4668: 4629: 4625: 4617: 4613: 4595: 4591: 4585:Wayback Machine 4575: 4571: 4561: 4559: 4551: 4550: 4546: 4536: 4534: 4524: 4520: 4510: 4508: 4499: 4498: 4494: 4485: 4484: 4480: 4474:Wayback Machine 4460: 4456: 4446: 4444: 4437:"Economist.com" 4435: 4434: 4430: 4420: 4418: 4407: 4403: 4393: 4391: 4382: 4381: 4377: 4367: 4365: 4350: 4346: 4336: 4334: 4325: 4324: 4320: 4310: 4308: 4298: 4294: 4284: 4282: 4272: 4268: 4258: 4256: 4255:. June 28, 2012 4251: 4250: 4246: 4236: 4234: 4224: 4220: 4210: 4208: 4201: 4197: 4181: 4180: 4173: 4171: 4167: 4160: 4158:"Archived copy" 4156: 4155: 4151: 4137: 4128: 4115:Liz Kowalczyk, 4114: 4105: 4090: 4081: 4062: 4051: 4037: 4024: 4018:Wayback Machine 4004: 4000: 3984: 3980: 3974:Urban Institute 3971:Wayback Machine 3961: 3954: 3940: 3938: 3926: 3922: 3905: 3894: 3881: 3880: 3876: 3872:, June 13, 2008 3862: 3858: 3848: 3846: 3842: 3835: 3831: 3830: 3826: 3816: 3814: 3810: 3806: 3805: 3801: 3795:Wayback Machine 3786: 3782: 3776:Wayback Machine 3763: 3759: 3749: 3747: 3744: 3740: 3739: 3735: 3722: 3718: 3709:Wayback Machine 3700: 3696: 3659: 3655: 3635: 3631: 3616: 3612: 3584: 3580: 3573: 3552: 3548: 3539: 3538: 3534: 3524: 3522: 3513: 3512: 3508: 3498: 3496: 3486: 3479: 3469: 3467: 3463: 3456: 3452: 3451: 3447: 3437: 3435: 3425: 3421: 3411: 3409: 3400: 3399: 3395: 3385: 3383: 3374: 3373: 3369: 3362: 3358: 3347: 3343: 3333: 3331: 3318: 3317: 3313: 3303: 3301: 3292: 3291: 3287: 3278: 3277: 3273: 3263: 3261: 3252: 3251: 3247: 3237: 3235: 3234:. NewYorker.com 3232:"NewYorker.com" 3228: 3224: 3214: 3212: 3211:. NewYorker.com 3209:"NewYorker.com" 3205: 3201: 3191: 3189: 3180: 3179: 3175: 3165: 3163: 3158: 3157: 3150: 3140: 3138: 3133: 3132: 3128: 3118: 3116: 3107: 3106: 3102: 3094: 3090: 3080: 3078: 3073: 3072: 3068: 3027: 3023: 3013: 3011: 3004: 2995: 2980: 2976: 2968: 2964: 2949: 2942: 2932: 2930: 2929:. 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Newyorker.com 2161: 2157: 2147: 2145: 2141: 2134: 2130: 2129: 2125: 2115: 2113: 2103: 2099: 2085: 2083: 2066: 2062: 2053: 2052: 2048: 2038: 2036: 2024: 2020: 2010: 2008: 1996: 1992: 1985: 1981: 1971: 1969: 1954: 1953: 1949: 1936: 1935: 1931: 1923: 1919: 1918: 1914: 1900: 1898: 1889: 1885: 1884: 1880: 1876:, December 2007 1871:Wayback Machine 1861: 1857: 1847: 1845: 1844:. Newyorker.com 1838: 1829: 1819: 1817: 1808: 1807: 1803: 1793: 1791: 1782: 1781: 1777: 1763: 1761: 1750: 1749: 1745: 1735: 1733: 1729: 1722: 1718: 1717: 1713: 1699: 1697: 1696:. June 15, 2009 1686: 1685: 1681: 1666: 1662: 1641:(10): 949–954. 1626: 1622: 1602: 1595: 1585: 1583: 1576: 1572: 1552: 1548: 1538: 1536: 1531: 1530: 1526: 1516: 1514: 1504: 1500: 1490: 1488: 1483: 1482: 1478: 1469: 1468: 1464: 1451: 1447: 1443: 1434: 1428: 1423: 1410: 1386: 1384:Waste and fraud 1373: 1318: 1312: 1259: 1253: 1244: 1214: 1208: 1199: 1186: 1181: 1145:David Leonhardt 1130: 1124: 1070:Writing in the 1041:Urban Institute 1036: 1030: 997: 992: 927: 888: 832: 804: 768: 749: 744: 735: 719: 681: 666: 640:Overutilization 629: 607: 602: 594:wage stagnation 553: 518:Cover everyone; 397: 366: 330: 328: 327: 319: 317: 312: 311: 302:Fee-for-service 287: 279: 278: 252:Publicly-funded 232: 224: 223: 194: 186: 185: 181: 69: 42: 23: 17: 12: 11: 5: 8487: 8477: 8476: 8471: 8466: 8461: 8444: 8443: 8441: 8440: 8435: 8428: 8427: 8420: 8412: 8411: 8408: 8407: 8404: 8403: 8400: 8399: 8397: 8396: 8391: 8386: 8381: 8380: 8379: 8369: 8368: 8367: 8357: 8352: 8347: 8342: 8340:Mass shootings 8337: 8332: 8331: 8330: 8328:Climate change 8325: 8315: 8310: 8309: 8308: 8303: 8298: 8293: 8288: 8283: 8278: 8273: 8266:Discrimination 8263: 8258: 8257: 8256: 8246: 8240: 8238: 8234: 8233: 8231: 8230: 8225: 8220: 8215: 8210: 8205: 8200: 8195: 8190: 8185: 8180: 8179: 8178: 8173: 8168: 8158: 8157: 8156: 8151: 8146: 8141: 8136: 8131: 8121: 8115: 8113: 8107: 8106: 8104: 8103: 8098: 8093: 8088: 8083: 8078: 8073: 8068: 8063: 8058: 8056:American Dream 8053: 8047: 8045: 8039: 8038: 8036: 8035: 8030: 8025: 8023:Transportation 8020: 8015: 8010: 8005: 8000: 7995: 7990: 7985: 7980: 7975: 7970: 7969: 7968: 7963: 7958: 7956:Mount Rushmore 7953: 7943: 7938: 7933: 7928: 7927: 7926: 7921: 7916: 7911: 7906: 7896: 7891: 7890: 7889: 7884: 7879: 7869: 7864: 7859: 7854: 7853: 7852: 7842: 7837: 7836: 7835: 7825: 7820: 7815: 7814: 7813: 7808: 7798: 7797: 7796: 7791: 7786: 7781: 7776: 7771: 7766: 7761: 7756: 7751: 7746: 7736: 7731: 7726: 7721: 7716: 7711: 7706: 7700: 7698: 7685: 7679: 7678: 7675: 7674: 7672: 7671: 7666: 7661: 7656: 7651: 7646: 7641: 7635: 7633: 7627: 7626: 7624: 7623: 7618: 7613: 7608: 7603: 7598: 7593: 7588: 7583: 7578: 7576:Federal budget 7573: 7568: 7563: 7562: 7561: 7556: 7551: 7546: 7541: 7536: 7531: 7526: 7521: 7516: 7514:Communications 7511: 7506: 7495: 7489: 7483: 7482: 7479: 7478: 7475: 7474: 7472: 7471: 7466: 7465: 7464: 7459: 7454: 7444: 7443: 7442: 7437: 7435:exceptionalism 7432: 7422: 7417: 7416: 7415: 7413:foreign policy 7405: 7404: 7403: 7398: 7388: 7382: 7379: 7378: 7375: 7374: 7372: 7371: 7370: 7369: 7358: 7356: 7350: 7349: 7347: 7346: 7341: 7335: 7333: 7327: 7326: 7324: 7323: 7318: 7313: 7308: 7303: 7298: 7293: 7288: 7283: 7278: 7272: 7270: 7266: 7265: 7263: 7262: 7257: 7252: 7247: 7241: 7239: 7230: 7224: 7223: 7221: 7220: 7215: 7214: 7213: 7203: 7202: 7201: 7196: 7191: 7181: 7175: 7173: 7167: 7166: 7163: 7162: 7160: 7159: 7154: 7149: 7144: 7138: 7136: 7130: 7129: 7127: 7126: 7125: 7124: 7114: 7113: 7112: 7110:Chief justices 7105:Supreme courts 7101: 7099: 7093: 7092: 7090: 7089: 7084: 7078: 7076: 7070: 7069: 7067: 7066: 7065: 7064: 7054: 7049: 7044: 7039: 7034: 7029: 7024: 7019: 7018: 7017: 7007: 7006: 7005: 6994: 6992: 6983: 6966: 6965: 6962: 6961: 6959: 6958: 6953: 6948: 6947: 6946: 6944:National Guard 6941: 6936: 6931: 6926: 6921: 6916: 6905: 6903: 6897: 6896: 6894: 6893: 6888: 6887: 6886: 6881: 6876: 6871: 6861: 6856: 6855: 6854: 6847:Bill of Rights 6843: 6841: 6835: 6834: 6832: 6831: 6826: 6821: 6820: 6819: 6817:list of judges 6814: 6812:list of courts 6800: 6799: 6798: 6796:list of judges 6788: 6787: 6786: 6781: 6776: 6765: 6763: 6757: 6756: 6754: 6753: 6748: 6743: 6738: 6733: 6731:Capitol Police 6728: 6727: 6726: 6721: 6716: 6706: 6705: 6704: 6699: 6688: 6686: 6680: 6679: 6677: 6676: 6671: 6666: 6661: 6660: 6659: 6654: 6652:Secret Service 6649: 6644: 6639: 6634: 6629: 6624: 6619: 6609: 6608: 6607: 6602: 6597: 6592: 6582: 6577: 6572: 6567: 6565:Vice President 6562: 6561: 6560: 6555: 6544: 6542: 6535: 6522: 6516: 6515: 6512: 6511: 6509: 6508: 6503: 6498: 6493: 6492: 6491: 6486: 6481: 6476: 6471: 6466: 6461: 6456: 6445: 6444: 6443: 6438: 6433: 6428: 6423: 6418: 6413: 6408: 6403: 6398: 6393: 6388: 6383: 6378: 6373: 6368: 6363: 6353: 6352: 6351: 6349:National Parks 6341: 6340: 6339: 6334: 6329: 6324: 6319: 6309: 6304: 6302:Extreme points 6299: 6294: 6293: 6292: 6287: 6282: 6277: 6272: 6267: 6262: 6257: 6252: 6241: 6235: 6229: 6228: 6225: 6224: 6222: 6221: 6216: 6211: 6206: 6201: 6196: 6191: 6186: 6180: 6178: 6174: 6173: 6171: 6170: 6165: 6160: 6159: 6158: 6153: 6143: 6138: 6133: 6128: 6123: 6118: 6113: 6108: 6103: 6098: 6097: 6096: 6086: 6081: 6076: 6071: 6066: 6061: 6060: 6059: 6054: 6049: 6041: 6036: 6031: 6026: 6021: 6016: 6011: 6006: 6001: 5996: 5991: 5989:Federalist Era 5986: 5985: 5984: 5982:Bill of Rights 5979: 5969: 5964: 5963: 5962: 5957: 5947: 5946: 5945: 5940: 5930: 5925: 5923:Lee Resolution 5920: 5915: 5914: 5913: 5908: 5903: 5898: 5893: 5888: 5883: 5873: 5867: 5865: 5861: 5860: 5858: 5857: 5852: 5847: 5842: 5837: 5832: 5827: 5822: 5817: 5812: 5807: 5801: 5799: 5792: 5786: 5785: 5783: articles 5777: 5776: 5769: 5762: 5754: 5745: 5744: 5742: 5741: 5736: 5731: 5726: 5724:Sint Eustatius 5721: 5716: 5711: 5706: 5701: 5696: 5691: 5686: 5681: 5676: 5671: 5669:Cayman Islands 5666: 5661: 5656: 5651: 5646: 5640: 5638: 5633: 5630: 5629: 5627: 5626: 5621: 5616: 5611: 5606: 5601: 5596: 5591: 5586: 5581: 5576: 5571: 5566: 5561: 5556: 5551: 5546: 5541: 5536: 5531: 5526: 5521: 5516: 5510: 5508: 5504: 5503: 5498: 5497: 5490: 5483: 5475: 5469: 5468: 5463: 5457: 5453:Health Affairs 5445: 5441:Health Affairs 5433: 5429:Health Affairs 5421: 5417:Health Affairs 5409: 5404: 5399: 5394: 5368: 5361: 5360:External links 5358: 5356: 5355: 5332: 5321: 5310: 5283: 5271:New York Times 5257: 5231: 5205: 5174: 5159: 5130: 5115: 5094: 5085:|journal= 5059: 5041: 5027: 5023:Monthly Review 5006: 4955: 4949:Todd Zywicki, 4942: 4899: 4880: 4843: 4817: 4791: 4780: 4749: 4718: 4707: 4685: 4666: 4645:(6): 1629–39. 4623: 4611: 4589: 4569: 4544: 4518: 4492: 4478: 4454: 4428: 4411:"Politico.com" 4401: 4375: 4344: 4318: 4292: 4266: 4244: 4218: 4195: 4149: 4126: 4103: 4101:, June 4, 2009 4079: 4071:Cato Institute 4049: 4022: 3998: 3978: 3952: 3935:whitehouse.gov 3920: 3906:Ira Rosen and 3892: 3874: 3856: 3824: 3799: 3780: 3757: 3733: 3716: 3694: 3675:(1): 174–181. 3668:Health Affairs 3653: 3629: 3624:New York Times 3610: 3604:10.3386/w13881 3589:(March 2008). 3578: 3571: 3563:Cato Institute 3546: 3532: 3506: 3477: 3445: 3419: 3393: 3382:. July 3, 2009 3367: 3356: 3341: 3311: 3285: 3271: 3245: 3222: 3199: 3173: 3148: 3137:. Medscape.com 3135:"Medscape.com" 3126: 3100: 3088: 3066: 3039:(4): 374–377. 3021: 2993: 2974: 2962: 2940: 2917: 2891: 2865: 2841: 2817: 2791: 2769: 2737: 2711: 2685: 2659: 2633: 2610: 2584: 2566: 2552: 2501: 2474: 2448: 2422: 2396: 2374: 2352: 2330: 2304: 2282: 2266: 2263:New York Times 2251: 2200: 2178: 2155: 2123: 2097: 2060: 2046: 2018: 1990: 1979: 1947: 1929: 1912: 1895:whitehouse.gov 1878: 1855: 1827: 1801: 1775: 1757:whitehouse.gov 1743: 1711: 1693:whitehouse.gov 1679: 1660: 1620: 1593: 1570: 1546: 1524: 1498: 1476: 1462: 1444: 1442: 1439: 1427: 1424: 1422: 1419: 1409: 1406: 1390:Donald Berwick 1385: 1382: 1371:Uninsured rate 1369: 1352:Health Affairs 1331:Health Affairs 1311: 1308: 1287:Warren Buffett 1267:underinsurance 1255:Main article: 1252: 1249: 1243: 1240: 1210:Main article: 1207: 1204: 1198: 1195: 1185: 1182: 1180: 1177: 1126:Main article: 1123: 1120: 1089:In April 2009 1072:New York Times 1060:Cato Institute 1032:Main article: 1029: 1026: 996: 993: 991: 988: 978:Health Affairs 926: 923: 887: 884: 875:George W. Bush 831: 828: 815: 814: 811: 803: 800: 767: 764: 748: 745: 743: 740: 734: 731: 724:New York Times 718: 715: 680: 677: 665: 664:Pilot programs 662: 628: 625: 621:David Ignatius 606: 603: 601: 600:Best practices 598: 590: 589: 586: 583: 580: 552: 549: 528:The New Yorker 523: 522: 519: 516: 513: 396: 393: 368: 367: 365: 364: 357: 350: 342: 339: 338: 314: 313: 310: 309: 307:Global payment 304: 299: 294: 288: 285: 284: 281: 280: 277: 276: 271: 266: 265: 264: 254: 249: 244: 239: 233: 230: 229: 226: 225: 222: 221: 216: 211: 206: 204:Public opinion 201: 195: 192: 191: 188: 187: 184: 183: 176: 169: 168: 167:Latest enacted 164: 163: 157: 151: 145: 138: 137: 133: 132: 126: 120: 113: 112: 108: 107: 101: 95: 89: 82: 81: 75: 74: 70: 67: 66: 63: 62: 61: 60: 55: 47: 46: 36: 35: 15: 9: 6: 4: 3: 2: 8486: 8475: 8472: 8470: 8467: 8465: 8462: 8460: 8457: 8456: 8454: 8439: 8436: 8434: 8431: 8430: 8425: 8421: 8418: 8414: 8413: 8409: 8395: 8392: 8390: 8387: 8385: 8382: 8378: 8375: 8374: 8373: 8370: 8366: 8363: 8362: 8361: 8358: 8356: 8353: 8351: 8348: 8346: 8343: 8341: 8338: 8336: 8333: 8329: 8326: 8324: 8321: 8320: 8319: 8316: 8314: 8313:Energy policy 8311: 8307: 8304: 8302: 8299: 8297: 8294: 8292: 8289: 8287: 8284: 8282: 8279: 8277: 8274: 8272: 8269: 8268: 8267: 8264: 8262: 8259: 8255: 8254:incarceration 8252: 8251: 8250: 8247: 8245: 8242: 8241: 8239: 8235: 8229: 8226: 8224: 8221: 8219: 8216: 8214: 8211: 8209: 8206: 8204: 8201: 8199: 8196: 8194: 8191: 8189: 8186: 8184: 8181: 8177: 8174: 8172: 8169: 8167: 8164: 8163: 8162: 8159: 8155: 8152: 8150: 8147: 8145: 8142: 8140: 8139:Prenatal care 8137: 8135: 8134:Birth control 8132: 8130: 8127: 8126: 8125: 8122: 8120: 8117: 8116: 8114: 8112: 8108: 8102: 8099: 8097: 8094: 8092: 8089: 8087: 8084: 8082: 8079: 8077: 8074: 8072: 8071:Homeownership 8069: 8067: 8064: 8062: 8059: 8057: 8054: 8052: 8049: 8048: 8046: 8044: 8040: 8034: 8031: 8029: 8026: 8024: 8021: 8019: 8016: 8014: 8011: 8009: 8006: 8004: 8001: 7999: 7996: 7994: 7991: 7989: 7986: 7984: 7981: 7979: 7976: 7974: 7971: 7967: 7964: 7962: 7959: 7957: 7954: 7952: 7949: 7948: 7947: 7944: 7942: 7939: 7937: 7934: 7932: 7929: 7925: 7922: 7920: 7917: 7915: 7912: 7910: 7907: 7905: 7902: 7901: 7900: 7897: 7895: 7892: 7888: 7885: 7883: 7880: 7878: 7875: 7874: 7873: 7870: 7868: 7865: 7863: 7860: 7858: 7855: 7851: 7848: 7847: 7846: 7843: 7841: 7838: 7834: 7831: 7830: 7829: 7826: 7824: 7821: 7819: 7816: 7812: 7809: 7807: 7804: 7803: 7802: 7799: 7795: 7794:working class 7792: 7790: 7787: 7785: 7782: 7780: 7777: 7775: 7772: 7770: 7767: 7765: 7762: 7760: 7757: 7755: 7754:homeownership 7752: 7750: 7747: 7745: 7742: 7741: 7740: 7737: 7735: 7732: 7730: 7727: 7725: 7722: 7720: 7717: 7715: 7712: 7710: 7707: 7705: 7702: 7701: 7699: 7697: 7693: 7689: 7686: 7684: 7680: 7670: 7667: 7665: 7662: 7660: 7657: 7655: 7652: 7650: 7647: 7645: 7642: 7640: 7637: 7636: 7634: 7632: 7628: 7622: 7619: 7617: 7614: 7612: 7609: 7607: 7604: 7602: 7599: 7597: 7594: 7592: 7589: 7587: 7584: 7582: 7579: 7577: 7574: 7572: 7569: 7567: 7564: 7560: 7557: 7555: 7552: 7550: 7547: 7545: 7542: 7540: 7537: 7535: 7534:Manufacturing 7532: 7530: 7527: 7525: 7522: 7520: 7517: 7515: 7512: 7510: 7507: 7505: 7502: 7501: 7500: 7497: 7496: 7493: 7490: 7488: 7484: 7470: 7467: 7463: 7462:Third parties 7460: 7458: 7455: 7453: 7450: 7449: 7448: 7445: 7441: 7438: 7436: 7433: 7431: 7428: 7427: 7426: 7423: 7421: 7418: 7414: 7411: 7410: 7409: 7406: 7402: 7399: 7397: 7394: 7393: 7392: 7389: 7387: 7384: 7383: 7380: 7368: 7365: 7364: 7363: 7360: 7359: 7357: 7355: 7351: 7345: 7342: 7340: 7337: 7336: 7334: 7332: 7328: 7322: 7319: 7317: 7314: 7312: 7309: 7307: 7304: 7302: 7299: 7297: 7294: 7292: 7289: 7287: 7284: 7282: 7279: 7277: 7274: 7273: 7271: 7267: 7261: 7258: 7256: 7253: 7251: 7248: 7246: 7243: 7242: 7240: 7238: 7234: 7231: 7229: 7225: 7219: 7216: 7212: 7209: 7208: 7207: 7204: 7200: 7197: 7195: 7192: 7190: 7187: 7186: 7185: 7182: 7180: 7177: 7176: 7174: 7172: 7168: 7158: 7155: 7153: 7150: 7148: 7145: 7143: 7140: 7139: 7137: 7135: 7131: 7123: 7120: 7119: 7118: 7115: 7111: 7108: 7107: 7106: 7103: 7102: 7100: 7098: 7094: 7088: 7085: 7083: 7080: 7079: 7077: 7075: 7071: 7063: 7060: 7059: 7058: 7055: 7053: 7050: 7048: 7045: 7043: 7040: 7038: 7035: 7033: 7030: 7028: 7025: 7023: 7020: 7016: 7013: 7012: 7011: 7008: 7004: 7001: 7000: 6999: 6996: 6995: 6993: 6991: 6987: 6984: 6982: 6976: 6971: 6967: 6957: 6954: 6952: 6949: 6945: 6942: 6940: 6937: 6935: 6932: 6930: 6927: 6925: 6922: 6920: 6917: 6915: 6912: 6911: 6910: 6907: 6906: 6904: 6902: 6898: 6892: 6889: 6885: 6882: 6880: 6877: 6875: 6872: 6870: 6867: 6866: 6865: 6862: 6860: 6857: 6853: 6850: 6849: 6848: 6845: 6844: 6842: 6840: 6836: 6830: 6829:U.S. attorney 6827: 6825: 6822: 6818: 6815: 6813: 6810: 6809: 6808: 6804: 6801: 6797: 6794: 6793: 6792: 6789: 6785: 6782: 6780: 6777: 6775: 6774:Chief Justice 6772: 6771: 6770: 6769:Supreme Court 6767: 6766: 6764: 6762: 6758: 6752: 6749: 6747: 6744: 6742: 6739: 6737: 6734: 6732: 6729: 6725: 6722: 6720: 6717: 6715: 6712: 6711: 6710: 6707: 6703: 6700: 6698: 6695: 6694: 6693: 6690: 6689: 6687: 6685: 6681: 6675: 6674:Public policy 6672: 6670: 6669:Civil service 6667: 6665: 6662: 6658: 6655: 6653: 6650: 6648: 6645: 6643: 6640: 6638: 6635: 6633: 6630: 6628: 6625: 6623: 6620: 6618: 6615: 6614: 6613: 6610: 6606: 6603: 6601: 6598: 6596: 6593: 6591: 6588: 6587: 6586: 6583: 6581: 6578: 6576: 6573: 6571: 6568: 6566: 6563: 6559: 6556: 6554: 6551: 6550: 6549: 6546: 6545: 6543: 6539: 6536: 6534: 6530: 6526: 6523: 6521: 6517: 6507: 6504: 6502: 6499: 6497: 6494: 6490: 6487: 6485: 6482: 6480: 6477: 6475: 6472: 6470: 6467: 6465: 6462: 6460: 6457: 6455: 6452: 6451: 6450: 6446: 6442: 6439: 6437: 6434: 6432: 6429: 6427: 6424: 6422: 6419: 6417: 6414: 6412: 6409: 6407: 6404: 6402: 6399: 6397: 6394: 6392: 6389: 6387: 6384: 6382: 6379: 6377: 6374: 6372: 6369: 6367: 6364: 6362: 6359: 6358: 6357: 6354: 6350: 6347: 6346: 6345: 6342: 6338: 6337:Sierra Nevada 6335: 6333: 6330: 6328: 6325: 6323: 6320: 6318: 6315: 6314: 6313: 6310: 6308: 6305: 6303: 6300: 6298: 6295: 6291: 6288: 6286: 6283: 6281: 6278: 6276: 6275:insular zones 6273: 6271: 6268: 6266: 6263: 6261: 6258: 6256: 6253: 6251: 6248: 6247: 6246: 6243: 6242: 6239: 6236: 6234: 6230: 6220: 6217: 6215: 6212: 6210: 6207: 6205: 6202: 6200: 6197: 6195: 6192: 6190: 6187: 6185: 6182: 6181: 6179: 6175: 6169: 6166: 6164: 6161: 6157: 6154: 6152: 6149: 6148: 6147: 6146:War on Terror 6144: 6142: 6139: 6137: 6134: 6132: 6129: 6127: 6126:LGBT Movement 6124: 6122: 6119: 6117: 6114: 6112: 6109: 6107: 6104: 6102: 6099: 6095: 6092: 6091: 6090: 6087: 6085: 6082: 6080: 6077: 6075: 6072: 6070: 6067: 6065: 6062: 6058: 6055: 6053: 6050: 6048: 6045: 6044: 6042: 6040: 6037: 6035: 6032: 6030: 6027: 6025: 6022: 6020: 6017: 6015: 6012: 6010: 6007: 6005: 6002: 6000: 5997: 5995: 5992: 5990: 5987: 5983: 5980: 5978: 5975: 5974: 5973: 5970: 5968: 5965: 5961: 5958: 5956: 5953: 5952: 5951: 5948: 5944: 5941: 5939: 5936: 5935: 5934: 5931: 5929: 5926: 5924: 5921: 5919: 5916: 5912: 5909: 5907: 5904: 5902: 5899: 5897: 5894: 5892: 5889: 5887: 5884: 5882: 5879: 5878: 5877: 5874: 5872: 5869: 5868: 5866: 5862: 5856: 5853: 5851: 5848: 5846: 5843: 5841: 5838: 5836: 5833: 5831: 5828: 5826: 5823: 5821: 5818: 5816: 5813: 5811: 5808: 5806: 5803: 5802: 5800: 5796: 5793: 5791: 5787: 5782: 5781:United States 5775: 5770: 5768: 5763: 5761: 5756: 5755: 5752: 5740: 5737: 5735: 5732: 5730: 5727: 5725: 5722: 5720: 5717: 5715: 5712: 5710: 5707: 5705: 5702: 5700: 5697: 5695: 5692: 5690: 5687: 5685: 5682: 5680: 5677: 5675: 5672: 5670: 5667: 5665: 5662: 5660: 5657: 5655: 5652: 5650: 5647: 5645: 5642: 5641: 5639: 5631: 5625: 5624:United States 5622: 5620: 5617: 5615: 5612: 5610: 5607: 5605: 5602: 5600: 5597: 5595: 5592: 5590: 5587: 5585: 5582: 5580: 5577: 5575: 5572: 5570: 5567: 5565: 5562: 5560: 5557: 5555: 5552: 5550: 5547: 5545: 5542: 5540: 5537: 5535: 5532: 5530: 5527: 5525: 5522: 5520: 5517: 5515: 5512: 5511: 5509: 5505: 5496: 5491: 5489: 5484: 5482: 5477: 5476: 5473: 5467: 5464: 5462: 5458: 5455: 5454: 5450: 5447:Susan Jaffe, 5446: 5443: 5442: 5438: 5435:Susan Jaffe, 5434: 5431: 5430: 5426: 5423:Susan Jaffe, 5422: 5419: 5418: 5414: 5411:Mark Merlis, 5410: 5408: 5405: 5403: 5400: 5398: 5395: 5393: 5389: 5384: 5380: 5379: 5374: 5369: 5367: 5364: 5363: 5343: 5336: 5330: 5325: 5319: 5314: 5298: 5294: 5287: 5272: 5268: 5261: 5246: 5242: 5235: 5220: 5219:Politicus USA 5216: 5209: 5193: 5189: 5185: 5178: 5170: 5166: 5162: 5160:9781501702310 5156: 5152: 5148: 5144: 5137: 5135: 5126: 5122: 5118: 5116:9780745332123 5112: 5108: 5101: 5099: 5090: 5078: 5070: 5069:j.ctt7zswmt.7 5066: 5062: 5060:9781626160774 5056: 5052: 5045: 5037: 5031: 5024: 5020: 5016: 5010: 5002: 4998: 4993: 4988: 4984: 4980: 4976: 4972: 4971: 4966: 4959: 4952: 4946: 4938: 4934: 4930: 4926: 4922: 4918: 4914: 4910: 4903: 4896: 4892: 4891: 4884: 4876: 4872: 4867: 4862: 4858: 4854: 4847: 4836:September 13, 4831: 4827: 4821: 4805: 4801: 4795: 4789: 4784: 4768: 4764: 4760: 4753: 4737: 4733: 4729: 4722: 4716: 4711: 4695: 4689: 4683: 4679: 4676: 4670: 4662: 4658: 4653: 4648: 4644: 4640: 4639: 4634: 4627: 4620: 4615: 4608: 4607: 4602: 4598: 4593: 4586: 4582: 4579: 4573: 4558: 4554: 4548: 4533: 4529: 4522: 4506: 4502: 4496: 4488: 4482: 4475: 4471: 4468: 4464: 4458: 4442: 4441:The Economist 4438: 4432: 4416: 4412: 4405: 4389: 4385: 4379: 4363: 4359: 4355: 4348: 4332: 4328: 4322: 4307: 4303: 4296: 4281: 4277: 4270: 4254: 4248: 4233: 4229: 4228:"Nytimes.com" 4222: 4206: 4205:"Nytimes.com" 4199: 4191: 4185: 4166: 4159: 4153: 4146: 4145: 4141: 4135: 4133: 4131: 4123: 4122: 4118: 4112: 4110: 4108: 4100: 4099: 4094: 4091:The Editors, 4088: 4086: 4084: 4076: 4072: 4068: 4067: 4060: 4058: 4056: 4054: 4046: 4045: 4041: 4035: 4033: 4031: 4029: 4027: 4019: 4015: 4012: 4008: 4002: 3995: 3991: 3988: 3982: 3975: 3972: 3968: 3965: 3959: 3957: 3948: 3937: 3936: 3931: 3924: 3917: 3913: 3910:, producers, 3909: 3903: 3901: 3899: 3897: 3888: 3884: 3878: 3871: 3870: 3866: 3860: 3841: 3834: 3828: 3809: 3803: 3796: 3792: 3789: 3784: 3777: 3773: 3770: 3766: 3761: 3743: 3737: 3730: 3726: 3720: 3713: 3710: 3706: 3703: 3698: 3690: 3686: 3682: 3678: 3674: 3670: 3669: 3664: 3657: 3649: 3648: 3643: 3639: 3633: 3625: 3621: 3614: 3605: 3600: 3596: 3592: 3588: 3582: 3574: 3568: 3564: 3560: 3556: 3555:Kling, Arnold 3550: 3542: 3536: 3520: 3519:The Economist 3516: 3510: 3495: 3491: 3484: 3482: 3462: 3455: 3449: 3434: 3430: 3423: 3407: 3403: 3397: 3381: 3377: 3371: 3365: 3360: 3352: 3345: 3329: 3325: 3321: 3315: 3299: 3295: 3289: 3281: 3275: 3259: 3255: 3254:"CBSNews.com" 3249: 3233: 3226: 3210: 3203: 3187: 3183: 3177: 3161: 3155: 3153: 3136: 3130: 3114: 3110: 3109:"YouTube.com" 3104: 3097: 3092: 3076: 3070: 3062: 3058: 3054: 3050: 3046: 3042: 3038: 3034: 3033: 3025: 3009: 3002: 3000: 2998: 2989: 2985: 2978: 2971: 2966: 2958: 2954: 2947: 2945: 2928: 2921: 2906: 2902: 2895: 2880: 2876: 2869: 2851: 2845: 2827: 2821: 2805: 2801: 2795: 2779: 2773: 2754: 2747: 2741: 2725: 2721: 2715: 2699: 2695: 2689: 2673: 2669: 2663: 2647: 2643: 2637: 2621: 2614: 2598: 2594: 2588: 2580: 2573: 2571: 2562: 2556: 2548: 2544: 2539: 2534: 2529: 2524: 2520: 2516: 2512: 2505: 2489: 2485: 2478: 2463: 2459: 2452: 2437: 2433: 2426: 2411: 2407: 2400: 2384: 2378: 2362: 2356: 2340: 2334: 2319: 2315: 2308: 2292: 2286: 2279: 2276: 2273:David Brown, 2270: 2264: 2261: 2255: 2247: 2243: 2238: 2233: 2228: 2223: 2219: 2215: 2211: 2204: 2198: 2195: 2191: 2188: 2182: 2166: 2159: 2140: 2133: 2127: 2112: 2108: 2101: 2093: 2081: 2077: 2076: 2071: 2064: 2056: 2050: 2035: 2034: 2029: 2022: 2007: 2006: 2001: 1994: 1988: 1983: 1967: 1963: 1962: 1957: 1951: 1943: 1939: 1933: 1922: 1916: 1908: 1897: 1896: 1888: 1882: 1875: 1872: 1868: 1865: 1859: 1843: 1836: 1834: 1832: 1815: 1811: 1805: 1789: 1785: 1779: 1771: 1759: 1758: 1753: 1747: 1728: 1721: 1715: 1707: 1695: 1694: 1689: 1683: 1675: 1671: 1664: 1656: 1652: 1648: 1644: 1640: 1636: 1632: 1624: 1617: 1613: 1609: 1605: 1600: 1598: 1586:September 11, 1581: 1574: 1567: 1563: 1559: 1555: 1550: 1534: 1528: 1513: 1509: 1502: 1486: 1480: 1472: 1466: 1459: 1455: 1449: 1445: 1438: 1433: 1418: 1415: 1405: 1403: 1397: 1395: 1391: 1381: 1379: 1374: 1372: 1367: 1365: 1359: 1355: 1353: 1349: 1345: 1341: 1337: 1332: 1329:published in 1328: 1324: 1317: 1307: 1304: 1300: 1295: 1290: 1288: 1282: 1280: 1276: 1272: 1268: 1263: 1258: 1248: 1239: 1237: 1231: 1228: 1224: 1218: 1213: 1203: 1194: 1191: 1176: 1174: 1173:The Economist 1170: 1166: 1165:Newt Gingrich 1161: 1157: 1154: 1149: 1146: 1142: 1138: 1135: 1129: 1119: 1117: 1112: 1109: 1104: 1102: 1097: 1092: 1087: 1085: 1081: 1080:Marcia Angell 1077: 1073: 1068: 1066: 1061: 1056: 1053: 1048: 1044: 1042: 1035: 1025: 1023: 1018: 1015: 1009: 1006: 1002: 987: 983: 980: 979: 974: 969: 965: 963: 962:The Economist 958: 957: 952: 947: 942: 940: 931: 922: 919: 918: 913: 909: 905: 901: 897: 895: 894: 883: 879: 876: 871: 867: 864: 859: 856: 851: 848: 843: 841: 837: 827: 823: 819: 812: 809: 808: 807: 799: 796: 791: 788: 783: 780: 776: 771: 763: 760: 758: 754: 739: 730: 727: 725: 714: 710: 708: 703: 698: 695: 691: 686: 675: 670: 661: 658: 654: 650: 646: 641: 633: 624: 622: 616: 611: 597: 595: 587: 584: 581: 578: 577: 576: 573: 569: 565: 557: 551:Cost overview 548: 545: 542: 537: 534: 530: 529: 520: 517: 514: 511: 510: 509: 506: 502: 500: 495: 491: 486: 484: 478: 476: 472: 467: 464: 460: 455: 448: 443: 436: 432: 428: 421: 417: 413: 406: 401: 392: 390: 386: 382: 377: 375: 363: 358: 356: 351: 349: 344: 343: 341: 340: 337: 326: 316: 315: 308: 305: 303: 300: 298: 295: 293: 290: 289: 283: 282: 275: 272: 270: 267: 263: 260: 259: 258: 255: 253: 250: 248: 245: 243: 240: 238: 235: 234: 228: 227: 220: 217: 215: 212: 210: 207: 205: 202: 200: 197: 196: 190: 189: 180: 177: 174: 171: 170: 166: 165: 161: 158: 155: 152: 149: 146: 143: 140: 139: 135: 134: 130: 127: 124: 121: 118: 115: 114: 110: 109: 105: 102: 99: 96: 93: 90: 87: 84: 83: 80: 77: 76: 72: 71: 65: 64: 59: 56: 54: 51: 50: 49: 48: 45: 43:United States 38: 37: 33: 29: 28: 25: 22: 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