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The health care reform debate in the United States has been a political issue for many years, focusing upon increasing coverage, decreasing the cost and social burden of healthcare, insurance reform, and the philosophy of its provision, funding, and government involvement. Following the election of Barack Obama as president, who campaigned heavily on accomplishing health care reform, the Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010. In 2009, the U.S. had the highest healthcare costs relative to the size of the economy (GDP) in the world, with an estimated 50.2 million citizens (approximately 15.6% of the September 2011 estimated population of 312 million) without insurance coverage. Some critics of reform counter that almost four out of ten of these uninsured come from a household with over $50,000 income per year, and thus might be uninsured voluntarily, or opting to pay for health care services on a "pay-as-you-go" basis.〔(【引用サイトリンク】title=Almost 4 Out of 10 Uninsured Americans Live in Households Making More Than $50,000 Per Year )〕 Further, an estimated 77 million Baby Boomers 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. Maintaining the long-term fiscal health of the U.S. federal government is significantly dependent on healthcare costs being controlled.〔(【引用サイトリンク】title=Charlie Rose-Peter Orszag Interview Transcript )〕 ==Quality of care== There is significant debate regarding the quality of the U.S. healthcare system relative to those of other countries. Physicians for a National Health Program, a political advocacy group, has claimed that a free market solution to health care provides a lower quality of care, with higher mortality rates, than publicly funded systems.〔(For-Profit Hospitals Cost More and Have Higher Death Rates ), ''Physicians for a National Health Program''〕 The quality of health maintenance organizations and managed care have also been criticized by this same group.〔(For-Profit HMOs Provide Worse Quality Care ), ''Physicians for a National Health Program''〕 According to a 2000 study of the World Health Organization, publicly funded systems of industrial nations spend less on health care, both as a percentage of their GDP and per capita, and enjoy superior population-based health care outcomes.〔(【引用サイトリンク】title=Prelims i-ixx/E )〕 However, conservative commentator David Gratzer and the Cato Institute, a libertarian think tank, have both criticized the WHO's comparison method for being biased; the WHO study marked down countries for having private or fee-paying health treatment and rated countries by comparison to their expected health care performance, rather than objectively comparing quality of care.〔David Gratzer, (Why Is not Government Health Care The Answer? ), ''Free Market Cure'', July 16, 2007〕〔Glen Whitman, ("WHO’s Fooling Who? The World Health Organization’s Problematic Ranking of Health Care Systems," ) Cato Institute, February 28, 2008〕 Some medical researchers say that patient satisfaction surveys are a poor way to evaluate medical care. Researchers at the RAND Corporation and the Department of Veterans Affairs asked 236 elderly patients in two different managed care plans to rate their care, then examined care in medical records, as reported in Annals of Internal Medicine. There was no correlation. "Patient ratings of health care are easy to obtain and report, but do not accurately measure the technical quality of medical care," said John T. Chang, UCLA, lead author. There are health losses from insufficient health insurance. A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance.〔(【引用サイトリンク】title=American Journal of Public Health | December 2009, Vol 99, No.12 )〕〔(【引用サイトリンク】title=State-by-state breakout of excess deaths from lack of insurance )〕 More broadly, estimates of the total number of people in the United States, whether insured or uninsured, who die because of lack of medical care were estimated in a 1997 analysis to be nearly 100,000 per year.〔A 1997 study carried out by Professors David Himmelstein and Steffie Woolhandler (''New England Journal of Medicine'' 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." (The Inhuman State of U.S. Health Care ), ''Monthly Review'', Vicente Navarro, September 2003. Retrieved September 10, 2009〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Health care reform debate in the United States」の詳細全文を読む スポンサード リンク
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