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The problem

The problem


• Spending on healthcare in the United States has grown from 7.2 percent of GDP in 1970 to 12.3 percent in 1990 and 16.2 percent in 2007.

• In 2007 Medicare and Medicaid accounted for nearly 20 percent of the federal budget and more than 27 percent of total healthcare expenditures.

• 47 million Americans are uninsured.

• Premiums increased 114 percent between 1999 and 2007 while workers' earnings increased only 27 percent.

• The average cost of an employer-based insurance policy in 2008 was $12,680 for a family and $4,704 for an individual.

• The United States had approximately 8.1 million uninsured children in 2007.

The players

The administration

• HHS: Sebelius

• Treasury: Geithner

• Budget: Orszag

• NEC: Summers

The Senate

• Leadership: Reid, D-Nev.; McConnell, R-Ky.

• Budget: Conrad, D-N.D.; Gregg, R-N.H.

• Finance: Baucus, D-Mont.; 
Grassley, R-Iowa

• HELP committee: Kennedy, D-Mass.; Enzi, R-Wyo.

The House

• Leadership: Pelosi, D-Calif.; Boehner, R-Ohio

• Commerce: Waxman, D-Calif.; Barton, R-Texas

• Budget: Spratt, D-S.C.; 
Ryan, R-Wis.

• Ways and Means: 
Rangel, D-N.Y.; Camp, R-Mich.

• Education and Labor: Miller, D-Calif.; Kline, R-Minn.


• The nation's insurers, hospitals, pharmaceuticals, doctors, employers, and medical groups are spending $1.4 million a day on influencing the debate.

The proposals

• Impose an individual mandate to carry health insurance or face tax penalties.

• Force employers to pay for 50 percent to 65 percent of employee premiums or pay penalty.

• Expand Medicaid to households earning less than 150 percent of the federal poverty level; expand Medicaid to childless adults.

• Provide subsidies to purchase insurance for families earning up to 300 percent or 400 percent of federal poverty level ($66,000 or $88,000 for a family of four).

• Provide government-funded comparative effectiveness research.

• Establish a government-run "public plan" option to compete with private insurers; it may be able to set prices for doctors and hospitals, which opponents say would put private plans at a competitive disadvantage.

• Provide a refundable tax credit for the uninsured to purchase coverage.

The price

The costs for Democratic proposals range from $1.04 trillion to $1.6 trillion over 10 years, to be paid for by:

• A new tax on employer-provided health insurance benefits ($90 billion to $300 billion over 10 years)

• Limiting itemized deductions like mortgages and charitable contributions for high-income earners ($326 billion over 10 years)

• A new "value-added" tax on sugary drinks and increased taxes on alcoholic beverages: $110 billion over 10 years

• A penalty for employers not offering health insurance ($300 billion)

• A new tax on Flexible Savings Account and health reimbursement accounts ($70 billion)

• Trimming Medicare/Medicaid payments to hospitals and other providers ($313 billion)

• An income tax surcharge of 1 percent to 3 percent on Americans earning more than $280,000. The surtax would rise for those earning $500,000 and rise again for those earning more than $1 million, sending the top federal tax rate toward 52 percent ($500 billion over 10 years)

• A voluntary agreement by drug manufacturers to provide a discount on medicines purchased for government programs like Medicare ($80 billion)

• Savings offered by hospitals ($155 billion)

Opponents of many of these items say they would harm the economy and increase unemployment.

Edward Lee Pitts

Edward Lee Pitts

Lee is the associate dean of World Journalism Institute and former Washington, D.C. bureau chief for WORLD Magazine. He is a graduate of Northwestern University's Medill School of Journalism and teaches journalism at Dordt University in Sioux Center, Iowa. Lee resides with his family in Iowa.