Health care is as much an economic issue as a social issue. Fixing the economy requires fixing health care, as well. In 2008, the United States spent more than $2 trillion on health care—nearly 17 percent of our entire economy. Meanwhile, at least 15 percent of Americans—46 million people—are uninsured. According to the Institute of Medicine, nearly three people die every hour because they were uninsured and couldn’t get care.

Coverage is the gateway to reform, but covering the uninsured alone won’t solve what’s ailing the health care system. Meaningful reform will require a comprehensive approach that also includes attention to the quality and value of health care, to preventive and public health services, and to health care spending and cost.

Accepting the status quo and doing nothing is not a viable alternative; the consequences of inaction are far too serious.

For more than 35 years, the Robert Wood Johnson Foundation has been committed to improving the health and health care of all Americans. Today, as the opportunity for federal health reform seems more promising than at any time in recent history, RWJF aims to be a resource for credible, neutral, timely research and information that can help inform the national health reform debate among policy-makers and other stakeholders. We do not support any specific plan or approach to enacting health reform, but we do support key principles that comprise comprehensive, meaningful reform:

• Cover the uninsured. Forty-six million Americans, including 9 million children, are uninsured, and the problem is growing. As health care costs rise, fewer individuals and families have insurance, and fewer businesses can afford to offer insurance to their employees. Having a job, even a full-time job, doesn’t necessarily guarantee coverage. In fact, eight out of 10 uninsured Americans are in working families. Rising costs also strain the ability of the federal and state governments to fund vital public coverage programs, forcing governments to scale back coverage for those adults who are least likely to obtain affordable health care coverage through their jobs.
• Improve health care quality. Americans pay more for health care and receive poorer health outcomes than people living in all of the world’s other developed nations. Patients receive only about half of recommended care, and disparities of race, ethnicity, residence, education and income are persistent. Despite advances in medical technology and science, health care in America is still fraught with uneven and often poor quality, especially in the treatment of chronic diseases that affect millions of Americans, like diabetes, asthma and cardiovascular disease. Although we know many of the best practices to improve the quality of treatment, in most communities, health care is delivered through fragmented systems within which hospitals, clinics, doctors, nurses and patients struggle to understand what quality care is and how to achieve it.
• Invest in public health and prevention. Whether or not a person stays well in the first place has little to do with seeing a doctor. Public health epidemics such as obesity and tobacco use and exposure are putting millions of adults and children at risk for unprecedented levels of major diseases like cancer, diabetes and heart disease. Strategic investment in disease prevention and population health saves lives, strengthens families and the workforce, and reduces health care spending.
• Address cost and value. Compared to health care in other countries, the care in the United States is high-cost and low quality. United States spending on health care, as a percentage of gross domestic product (GDP), is more than six percentage points higher than the average for other developed countries, but we rank 20th in life expectancy among major industrialized nations, and 27th in infant mortality. The key driver of spending—accounting for an estimated one-half to two-thirds of spending growth—is technology, not changing demographics or medical malpractice. Other important drivers of health care spending include health status, particularly obesity, and low productivity gains in the in the health care sector. But higher spending does not achieve better outcomes.