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    Health Care Reform:

    Health Insurance & Affordable Care Act

    High Cost, Poor Efficiency, and Lack of Fairness Mar System

    U.S. Health System Gets Dismal Score

    Fragmented Care continued...

    "The challenge, I think, is spread. It's a very fragmented system," says Maureen Bisognano, a member of the commission and executive vice president of the Institute for Healthcare Improvement, a New York-based policy group.

    Among the report's other findings:

    • Hospital and doctor care for heart attacks, hip fractures, and coloncancer now cost a median of $26,000, though quality is largely unrelated to how much is spent.

    • The U.S. spends more than 3 times what France does administering health insurance, as a percentage of overall medical spending.

    • Fewer than 20% of U.S. doctors use electronic medical records, among the lowest rates in industrialized countries.

    • 1/3 of American adults have outstanding medical debt.

    Appetite for Reform?

    The commission urged U.S. policy makers to take broad steps to guarantee universal access to health insurance.

    But that goal has proven politically hazardous, most recently in 1994, when the White House tried and failed to execute broad health insurance reforms, led by Sen. Hillary Rodham Clinton (D-N.Y.), then the first lady.

    Ever since, lawmakers have shied away from comprehensive reforms in favor of smaller, incremental steps.

    Medicare is beginning to use financial incentives to convince hospitals, nursing homes, and others to report quality information to the public.

    And the government is slowly shepherding the development of electronic medical records like those already widely used in many European countries -- another of the commission's recommendations.

    But experts warned that, overall, reforms are moving too slowly to keep up with a rapidly aging U.S. population.

    "The security of a healthy nation is at stake. Actions are urgently needed," says Cathy Schoen, the commission's research director.

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