Emerging health care reform issues in the US presidential debate.

The 2008 presidential election in the United States has again elevated the issue of health care reform to center stage. Reform proposals are proliferating in the states as well as nationally. Virtually all candidates – both Republican and Democratic – running for President have outlined their plans for reforming health care. The renewed interest in health care reform reflects the fact that several key measures of the performance of the US health care system continue to deteriorate. Since 2000, the (nominal) cost of private health insurance has doubled. Over the same period, the number of Americans without health insurance has increased from 38.7 million to 47million in 2006. Objective measures of the quality of health care provided to chronically ill patients are also of concern; such patients only receive approximately 56% of the clinically recommended preventive health care (McGlynn et al., 2003). Of course, these problems plaguing the American health care system are not new. However, what is new is the flurry of activity at the state level. Absent federal leadership of the issue over the past seven years, two states – Vermont and Massachusetts – have recently passed comprehensive health care reform plans. Massachusetts passed an individual mandate that requires all residents of the state to have health insurance. Health plans offered through the state’s insurance ‘‘connector’’ offer comprehensive benefits. Individuals can purchase a low cost sharing or a higher cost sharing version of these plans (premiums differ by about $35 per month for the two plans). Certain exceptions to the law were made for individuals and families earning more than three times the US poverty level. These individuals may apply for a waiver from the requirement and remain