The debate over health care reform in the United States centers on questions about whether there is a fundamental right to health care, on who should have access to health care and under what circumstances, on the quality achieved for the high sums spent, and on the sustainability of expenditures that have been rising faster than the level of general inflation and the growth in the economy. The leading cause of personal bankruptcy in the United States is medical debt which is almost unknown in other countries in the developed world. The United States spends a greater portion of total yearly income in the nation on health care than any United Nations member state except for East Timor (Timor-Leste), although the actual use of health care services in the U.S., by most measures of health services use, is below the median among the world's developed countries.
According to the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage". Americans are divided along party lines in their views regarding the role of government in the health economy and especially whether a new public health plan should be created and administered by the federal government. Those in favor of universal health care argue that the large number of uninsured Americans creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality. Opponents of laws requiring people to have health insurance argue that this impinges on their personal freedom. Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care which needs to be protected by their government.
The focus is currently on the recently passed Affordable Health Care for America Act in the House of Representatives, which has yet to be acted on by the Senate.