Journal of Family Medicine and Health Care 2020; 6(1): 24-30 http://www.sciencepublishinggroup.com/j/jfmhc doi: 10.11648/j.jfmhc.20200601.15 ISSN: 2469-8326 (Print); ISSN: 2469-8342 (Online) Commentary Healthcare Reform in the U.S. Must Be Driven by Policy and Data, Not Politics and Ideology Teresa Waters 1, * , Michael Karpf 2 1 Department of Health Management & Policy, University of Kentucky College of Public Health, Lexington, Kentucky, United States 2 Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, United States Email address: * Corresponding author To cite this article: Teresa Waters, Michael Karpf. Healthcare Reform in the U.S. Must Be Driven by Policy and Data, Not Politics and Ideology. Journal of Family Medicine and Health Care. Vol. 6, No. 1, 2020, pp.24-30. doi: 10.11648/j.jfmhc.20200601.15 Received: February 21, 2020; Accepted: March 9, 2020; Published: March 31, 2020 Abstract: Background U.S. healthcare spending will reach 20% of GDP by 2026. Despite this spending, almost 14% of our under-65 population still lacks health insurance and out-of-pocket healthcare spending is high. To date, much of the healthcare reform debate has focused on who pays—the government, employers or individuals. Objective To review current healthcare reform issues and evidence. Method We address the questions of how much we pay, how we pay and what we receive for the money as a potential foundation for constructive dialogue. Results U.S. healthcare spending continues to exceed that of other countries, without offering universal coverage. Notwithstanding coverage expansions implemented under the Affordable Care Act, uninsurance rates have been rising. Rapid growth of high deductible plans has also significantly increased rates of underinsurance. There is very little evidence that specific policies or interventions employed to date will significantly reduce cost, especially under a fee for service system, where volume makes up for cuts. Global risk payments hold the greatest promise for real cost containment because they can drive true delivery system reform. Conclusion Meaningful, long-term healthcare reform cannot be successful until comprehensive, evidence-based policies that address healthcare costs are fully embraced and implemented. Keywords: Healthcare Reform, Healthcare Cost, U.S. Healthcare System, Access and Coverage 1. Introduction U.S. healthcare spending will reach 20% of GDP by 2026 [1]. Despite this spending, almost 14% of the U.S. under-65 population still lack health insurance [2]. Because out-of-pocket costs for healthcare are high and continue to go up, an increasing number of insured Americans are having difficulty accessing comprehensive care. The plight of those who lack insurance (uninsured) and those who lack adequate insurance (underinsured) cannot be ignored. To date, much of the healthcare reform debate in the U.S. has focused on who pays—the government, employers or individuals. Ultimately, the American people pay in one way or the other: through taxes, paycheck deductions, benefits in lieu of wages, or straight out of pocket. The real questions should not be who pays but should be how much can the American public can afford to pay, how they pay and what they receive for the money. Healthcare reform will not be successful in the U.S. until comprehensive, evidence-based policies are fully embraced and implemented. The root causes of the American health system’s problems must be clearly articulated, openly and publicly debated and addressed in order to develop a rational delivery model rather than one that just rations care. 2. Skyrocketing Costs: Implications and Consequences In the U.S., the Medicaid program is funded jointly between state and federal governments to provide coverage for low-income populations. Medicaid accounted for 19.6% of