This Commonweath Fund report offers recommendations for a set of insurance, payment, and system reforms that could make health insurance coverage universally affordable and improve health outcomes. Recommendations include policies to change the health care financing system, investments in information systems to improve quality and safety, and increased competition to produce higher quality and reduced costs for individuals, employers and the public sector.

From the report:

The nation's health and economic security are at risk: rising costs are putting pressure on families, businesses, and governments, and sharp increases in the number of uninsured and underinsured are leaving millions without access to care or essential financial protection when sick. The U.S. health care system is already the most expensive in the world, by far, and total health spending is projected to double by 2020—rising from a projected $2.6 trillion in 2009 to $5.2 trillion by 2020 to consume 21 percent of the nation's economic resources (gross domestic product). To achieve more affordable coverage and ensure access for everyone in the country, we must change the way health care is delivered and the way we pay for care. We must focus on value. Despite having centers of excellence, our health care system falls short. It fails to produce the outcomes and care it could, wastes resources, often fails to provide the right care at the right time, and delivers unacceptably wide variations in quality and safety. Unless we move to a high performance delivery system and improve the value of care that is delivered, efforts to expand coverage will be difficult, if not impossible, to sustain over time.

Full Report: The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way

The Commonwealth Fund Commission on a High Performance Health System. (2009). The path to a high performance U.S. health system: a 2020 vision and the policies to pave the way.