The need for change in the system of health care delivery in the United States has finally emerged as a political issue alongside continuing budget deficits, a growing national debt, declining educational outcomes, and decreased competitiveness of American business in the global economy. The two most pressing health care problems at the present time are rapidly increasing costs and lack of access to the system. A more distant but potentially more recalcitrant problem is the ageing of our population. This paper (...) outlines and discusses some of the options for reform which are currently under consideration in the United States. (shrink)