<P> A poll released in March 2008 by the Harvard School of Public Health and Harris Interactive found that Americans are divided in their views of the U.S. health system, and that there are significant differences by political affiliation . When asked whether the U.S. has the best health care system or if other countries have better systems, 45% said that the U.S. system was best and 39% said that other countries' systems are better . Belief that the U.S. system is best was highest among Republicans (68%), lower among independents (40%), and lowest among Democrats (32%). Over half of Democrats (56%) said they would be more likely to support a presidential candidate who advocates making the U.S. system more like those of other countries; 37% of independents and 19% of Republicans said they would be more likely to support such a candidate . 45% of Republicans said that they would be less likely to support such a candidate, compared to 17% of independents and 7% of Democrats . </P> <P> A 2004 Institute of Medicine (IOM) report said, "the United States is among the few industrialized nations in the world that does not guarantee access to health care for its population ." There is currently an ongoing political debate centering on questions of access, efficiency, quality, and sustainability . Whether a government - mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic, with Americans divided along party lines in their views of the U.S. health system and what should be done to improve it . 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 . Cato Institute Senior Fellow Alan Reynolds argues that people should be free to opt out of health insurance, citing a study by economists Craig Perry and Harvey Rosen that found "the lack of health insurance among the self - employed does not affect their health . For virtually every subjective and objective measure of their health status, the self - employed and wage - earners are statistically indistinguishable for each other ." Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government . </P> <P> Lobbying by insurance company and health care industry representatives has played an important role in health care reform efforts . Key politicians such as Senator Max Baucus have taken the option of single payer health care off the table entirely . In a June 2009 NBC News / Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance ." </P> <P> Advocates for single - payer health care often point to other countries, where national government - funded systems produce better health outcomes at lower cost . Opponents deride this type of system as "socialized medicine", and it has not been one of the favored reform options by Congress or the President in both the Clinton and Obama reform efforts . It has been pointed out that socialized medicine is a system in which the government owns the means of providing medicine . The United Kingdom is an example of socialized system, as, in the United States, is the Veterans Health Administration . Medicare is an example of a mostly single - payer system, as is France . Both of these systems have private insurers to choose from, but the government is the dominant purchaser . </P>

Which of the following is a primary reason health care in the united states is more expensive