Americans should have universal access to health insurance by the year 2012, a congressionally mandated report concluded Monday.

The report calls on Congress to move by next year to pass insurance reforms protecting all citizens from catastrophic medical bills using either market-based insurance policies or taxpayer-funded methods.

It then calls for new laws guaranteeing universal access to affordable health insurance to be in place by 2012.

The report was issued by the Citizens’ Health Care Working Group, which was directed by Congress to hold a series of public forums nationwide on how to reform the health care system. Congress is required to hold hearings on the report next year.

“The overwhelming majority of Americans that the working group heard from … want health care system change to begin now,” the report states.

Approximately 46 million Americans are estimated to lack health coverage. Meanwhile, the cost of private health insurance for a family of four now tops $10,000. The report does not endorse a particular policy for expanding coverage, though experts acknowledged that progress would likely end up encompassing a combination of private incentives and government expansions.

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Sen. Ron Wyden, D-Ore., who co-authored the bill creating the working group, pointed to recent bipartisan reforms in Massachusetts that spread insurance coverage statewide with a combination of market incentives and coverage mandates.

“That’s the kind of mix that can produce some common ground,” Wyden tells WebMD.

A report released last week by the Commonwealth Fund think-tank gave mostly dismal scores to the U.S. health care system for running high costs without enough attention to efficiency and quality care.

That report’s authors acknowledged fundamental reforms would likely have to be incremental because of the electrified politics of the $2 trillion-per-year American health care system.

Congress has recently moved to expand access to tax-free health savings accounts. Supporters, including President Bush, say the accounts can increase efficiency by allowing individuals to save and spend more of their own money on medical care. The accounts have been taken up by more than 3 million people, according to health industry estimates.

Michael Cannon, director of health policy at the Cato Institute, a free-market think tank, criticized Monday’s report for pointing the way to an expansion of government’s role in health care.

“Their ‘market-based’ model would increase taxes and increase spending. This is not free-market stuff,” he says.

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By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: Health Care That Works for All Americans, Citizens Health Care Working Group, Sept. 25, 2006. Sen. Ron Wyden, D-Ore. Michael Cannon, director of health policy studies, Cato Institute.