Health care reform has emerged as an issue in the 111th Congress, driven by growing concern about widely discussed problems. Three predominant concerns involve coverage, cost and spending, and quality. Commonly cited figures indicate that more than 45 million people have no insurance, which can limit their access to care and their ability to pay for the care they receive. Costs are rising for nearly everyone, and the country now spends over $2.2 trillion, more than 16% of gross domestic product (GDP), on health care services and products, far more than other industrialized countries.