After lifestyle, which drives much of the cost, the second biggest challenge, hospitals, physicians, drug companies, imaging(x-ray), and other healthcare providers have insufficient motive or incentive to work harder to save patient's money. The provider reimbursment system is set up so the more you do, the more you get paid. There isn't enough consideration given to the cost effectiveness of the surgery, treatment, test, drug, MRI, etc.

The costs are out of control. There is no doubt of that. Fee for service is a dinosaur AND a bottomless pit. The diagnostically destitute are running amok.

The biggest challenge is keeping cost affordable and still be able to pay for services without going into the negative. There is also a challenge to keep America healthy with preventive care.

I think many things drive the cost of Healthcare in today's world. The fact there are many that are uninsured, we are facing an aging population and we do NOT pay for performance are just some characteristics we are up against. Also, we need to be cognizant of the fact that many folk still use the ER as a Primary Care provider. Raising copay's or deductibles for "place of service" visits may not be the answer because most folks that account for this type of activity are uninsured anyway.

I didn't select one of the multiple choices answers, because I believe the greatest challenge facing the U.S. healthcare system is illegal immigrants who use healthcare services without paying for them, as well as clogging up the system and causing bottlenecks for legal citizens.

There are many people who are from other contries who are undocumented but working and not paying taxes or paying health insurance premiums and they are given the right to go to the public hospital for free. They recieve better care than I can afford even with health insurance and they are not US citizens and are in the country illegally. The undocumented workers have babies here paid for by my tax and insurance premium dollars. Add insult to injury they can get food stamps, subsidised housing and medicaid. Something is very wrong in this country. This is a major issue that is driving up hospital costs and taxes.

Lifestyle is a big one. Something like 25% of Americans get NO exercise.

Unfortunately I personally know of several US citizens who do the same.

Illegal immigrants that are not paying taxes or anything else but get money from our government that US citizens cannot get themselves.

There are many citizens of this country that do the very same thing with one critical difference, they do not work. Some of them are even on disability for conditions that aren't remotely debilitating. Perhaps the welfare system is the problem not a specific ethnic group.

All of the options are major contributing factors to the challenge's we face in this country. Most of these are socio-economic, cultural, and behavioral related. Most of these factors are not issues that can be resolved by health care or insurance reform. The majority of them would require a major overhaul on the government, media, and average American mindset. There is an enormous issue with the aging population. This is an extremely large group that is going to require health care faced with a younger population that is much smaller in number. Consider that life expectancy is significantly longer and getting longer with each medical advance. Surgeries, machines, medications, long term nursing facilities all enable debilitated individuals to live for very long periods. The body can be enhanced to perform long after it is ready to give out. There are some of these people that we will be providing constant health care to for decades. In addition, taxing the system is an outdated, abused welfare system. I agree that lifestyle does have an effect on health but I don't think that is the biggest problem our country faces at this time. We have many more pressing issues than whether John Doe goes for a jog or not. The fact is that our environment has changed and we are evolving to that environment.

My husband is self employed and pays for his own insurance. I am currently employed, and have insurance with my job, but want to become self-employed. My husband and I would also like to have children in the next year. As I understand it, America is the land of opportunity which encourages people to become entrepreneurs and strive for the American Dream. Unfortunately, we cannot afford to have a baby while paying for our own coverage- Maternity coverage is between $100-600 a month, and most of it doesn't cover very much! Delivering a child in the US costs about $8000. In the UK and other countries with social health care- $0. I see a major problem here!

This is a very broad topic and hard to answer as it is a combination of a lot of things. Cost is a major factor and part of the reason for this is the job market is down, companies have been hiring more contractors instead of regular employment. Contractors usually make a lot less money and people can't afford insurance, or they select the cheapest plan. What's more important eating and having a roof over your head or knowing you have insurance but no food on the table.

Hard to pick one on this question, as they are all playing a huge factor at this time. With the middle class slowly sinking to the bottom, all of these issues come into play. A healthy life style is usually not available to those individuals. Healthy food is not cheap and many cannot afford those choices. Working long hrs, 2-3 jobs to make ends meet does not allow for healthy activity, nor the time to prepare a healthy meal.

There should have been an "All of the above" choice.