The debate about health care reform in this country has been contentious and confusing. The U.S. House of Representatives and the U.S. Senate are separately considering multiple bills.

When the two bodies hammer out their different versions of a health care reform bill, they will then have to create a compromise before it becomes law. Many of the changes won't take effect until several years hence.

But the basics of the reform would:

n Insure all Americans, giving them at least a basic, affordable plan. Currently more than 40 million residents lack any health insurance and many millions more are under-insured.

n Require everyone to have health insurance. The government would provide subsidies to help people and small businesses that couldn't otherwise afford it; it would impose some sort of tax or penalty on people who refuse to take out insurance and businesses that don't offer it.

n Allow people to keep the insurance plan they have, if they like it.

n Guarantee that no one will be refused health insurance because of a pre-existing medical condition, or that no insurer could drop someone's coverage because of a medical condition.

n Create exchanges where people and small businesses could purchase health insurance.

n Increase Medicaid eligibility so more low-income Americans could sign up for its benefits.

n Improve efficiency and cut waste throughout the health care system.

n Make insurers cover preventive care programs.

n Set up a body of experts to review Medicare and make the system run more efficiently and less expensively.

The fate of a government-run "public option'' insurance plan has not been decided. Many in Congress say it's essential to provide competition in the field. Others say it would be unfair competition to private insurance companies, putting them out of business.

The cost of the reform package has been estimated at $1 trillion over 10 years. President Barack Obama has pledged that health care reform costs won't add to the federal deficit.

-- Bob Miller