text:
Health care reform

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
 * Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
 * Expand the array of health care providers consumers may choose among
 * Improve the access to health care specialists
 * Improve the quality of health care
 * Give more care to citizens
 * Decrease the cost of health care

United States
In the United States, the debate regarding health care reform includes questions of a right to health care, access, fairness, sustainability, quality and amounts spent by government. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for East Timor (Timor-Leste).

Hawaii and Massachusetts
Both Hawaii and Massachusetts have implemented some incremental reforms in health care, but neither state has complete coverage of its citizens. For example, data from the Kaiser Family Foundation shows that 5% of Massachusetts and 8% of Hawaii residents are uninsured. To date, The U.S. Uniform Law Commission, sponsored by the National Conference of Commissioners on Uniform State Laws has not submitted a uniform act or model legislation regarding health care insurance or health care reform.

United Kingdom
Healthcare was reformed in 1948 after the Second World War, broadly along the lines of the 1942 Beveridge Report, with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of healthcare was never contingent upon making contributions towards the National Insurance Fund. Private health care was not abolished but had to compete with the NHS. About 15% of all spending on health in the UK is still privately funded but this includes the patient contributions towards NHS provided prescription drugs, so private sector healthcare in the UK is quite small. As part of a wider reform of social provision it was originally thought that the focus would be as much about the prevention of ill-health as it was about curing disease. The NHS for example would distribute baby formula milk fortified with vitamins and minerals in an effort to improve the health of children born in the post war years as well as other supplements such as cod liver oil and malt. Many of the common childhood diseases such as measles, mumps, and chicken pox were mostly eradicated with a national program of vaccinations.

The NHS has been through many reforms since 1974. The Conservative Thatcher administrations attempted to bring competition into the NHS by developing a supplier/buyer role between hospitals as suppliers and health authorities as buyers. This necessitated the detailed costing of activities, something which the NHS had never had to do in such detail, and some felt was unnecessary. The Labour Party generally opposed these changes, although after the party became New Labour, the Blair government retained elements of competition and even extended it, allowing private health care providers to bid for NHS work. Some treatment and diagnostic centres are now run by private enterprise and funded under contract. However, the extent of this privatisation of NHS work is still small, though remains controversial. The administration committed more money to the NHS raising it to almost the same level of funding as the European average and as a result, there was large expansion and modernisation programme and waiting times improved.

The government of Gordon Brown proposed new reforms for care in England. One is to take the NHS back more towards health prevention by tackling issues that are known to cause long term ill health. The biggest of these is obesity and related diseases such as diabetes and cardio-vascular disease. The second reform is to make the NHS a more personal service, and it is negotiating with doctors to provide more services at times more convenient to the patient, such as in the evenings and at weekends. This personal service idea would introduce regular health check-ups so that the population is screened more regularly. Doctors will give more advice on ill-health prevention (for example encouraging and assisting patients to control their weight, diet, exercise more, cease smoking etc.) and so tackle problems before they become more serious. Waiting times, which fell considerably under Blair (median wait time is about 6 weeks for elective non-urgent surgery) are also in focus. A target was set from December 2008, to ensure that no person waits longer than 18 weeks from the date that a patient is referred to the hospital to the time of the operation or treatment. This 18-week period thus includes the time to arrange a first appointment, the time for any investigations or tests to determine the cause of the problem and how it should be treated. An NHS Constitution was published which lays out the legal rights of patients as well as promises (not legally enforceable) the NHS strives to keep in England.

Germany
Numerous healthcare reforms in Germany were legislative interventions to stabilise the public health insurance since 1983. 9 out of 10 citizens are publicly insured, only 8% privately. Health care in Germany, including its industry and all services, is one of the largest sectors of the German economy. The total expenditure in health economics of Germany was about 287.3 billion euro in 2010, equivalent to 11.6 percent of the gross domestic product (GDP) this year and about 3,510 euro per capita. Direct inpatient and outpatient care equal just about a quarter of the entire expenditure - depending on the perspective. Expenditure on pharmaceutical drugs is almost twice the amount of those for the entire hospital sector. Pharmaceutical drug expenditure grew by an annual average of 4.1% between 2004 and 2010.

These developments have caused numerous healthcare reforms since the 1980s. An actual example of 2010 and 2011: First time since 2004 the drug expenditure fell from 30.2 billion euro in 2010, to 29.1 billion Euro in 2011, i. e. minus 1.1 billion Euro or minus 3.6%. That was caused by restructuring the Social Security Code: manufacturer discount 16% instead of 6%, price moratorium, increasing discount contracts, increasing discount by wholesale trade and pharmacies.

The Netherlands
The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Furthermore, health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks.

A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.

Russia
Following the collapse of the Soviet Union, Russia embarked on a series of reforms intending to deliver better healthcare by compulsory medical insurance with privately owned providers in addition to the state run institutions. According to the OECD none of 1991-93 reforms worked out as planned and the reforms had in many respects made the system worse. Russia has more physicians, hospitals, and healthcare workers than almost any other country in the world on a per capita basis, but since the collapse of the Soviet Union, the health of the Russian population has declined considerably as a result of social, economic, and lifestyle changes. However, after Putin became president in 2000 there was significant growth in spending for public healthcare and in 2006 it exceed the pre-1991 level in real terms. Also life expectancy increased from 1991-93 levels, infant mortality rate dropped from 18.1 in 1995 to 8.4 in 2008. Russian Prime Minister Vladimir Putin announced a large-scale health care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billion) in the next few years to improve health care in the country.

Taiwan
Taiwan changed its healthcare system in 1995 to a National Health Insurance model similar to the US Medicare system for seniors. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered. It is said to deliver universal coverage with free choice of doctors and hospitals and no waiting lists. Polls in 2005 are reported to have shown that 72.5% of Taiwanese are happy with the system, and when they are unhappy, it's with the cost of premiums (equivalent to less than US$20 a month).

Employers and the self-employed are legally bound to pay National Health Insurance (NHI) premiums which are similar to social security contributions in other countries. However, the NHI is a pay-as-you-go system. The aim is for the premium income to pay costs. The system is also subsidized by a tobacco tax surcharge and contributions from the national lottery.

Elsewhere
As evidenced by the large variety of different healthcare systems seen across the world, there are several different pathways that a country could take when thinking about reform. In comparison to the UK, physicians in Germany have more bargaining power through professional organizations (i.e., physician associations); this ability to negotiate affects reform efforts. Germany makes use of sickness funds, which citizens are obliged to join but are able to opt out if they have a very high income (Belien 87). The Netherlands used a similar system but the financial threshold for opting out was lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides healthcare to just over 25% of its citizens through various agencies, but otherwise does not employ a system. Healthcare is generally centered around regulated private insurance methods.

One key component to healthcare reform is the reduction of healthcare fraud and abuse. In the U.S. and the EU, it is estimated that as much as 10 percent of all healthcare transactions and expenditures may be fraudulent. See Terry L. Leap, Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to do about It (Cornell University Press, 2011).

Also interesting to notice is the oldest healthcare system in the world and its advantages and disadvantages, see Health in Germany.

"Control knobs" theory
In "Getting Health Reform Right: A Guide to Improving Performance and Equity," Marc Roberts, William Hsiao, Peter Berman, and Michael Reich of the Harvard T.H. Chan School of Public Health aim to provide decision-makers with tools and frameworks for health care system reform. They propose five "control knobs" of health reform: financing, payment, organization, regulation, and behavior. These control knobs refer to the "mechanisms and processes that reformers can adjust to improve system performance". The authors selected these control knobs as representative of the most important factors upon which a policymaker can act to determine health system outcomes.

Their method emphasizes the importance of "identifying goals explicitly, diagnosing causes of poor performance systematically, and devising reforms that will produce real changes in performance". The authors view health care systems as a means to an end. Accordingly, the authors advocate for three intrinsic performance goals of the health system that can be adjusted through the control knobs. These goals include: The authors also propose three intermediate performance measures, which are useful in determining the performance of system goals, but are not final objectives. These include: While final performance goals are largely agreed upon, other frameworks suggest alternative intermediate goals to those mentioned here, such as equity, productivity, safety, innovation, and choice. The five proposed control knobs represent the mechanisms and processes that policy-makers can use to design effective health care reforms. These control knobs are not only the most important elements of a healthcare system, but they also represent the aspect that can be deliberately adjusted by reforms to affect change. The five control knobs are: The five control knobs of health care reform are not designed to work in isolation; health care reform may require the adjustment of more than one knob or of multiple knobs simultaneously. Further, there is no agreed-upon order of turning control knobs to achieve specific reforms or outcomes. Health care reform varies by setting and reforms from one context may not necessarily apply in another.
 * 1) Health status: This goal refers to the overall health of the target population, assessed by metrics such as life expectancy, disease burden, and/or the distribution of these across population subgroups.
 * 2) Customer satisfaction: This goal is concerned with the degree of satisfaction that the health care system produces among the target population.
 * 3) Financial risk protection: This goal refers to the health system's ability to protect the target population from the financial burden of poor health or disease.
 * 1) Efficiency:
 * 2) Technical efficiency: maximum output per unit cost
 * 3) Allocative efficiency: a given budget maximises health system user satisfaction or other defined goals
 * 4) Access: effective availability by which patients receive care
 * 5) Quality of care: consideration of both the average quality and distribution of quality
 * 1) Financing, which encompasses all the mechanisms and activities designed to raise money for the health system. With respect to mechanisms, the financing knob includes health-related taxes, insurance premiums and out-of-pocket expenses among others. Activities refers to the institutional organization that collects and distributes finance to participants in the health sector. In other words, financing is about the resources available to the healthcare system, who controls them and who receives them. The financing knob has clear implications for the health status of the population and particular groups in it, as well as the access to health care and protection from financial risk that these groups, and the population as a whole, have. The financing knob involves numerous potential financing mechanisms and processes that should be selected in accordance with a country's social values and politics.
 * 2) Payment refers to the mechanisms and processes through which the health system or patients distribute payments to providers, including fees, capitation and budgets on the part of the government and fees paid by patients. Payment is about the distribution of available resources to the providers of health services. Health care reform can implement a variety of incentive schemes for both providers and patients in a way to optimize limited resources.
 * 3) Organization of the health system refers to the structure of providers, their roles, activities and operations. Essentially, organization describes how the health care market is set up: who are the providers, who are the consumers, who are the competitors, and who runs them. Changes in the organization of a healthcare system happen at multiple levels at both the front-line and managerial level.
 * 4) Regulation refers to actions at the state level that modify or alter the behavior of various actors within the health care system. The actors may include health care providers, medical associations, individual consumers, insurance agents, and more. Regulations are only effective when enforced, therefore laws that are "on the books" but are not implemented in practice have little effect on the system as a whole.
 * 5) Behavior of healthcare actors includes actions of both providers (e.g., doctors' behavior) and patients (e.g., anti-smoking campaigns) and involves "changing individual behavior through population-based interventions". Healthcare reform with respect to behavior revolves around the behaviors that can be used to improve the outcomes and performance of the health care system. These behaviors include health-seeking behavior, professional/doctors' behavior, treatment compliance, and lifestyle and prevention behaviors.

The knobs interact with cultural and structural factors that are not illustrated within this framework, but which have an important effect on health care reform in a given context.

In summary, the authors of "Getting Health Reform Right: A Guide to Improving Performance and Equity" propose a framework for assessing health systems that guides decision-makers' understanding of the reform process. Rather than a prescriptive proposal of recommendations, the framework allows users to adapt their analysis and actions based on cultural context and relevance of interventions. As noted above, many frameworks for health care reform exist in the literature. Using a comprehensive yet responsive approach such as the control knobs framework proposed by Roberts, Hsiao, Berman, and Reich allows decision-makers to more precisely determine the "mechanisms and processes" that can be changed in order to achieve improved health status, customer satisfaction, and financial risk protection.

Topics on status quo in health care

 * Health insurance
 * Health care / Healthcare system / Health care provider
 * Health center / Clinic / Hospital
 * Health care politics
 * Medical education
 * Medicine / Doctor's visit / Nursing
 * Philosophy of healthcare / Universal health care
 * Social service / Social determinants of health
 * Family medicine / Preventive medicine / Social medicine
 * Health policy
 * Health insurance / Insurance /Social health insurance
 * Community health service / Direct primary care
 * Direct primary care / School health services
 * Family medicine / Preventive medicine / Social medicine
 * Military medicine
 * Occupational safety and health
 * Unnecessary health care

Reform

 * Health care compared - tabular comparisons of the US, Canada, and other countries not shown above.
 * Health care in the United States
 * Health care reform in the United States
 * Healthcare-NOW!
 * Health-care reform in China
 * History of the National Health Service - and related national sub-pages such as History of the National Health Service (England)
 * Integrated Benefits Institute
 * Journal of Health Care for the Poor and Underserved
 * Kaiser Family Foundation
 * List of healthcare reform advocacy groups in the United States
 * Massachusetts health care reform
 * Matthew effect: sociological disparity of coverage
 * Medicare for All Act
 * Medicare Rights Center
 * National health insurance
 * National Physicians Alliance
 * Progressive Democrats of America
 * Puerto Rico Health Reform
 * Single-payer healthcare
 * Universal Health Care Foundation of Connecticut

title: Health care reform


text:
Talk:Health care reform

This
This entire series of articles on health care reform appears to be a series of advocacy papers written from a left-liberal perspective. In particular, the articles about health care reform between the teens and forties, health care reform under Truman, health care reform under Nixon, health care reform under Carter, and health care reform under Clinton are all written from a point of view that clearly favors some sort of national single-payer or modified single-payer system. The author considers setbacks for increased state control of health care "unfortunate" at nearly every juncture.

While they contain valuable historical information, they need to be edited to conform to the NPOV policy. The coverage itself also violates the spirit of the NPOV policy: presidents George H.W. Bush and George W. Bush also proposed major health care system reforms which would emphasize market mechanisms and individual responsibility. They are currently are not covered at all. I have tagged all of them with a NPOV and quality tags. Since it seems clear that one person wrote all these articles--I'm including notes on all the talk pages to discuss the issues here.

Elirl

Anyone who read the history for these pages would quickly see they were not at all written by a single author. This material was posted by members in my Politics of Health Care class taught at Duke University. They use a common template in terms of how the information is "packaged" so that it's relatively to look across these "case studies" and see a common set of questions being addressed. Our focus in class was universal coverage proposals and the "puzzle" we were addressing is why such initiatives repeatedly have been defeated over nearly 100 years of effort given that public opinion polls repeatedly show overwhelming support for the idea of universal coverage. We did not have time in class to look at every administration or every set of proposals that has ever been advanced. Those wishing to post "case studies" of health reform efforts by Bush 41 or Bush 43 are more than welcome to do so.

FWIW, I am very far from being an advocate of single payer: indeed, I presented (to rather considerable ridicule) a paper at the American Political Science Association convention last September a paper titled How the U.S. Achieved Universal Coverage under George W. Bush, outlining a very market-oriented approach to universal coverage entailing an individual mandate coupled with high-deductible consumer-directed health plans. This style of reform has been championed in books published by American Enterprise Institute, Heritage Foundation and other market-oriented think tanks or writers, hardly champions of a single payer approach. I continue to believe that if we get universal coverage, it is far more likely to emerge through leadership from a Republican president using a platform that is market-oriented rather than single payer. Moreover, I think one could legitimately view the history of failed efforts to achieve universal coverage and make the case that it was the repeated dogmatic refusal of single payer advocates to compromise on their vision of what universal coverage should look like that has led us into the impasse we face even today.

Thus, if you detect bias in these cases, you can rest assured it was not encouraged by me. On the contrary, I repeatedly made clear that I expected these students fleshing out these cases to stick to reporting on the facts in each case: who did what, when, why and how, etc. as opposed to getting into philosophical discussions of the ethical merits of one approach to universal coverage versus another. I thought that sharing our collective class work on Wikipedia made far more sense than just creating these cases for our own use and thereafter consigned to the dustbin of academia. You may regard our focus on universal coverage as biased in and of itself, but as indicated above, it is the disconnect between repeated expressions of public opinion and our failure to address these that creates the puzzle. Were only 25% of the public in favor of universal coverage, there would be no puzzle to solve and not much interest in cases to help us better understand why this idea keeps failing.

Thus, if you believe there are certain expressions of bias within a given case, then the appropriate corrective is to simply make the requisite edit(s) as opposed to branding the entire page as being biased. I think any even-handed observer would conclude that 95% or more of the content is strictly factual. If occasional expressions of a less-than-neutral point of view crept in, it was not my intent; in the real world, neither my students nor the men's or women's basketball teams are perfect. That said, in my classes, 95% is A work. Armed with more perfect information than s/he may have had when applying the NPOV and quality tags to this work, I would encourage Elirl to consider their removal.

--Conoverc 16:51, 7 February 2006 (UTC)

The United States section does read very biased, in favor of the left. "I think any even-handed observer would conclude that 95% or more of the content is strictly factual." Factual isnt the case. Once data is taken out of a table and put in paragraph form, it becomes baised, which is how this section reads. Also, by the "factual evidence" which comes from what appears to be one source..., when studies have been conducted by multiple sources, from around the country. Meaning that results simply pertaining to PA are irrelavent, unless you want to make a section, US Health Care Reform with a PA POV. Next you have that 5% which is not factual, which does not belong in an encyclopedia. Infact, their appears to be alot of POV in this section.

I have to say, this is a very leftist baised section, one of the most biaset to the left Ive seen to date on Wikipedia, which is saying alot.

Lots of changes to this page needed...
The distinction between "health reform" and "health care reform" is very artificial. It would be best to combine the two into a more comprehensive article on both the political processes and the management practices surrounding planning for change in health systems. It should be an international account - the history of health reform in the US has rightly been moved to other pages. 85.210.43.69 01:24, 13 May 2006 (UTC)(stuartjcameron).

Merge
These two articles have mostly different content, but the basic subject is the same. I think they would both be stronger if someone merged the content into a single article. WhatamIdoing (talk) 00:24, 22 January 2008 (UTC)

 * It strikes me that a large portion of the Health care politics article has more in common with the article on Universal health care than it does with this one - for example, the discussion of philosophy and the arguments for and against socialized medicine. Do a word search on "universal health care" in the article - you'll be amazed at how many hits you get.  I'd suggest merging it with the universal health care article instead.  I don't see that the politics article adds much to the combination of the Universal health care, Health care reform, Health policy analysis and Health economics articles.  Perhaps it would help to have a separate "politics" article if it focused more on how different political systems address health care, why they result in different solutions, or how different interest groups engage the issue politically - but that doesn't seem to be the direction it has taken.  —Preceding unsigned comment added by EastTN (talk • contribs) 19:10, 22 January 2008 (UTC)

 * As I have stated in other discussions, I think there's a distinction between articles that are at least making an attempt at a global approach to the issue, and those that are clearly focused on the United States. To me, health care reform is a global issue, and so far the content here reflects an attempt to address it globally. On the other hand, the article on health care politics reflects primarily the debate in the United States. I have suggested elsewhere that the debate in the United States needs to be the subject of its own article, and that the debate sections that focus primarily on these issues in the United States (see the two-column table at the bottom of universal health care and the lengthy section in publicly funded health care should come out of more global articles and be moved to a U.S. specific article. I agree that the health care politics article is a mess as it stands. Perhaps the article could be called "Health care reform in the United States". Any support for that idea? --Sfmammamia (talk) 21:19, 26 February 2008 (UTC)

 * Sure - I don't know what the best way is to bring order to all this, but that suggestion sounds reasonable to me.EastTN (talk) 14:50, 27 February 2008 (UTC)

 * I've just noticed that there's also an article on National health insurance. I can't get my head around how all of these articles fit together: Universal health care;  Publicly-funded health care; Single-payer health care; National health insurance; Socialized medicine; and Social health insurance (what am I missing?).  I know there are real conceptual distinctions between at least some of these, and different people use these terms in different contexts, but what we've got right now is terribly confusing.  It would really help if someone could come up with a reasonable taxonomy for these different terms and build at least a short umbrella article that would set some context for how to distinguish between them, and bring together links to all of them in a way that would help readers understand how they relate to each other.EastTN (talk) 20:26, 29 February 2008 (UTC)

 * If we were to do this - rename the health care politics article "Health care reform in the United States" - which sections would we pull out of the other articles to populate it? The "Debate in the United States" section of Universal health care; the "Debate" section of Publicly-funded health care; the "Proponents and intent," "Opponents and criticisms," "Polls," and "State proposals" sections of Single-payer health care; the "2008 U.S. Presidential election" section of Socialized medicine?  Anything else?EastTN (talk) 18:18, 10 March 2008 (UTC)

I would support the creation of an article "Health care reform in the United States". It is clear that there is going to be reform and it would indeed be very helpful keep all the arguments and issues about reform in the U.S. in an article that is specific to that country. We should then try to eliminate all the U.S. centric arguments about health care funding, regulation etc.. from the general sections in articles such as Universal health Care, Health Insurance, socialized medicine and publicly-funded health care and keep these in specific sections dedicated to that country. These latter articles are global in nature and should not be dominated all the time by US political arguments. I don't agree with the idea that "health care reform is a global issue" expressed above. No country has a static health care system and reform is ongoing but different countries will have different issues and different start points. Thus what works for one country may not work for another and reform can be heading in different directions in different countries.Thus we should have articles describing various types of systems around the world and the pros and cons of each. But the big issue of reform in the U.S. should be in a U.S. specific article.--Tom (talk) 08:39, 13 March 2008 (UTC)

 * I've taken a first stab at creating a Health care reform in the United States article. I've tried to pull together all the material we've discussed, and done a very rudimentary job of weaving it together.  I have not attempted to remove the material from other articles, nor to add links to the new article.  Please take a look to see if all the appropriate material has been moved into it.  If so, perhaps we can start cleaning up the other articles a bit.EastTN (talk) 20:17, 21 March 2008 (UTC)

My reversion of the article to last version by Prowler08 (undoing edits by LincolnSt)
A whole series of edits were made to this article transforming it out of all recognition. It used to contain a lot of very useful and informative but following the edits of mostly one editor the article was completely devoid of useful information on the subject.

I have therefore reverted the article back to its original state. If the article is to undergo radical alteration the matter should be discussed here first. --Hauskalainen (talk) 07:32, 26 January 2009 (UTC)

 * Many of the links added in the versions of LincolSt had no reference to reform in them at all. I am inclined to the conclusion that the edits were inspired by a motive to keep any real information about health care reform out of Wikipedia! And because of WP policy to assume good faith I do not make such a statement lightly. --Hauskalainen ([[07:45, 26 January 2009 (UTC)

 * I agree that major changes should be discussed in Talk first. LincolnSt is entitled to be WP:BOLD and make drastic changes. Other editors are entitled to be WP:BOLD and revert them. If you want the changes to stay, best to get consensus.

 * Please give me a short statement of what those changes were intended to accomplish and why the article is better that way. Nbauman (talk) 08:12, 26 January 2009 (UTC)

 * Whoa guys, I'm on your side. I only restored the old See also links that LincolnSt deleted. I wasn't adding them. You need to take a closer look at the edit history. Also, please change the title of this section and remove my user name, as I didn't do what you claimed. --Cosmic Cowboy (talk) 08:35, 26 January 2009 (UTC)

 * Re comments left at talk.. Sorry Cosmic... you are right. I got confused in my checking back. I've put the thing back to the way it was on this talk page. I edited also Nbauman's comment to remove your name. I trust that he will appreciate that I do this in good faith (I'm sure he was just following my lead).--Hauskalainen (talk) 09:12, 26 January 2009 (UTC)

 * Thanks, and by the way, I'm Prowler08. I got logged out and can't remember my password, and I had not put an email address on my account to retrieve it. --Cosmic Cowboy (talk) 09:16, 26 January 2009 (UTC)

Deletion proposal
Oppose I can only guess that this idea has occured to the proposer because I placed a similar deletion proposal at Health care systems which does anything but discuss health care systems. As such the current proposal to delete Healthcare reform seems more like childish tit-for-tat than serious editorial work. I won't bother giving further reasons. --Hauskalainen (talk) 18:26, 26 January 2009 (UTC)

Oppose This article has useful information. The proposed Merge into Health care systems section "reform" would make the Health care systems article too big. Editing it would delete valuable information. Nbauman (talk) 18:47, 26 January 2009 (UTC)

Support The only content in this article is duplication of three articles. Health care systems article won't be "too big" after merge. After replacing content forking with links to main articles, the only thing left is this.LincolnSt (talk) 19:48, 26 January 2009 (UTC)

Removed prod Healthcare reform is a very legitimate article that should be expanded. Any major problems with the article have been the result of the prod's nominator, LincolnSt, making drastic changes to the page without seeking consensus. --Cosmic Cowboy (talk) 20:28, 26 January 2009 (UTC)
 * You did not deny that this is a content fork of Health care reform in the United States and few others. What "drastic changes"? These are the only changes done by me (unreferenced templates). Please don't remove the template before it has expired.LincolnSt (talk) 21:28, 26 January 2009 (UTC)

 * Please read the text of the template carefully: it says "You may remove this message if you improve the article or otherwise object to deletion for any reason." Since there are two opposes above, please use another process for deletion (RfD) if you wish, but I am removing this template as per the template's instructions.--Gregalton (talk) 22:00, 26 January 2009 (UTC)
 * I deny that the articles are wp:content fork: "Articles should not be split into multiple articles just so each can advocate a different stance on the subject." How are the different articles taking different stances? Nbauman (talk) 22:46, 26 January 2009 (UTC)

Belien
The "Elsewhere" section has the term "Belien" in parentheses several times ("Belien 87", etc.). There is no explanation for this in the entire article, as far as I can tell. —Preceding unsigned comment added by 129.89.14.188 (talk) 17:00, 4 August 2009 (UTC)

United States - add history and the main drivers of current reform efforts. Cut repetitions
In my opinion, the U.S. section focuses too much on current reforms and says little or nothing about previous reforms. The reason may be because this article used to contain information about health care reform in the United States before that article was created (see earlier discussion in this discussion page).

It should begin with a brief summary of the main health care reform actions (Medicare, Medicaid, EMTALA). Then the article should mention the main problems driving current reform proposals such as coverage (15% of population uninsured, employment linkage), insurance company behaviors (recissions, applicant pre-screening, high overheads), the high cost of care from providers and the reasons for it (e.e. fee-for-service rewarding quantity not quality, profit motive, defensive medicine). Beyond this the reader should refer to the main article Health care in the United States for more information. When adding the history which explains the current section we should also aim to cut the repetitious elements already in the section (e.g. on costs such as % of GDP/World/OECD etc). My preference would be for the efforts of individual states to be discussed only in the main article. The main thrust should be to provide the reader with sufficient wikilinks to get more information if the reader needs it and not to overwhelm the reader with all the arguments and references in this article. Does this seem reasonable?--Hauskalainen (talk) 10:41, 29 September 2009 (UTC)

 * I will take silence on this matter as being that this is a non-controversial proposal.--Hauskalainen (talk) 08:33, 2 October 2009 (UTC)

==United States General strike called for Monday November 16th, 2009 -

There are rumors of a general strike circulating over the internet. Can anyone confirm these? —Preceding unsigned comment added by 206.109.195.126 (talk) 19:43, 1 November 2009 (UTC)

Multiple grammar and comprehensibilty issues
There is peculiar and incomprehensible English throughout the article, especially in the 'Germany' section. I tried to fix some of it, but I'm not a native English speaker, nor do I know anything about this subject.

Article Evaluation
This article is advocating for a new health care system and gives a lot of information in favor of drastic change. The data that it provides seems to be sufficient enough to advocate for change, however, the information seems very persuasive rather than informative. The information provided draws comparisons between individual states and countries to show the reader the effectiveness of other health care systems across the globe. Even if the information is a little biased, there is still more information the article should and needs to address in order for viewers to have more general and informative perspective on this issue. Health care reform has been a topic in recent times and the article simply needs more information. — Preceding unsigned comment added by Rjo15 (talk • contribs) 18:09, 20 September 2015 (UTC)

External links modified
Hello fellow Wikipedians,

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title: Talk:Health care reform


text:
Henry Mayhew

Henry Mayhew (25 November 1812 – 25 July 1887) was an English journalist, playwright, and advocate of reform. He was one of the co-founders of the satirical magazine Punch in 1841, and was the magazine's joint editor, with Mark Lemon, in its early days. He is also known for his work as a social researcher, publishing an extensive series of newspaper articles in the Morning Chronicle that was later compiled into the three-volume book London Labour and the London Poor (1851), a groundbreaking and influential survey of the city's poor.

Early life
He was born in London, the thirteenth of 17 children to Joshua Mayhew. He was educated at Westminster School before running away from his studies to sea. He then served with the East India Company as a midshipman on a ship bound for Calcutta. He returned after several years, in 1829, becoming a trainee lawyer in Wales. He left this career to become a freelance journalist. He contributed to The Thief, a readers' digest, followed quickly by founding a weekly comic journal – Figaro in London (1831–1839). Mayhew reputedly fled his creditors and holed up at the Erwood Inn, a small public house in the village of Erwood, south of Builth Wells in Wales.

Paris and writing
In 1835, Mayhew found himself in a state of debt and, along with a fellow writer, escaped to Paris to avoid his creditors. He spent his time writing and in the company of other writers including William Thackeray and Douglas Jerrold. Mayhew spent over 10 years in Paris, returning to England in the 1850s, whereupon he was involved in several literary adventures, mostly the writing of plays. Two of his plays – The Wandering Minstrel (1834) and But, However (1842) – were successful, whilst his early work Figaro in London was less successful.

Punch magazine
On 17 July 1841, Mayhew cofounded Punch magazine. At its founding, the magazine was jointly edited by Mayhew and Mark Lemon. The two men hired a group of writers and illustrators to aid them. These included Douglas Jerrold, Angus Reach, John Leech, Richard Doyle, and Shirley Brooks. Initially, the magazine was subtitled The London Charivari, referencing the satirical humour magazine published in France under the title Le Charivari (a work Mayhew read often whilst in Paris). Reflecting their satirical and humorous intent, the two editors took for their name and masthead the anarchic glove puppet Mr. Punch.

Punch was an unexpected success, selling about 6,000 copies a week in the early years. However, sales of as many as 10,000 issues a week were required to cover all costs of the magazine. In December 1842, the magazine was sold to Bradbury and Evans; Mayhew resigned as joint editor, and he continued at the magazine as "suggestor in chief" with Mark Lemon reappointed as editor. Mayhew eventually severed his connection with the magazine, writing his last article in February 1845. His brother Horace stayed on the board of Punch until his own death.

The Punch years gave Mayhew the opportunity to meet talented illustrators whom he later employed to work from daguerreotypes on London Labour and the London Poor. Following Punch, Mayhew launched Iron Times, a railway magazine. However, this venture lost Mayhew so much money that he was forced to appear in a court of bankruptcy in 1846.

Formative work
In 1842, Mayhew contributed to the pioneering Illustrated London News. By this time, he had become reasonably secure financially, had settled his debts, and married Jane Jerrold, the daughter of his friend Douglas Jerrold. She lived until 1880.

London Labour and the London Poor
The articles comprising London Labour and the London Poor were initially collected into three volumes in 1851; the 1861 edition included a fourth volume, co-written with Bracebridge Hemyng, John Binny, and Andrew Halliday, on the lives of prostitutes, thieves, and beggars. This extra volume took a more general and statistical approach to its subject than volumes one to three.

Mayhew wrote in volume one: "I shall consider the whole of the metropolitan poor under three separate phases, according as they will work, they can't work, and they won't work". He interviewed everyone – beggars, street-entertainers (such as Punch and Judy men), market traders, prostitutes, labourers, sweatshop workers, even down to the "mudlarks" who searched the stinking mud on the banks of the River Thames for wood, metal, rope, and coal from passing ships, and the "pure-finders" who gathered dog faeces to sell to tanners. He described their clothes, how and where they lived, their entertainments and customs, and made detailed estimates of the numbers and incomes of those practising each trade. The books show how marginal and precarious many people's lives were, in what, at that time, was the richest city in the world.

Mayhew's richly detailed descriptions give an impression of what the street markets of his day were like. An example from volume one:

"The pavement and the road are crowded with purchasers and street-sellers. The housewife in her thick shawl, with the market-basket on her arm, walks slowly on, stopping now to look at the stall of caps, and now to cheapen a bunch of greens. Little boys, holding three or four onions in their hand, creep between the people, wriggling their way through every interstice, and asking for custom in whining tones, as if seeking charity. Then the tumult of the thousand different cries of the eager dealers, all shouting at the top of their voices, at one and the same time, is almost bewildering. 'So-old again,' roars one. 'Chestnuts all'ot, a penny a score,' bawls another. 'An 'aypenny a skin, blacking,' squeaks a boy. 'Buy, buy, buy, buy, buy– bu-u-uy!' cries the butcher. 'Half-quire of paper for a penny,' bellows the street stationer. 'An 'aypenny a lot ing-uns.' “Twopence a pound grapes.' “Three a penny Yarmouth bloaters.' “Who'll buy a bonnet for fourpence?' “Pick 'em out cheap here! three pair for a halfpenny, bootlaces.' “Now's your time! beautiful whelks, a penny a lot.' “Here's ha'p‘orths,' shouts the perambulating confectioner. 'Come and look at 'em! here's toasters!' bellows one with a Yarmouth bloater stuck on a toasting fork. 'Penny a lot, fine russets,' calls the apple woman: and so the Babel goes on."

Some of the London street traders did not like the way Mayhew wrote about them. In spring/summer 1851, they established a Street Trader's Protection Association to guard themselves against the journalist.

Family
Mayhew was the grandfather of Audrey Mayhew Allen (b. 1870), an author of a number of children's stories published in various periodicals, and of Gladys in Grammarland, an imitation of Lewis Carroll's Wonderland books.

Influence
Mayhew's work was embraced by and was an influence on the Christian Socialists, such as Thomas Hughes, Charles Kingsley, and F. D. Maurice. Radicals also published sizeable excerpts from the reports in the Northern Star, the Red Republican, and other newspapers. The often sympathetic investigations, with their immediacy and unswerving eye for detail, offered unprecedented insights into the condition of the Victorian poor. Alongside the earlier work of Edwin Chadwick, they are also speculated as a decisive influence on the thinking of Charles Dickens

Mayhew's work inspired the script of director Christine Edzard's 1990 film The Fool. Mayhew has appeared as a character in television and radio histories of Victorian London ; he was played by Timothy West in the documentary London (2004), and David Haig in the Afternoon Play A Chaos of Wealth and Want (2010). In the 2012 novel Dodger by Terry Pratchett, Mayhew and his wife appear as fictionalised versions of themselves, and he is mentioned in the dedication.

Publications, plays and public speeches: a select list
Although Mayhew is most remembered for his works of non-fiction, he also authored many plays, farces, novels, public speeches (many of which have been transcribed and subsequently published) alongside his numerous works of non-fiction and newspaper articles.
 * 1831 Figaro in London [co-founder and editor, weekly, radical paper]
 * 1832 The Thief  [periodical]
 * 1834: The Wandering Minstrel: A Farce in One Act (farce first performed at the Fitzroy Royal Theatre, 16 January 1834)
 * 1838 But, however: A Farce in One Act [play by Henry Mayhew and Henry Bayliss]
 * 1841-1842: Punch (satirical magazine, co-founded with Mark Lemon, Ebenezer Landells and possibly others)
 * 1844: The Comic Almanack , vol 2, 1844 [co-authored with William Makepeace Thackery, Gilbert Abbott A’ Beckett, Horace Mayhew (brother) and Albert Smith]
 * 1847: The Greatest Plague of Life: or, the Adventures of a Lady in Search of a Good Servant,  Carey and Hart, London, [satirical novel, co-authored with Augustus Mayhew (brother)]
 * 1849-1850: Survey of Labour and the Poor - series of 82 letters, surveying the conditions of the nation’s labouring population as published in the Morning Chronicle in 1849-1850
 * 1851: London Labour and the London Poor, 2 volumes, 1851, 1862 (reprinted 1865) [book, based on the Morning Chronicle articles]
 * 1851 The Adventures of Mr. and Mrs. Sandboys and Family, who Came up to London to Enjoy Themselves and See the Great Exhibition, George Newbold, London, 1851 [comic novel]
 * 1856: “The Great World of London” [Pamphlet series]
 * 1862: The Criminal Prisons of London: And Scenes of Prison Life
 * 1871: London Characters and the Humorous Side of London Life: with upwards of seventy illustrations, Stanley Rivers, London, 1871

title: Henry Mayhew


text:
Hydrogen

Hydrogen is a chemical element; it has symbol H and atomic number 1. It is the lightest element and, at standard conditions, is a gas of diatomic molecules with the formula H2, sometimes called dihydrogen, but more commonly called hydrogen gas, molecular hydrogen or simply hydrogen. It is colorless, odorless, tasteless, non-toxic, and highly combustible. Constituting approximately 75% of all normal matter, hydrogen is the most abundant chemical substance in the universe. Stars, including the Sun, primarily consist of hydrogen in a plasma state, while on Earth, hydrogen is found in water, organic compounds, as dihydrogen, and in other molecular forms. The most common isotope of hydrogen (symbol 1H) consists of one proton, one electron, and no neutrons.

In the early universe, the formation of hydrogen's protons occurred during the first second following the Big Bang, with neutral hydrogen atoms only forming approximately 370,000 years later during the recombination epoch as the universe cooled and plasma had cooled enough for electrons to remain bound to protons. Hydrogen, typically nonmetallic except under extreme pressures, readily forms covalent bonds with most nonmetals, contributing to the formation of compounds like water and various organic substances. Its role is crucial in acid-base reactions, which predominantly involve proton exchange among soluble molecules. In ionic compounds, hydrogen can take the form of either a negatively charged anion, where it is known as hydride, or as a positively charged cation denoted by the symbol H+. The cation, simply a proton (symbol p), exhibits specific behavior in aqueous solutions and in ionic compounds involves screening of its electric charge by surrounding polar molecules or anions. Hydrogen's unique position as the only neutral atom for which the Schrödinger equation can be directly solved has significantly contributed to the foundational principles of quantum mechanics through the exploration of its energetics and chemical bonding.

Historically, hydrogen gas was first produced artificially in the early 16th century through the reaction of acids with metals. Henry Cavendish, between 1766 and 1781, identified hydrogen gas as a distinct substance and discovered its property of producing water when burned—hence its name derived from the Greek "water-former".

The majority of hydrogen production occurs through steam reforming of natural gas, with a smaller portion derived from energy-intensive methods such as the electrolysis of water. Its primary industrial uses include fossil fuel processing, such as hydrocracking, and ammonia production, with emerging applications in fuel cells for electricity generation and as a heat source. When used in fuel cells, hydrogen's only emission at the point of use is water vapor, though combustion can produce nitrogen oxides. Hydrogen's interaction with metals may cause embrittlement.

Combustion

Hydrogen gas is highly flammable:
 * 2 H2(g) + O2(g) → 2 H2O(l) (572 kJ/2 mol = 286 kJ/mol = 141.865 MJ/kg)

The enthalpy of combustion is −286 kJ/mol.

Hydrogen gas forms explosive mixtures with air in concentrations from 4–74% and with chlorine at 5–95%. The hydrogen autoignition temperature, the temperature of spontaneous ignition in air, is 500 C.

Flame
Pure hydrogen-oxygen flames emit ultraviolet light and with high oxygen mix are nearly invisible to the naked eye, as illustrated by the faint plume of the Space Shuttle Main Engine, compared to the highly visible plume of a Space Shuttle Solid Rocket Booster, which uses an ammonium perchlorate composite. The detection of a burning hydrogen leak may require a flame detector; such leaks can be very dangerous. Hydrogen flames in other conditions are blue, resembling blue natural gas flames. The destruction of the Hindenburg airship was a notorious example of hydrogen combustion and the cause is still debated. The visible flames in the photographs were the result of carbon compounds in the airship skin burning.

Reactants
H2 is unreactive compared to diatomic elements such as halogens or oxygen. The thermodynamic basis of this low reactivity is the very strong H–H bond, with a bond dissociation energy of 435.7 kJ/mol. The kinetic basis of the low reactivity is the nonpolar nature of H2 and its weak polarizability. It spontaneously reacts with chlorine and fluorine to form hydrogen chloride and hydrogen fluoride, respectively. The reactivity of H2 is strongly affected by the presence of metal catalysts. Thus, while mixtures of H2 with O2 or air combust readily when heated to at least 500 °C by a spark or flame, they do not react at room temperature in the absence of a catalyst.

Electron energy levels
The ground state energy level of the electron in a hydrogen atom is −13.6 eV, which is equivalent to an ultraviolet photon of roughly 91 nm wavelength.

The energy levels of hydrogen can be calculated fairly accurately using the Bohr model of the atom, which conceptualizes the electron as "orbiting" the proton in analogy to the Earth's orbit of the Sun. However, the atomic electron and proton are held together by electromagnetic force, while planets and celestial objects are held by gravity. Because of the discretization of angular momentum postulated in early quantum mechanics by Bohr, the electron in the Bohr model can only occupy certain allowed distances from the proton, and therefore only certain allowed energies.

A more accurate description of the hydrogen atom comes from a quantum mechanical analysis that uses the Schrödinger equation, Dirac equation or Feynman path integral formulation to calculate the probability density of the electron around the proton. The most complex formulas include the small effects of special relativity and vacuum polarization. In the quantum mechanical treatment, the electron in a ground state hydrogen atom has no angular momentum—illustrating how the "planetary orbit" differs from electron motion.

Spin isomers
Molecular H2 exists as two spin isomers, i.e. compounds that differ only in the spin states of their nuclei. In the orthohydrogen form, the spins of the two nuclei are parallel, forming a spin triplet state having a total molecular spin $$S = 1$$; in the parahydrogen form the spins are antiparallel and form a spin singlet state having spin $$S = 0$$. The equilibrium ratio of ortho- to para-hydrogen depends on temperature. At room temperature or warmer, equilibrium hydrogen gas contains about 25% of the para form and 75% of the ortho form. The ortho form is an excited state, having higher energy than the para form by 1.455 kJ/mol, and it converts to the para form over the course of several minutes when cooled to low temperature. The thermal properties of the forms differ because they differ in their allowed rotational quantum states, resulting in different thermal properties such as the heat capacity.

The ortho-to-para ratio in H2 is an important consideration in the liquefaction and storage of liquid hydrogen: the conversion from ortho to para is exothermic and produces enough heat to evaporate most of the liquid if not converted first to parahydrogen during the cooling process. Catalysts for the ortho-para interconversion, such as ferric oxide and activated carbon compounds, are used during hydrogen cooling to avoid this loss of liquid.

Phases

 * Gaseous hydrogen
 * Liquid hydrogen
 * Solid hydrogen
 * Metallic hydrogen
 * Plasma hydrogen

Covalent and organic compounds
While H2 is not very reactive under standard conditions, it does form compounds with most elements. Hydrogen can form compounds with elements that are more electronegative, such as halogens (F, Cl, Br, I), or oxygen; in these compounds hydrogen takes on a partial positive charge. When bonded to a more electronegative element, particularly fluorine, oxygen, or nitrogen, hydrogen can participate in a form of medium-strength noncovalent bonding with another electronegative element with a lone pair, a phenomenon called hydrogen bonding that is critical to the stability of many biological molecules. Hydrogen also forms compounds with less electronegative elements, such as metals and metalloids, where it takes on a partial negative charge. These compounds are often known as hydrides.

Hydrogen forms many compounds with carbon called the hydrocarbons, and an even more with heteroatoms that, because of their association with living things, are called organic compounds. The study of their properties is known as organic chemistry and their study in the context of living organisms is called biochemistry. By some definitions, "organic" compounds are only required to contain carbon. However, most of them also contain hydrogen, and because it is the carbon-hydrogen bond that gives this class of compounds most of its particular chemical characteristics, carbon-hydrogen bonds are required in some definitions of the word "organic" in chemistry. Millions of hydrocarbons are known, and they are usually formed by complicated pathways that seldom involve elemental hydrogen.

Hydrogen is highly soluble in many rare earth and transition metals and is soluble in both nanocrystalline and amorphous metals. Hydrogen solubility in metals is influenced by local distortions or impurities in the crystal lattice. These properties may be useful when hydrogen is purified by passage through hot palladium disks, but the gas's high solubility is a metallurgical problem, contributing to the embrittlement of many metals, complicating the design of pipelines and storage tanks.

Hydrides
Compounds of hydrogen are often called hydrides, a term that is used fairly loosely. The term "hydride" suggests that the H atom has acquired a negative or anionic character, denoted H−, and is used when hydrogen forms a compound with a more electropositive element. The existence of the hydride anion, suggested by Gilbert N. Lewis in 1916 for group 1 and 2 salt-like hydrides, was demonstrated by Moers in 1920 by the electrolysis of molten lithium hydride (LiH), producing a stoichiometric quantity of hydrogen at the anode. For hydrides other than group 1 and 2 metals, the term is quite misleading, considering the low electronegativity of hydrogen. An exception in group 2 hydrides is BeH2, which is polymeric. In lithium aluminium hydride, the [AlH4]- anion carries hydridic centers firmly attached to the Al(III).

Although hydrides can be formed with almost all main-group elements, the number and combination of possible compounds varies widely; for example, more than 100 binary borane hydrides are known, but only one binary aluminium hydride. Binary indium hydride has not yet been identified, although larger complexes exist.

In inorganic chemistry, hydrides can also serve as bridging ligands that link two metal centers in a coordination complex. This function is particularly common in group 13 elements, especially in boranes (boron hydrides) and aluminium complexes, as well as in clustered carboranes.

Protons and acids
Oxidation of hydrogen removes its electron and gives H+, which contains no electrons and a nucleus which is usually composed of one proton. That is why H+ is often called a proton. This species is central to discussion of acids. Under the Brønsted–Lowry acid–base theory, acids are proton donors, while bases are proton acceptors.

A bare proton, H+, cannot exist in solution or in ionic crystals because of its strong attraction to other atoms or molecules with electrons. Except at the high temperatures associated with plasmas, such protons cannot be removed from the electron clouds of atoms and molecules, and will remain attached to them. However, the term 'proton' is sometimes used loosely and metaphorically to refer to positively charged or cationic hydrogen attached to other species in this fashion, and as such is denoted "H+" without any implication that any single protons exist freely as a species.

To avoid the implication of the naked "solvated proton" in solution, acidic aqueous solutions are sometimes considered to contain a less unlikely fictitious species, termed the "hydronium ion" ([H3O]+). However, even in this case, such solvated hydrogen cations are more realistically conceived as being organized into clusters that form species closer to [H9O4]+. Other oxonium ions are found when water is in acidic solution with other solvents.

Although exotic on Earth, one of the most common ions in the universe is the H3+ ion, known as protonated molecular hydrogen or the trihydrogen cation.

Isotopes
Hydrogen has three naturally occurring isotopes, denoted, and. Other, highly unstable nuclei ( to ) have been synthesized in the laboratory but not observed in nature.
 *  is the most common hydrogen isotope, with an abundance of more than 99.98%. Because the nucleus of this isotope consists of only a single proton, it is given the descriptive but rarely used formal name protium. It is unique among all stable isotopes in having no neutrons; see diproton for a discussion of why others do not exist.
 * , the other stable hydrogen isotope, is known as deuterium and contains one proton and one neutron in the nucleus. Nearly all deuterium in the universe is thought to have been produced at the time of the Big Bang, and has endured since that time. Deuterium is not radioactive, and does not represent a significant toxicity hazard. Water enriched in molecules that include deuterium instead of normal hydrogen is called heavy water. Deuterium and its compounds are used as a non-radioactive label in chemical experiments and in solvents for -NMR spectroscopy. Heavy water is used as a neutron moderator and coolant for nuclear reactors. Deuterium is also a potential fuel for commercial nuclear fusion.
 *  is known as tritium and contains one proton and two neutrons in its nucleus. It is radioactive, decaying into helium-3 through beta decay with a half-life of 12.32 years. It is radioactive enough to be used in luminous paint to enhance the visibility of data displays, such as for painting the hands and dial-markers of watches. The watch glass prevents the small amount of radiation from escaping the case. Small amounts of tritium are produced naturally by cosmic rays striking atmospheric gases; tritium has also been released during nuclear weapons tests. It is used in nuclear fusion reactions, as a tracer in isotope geochemistry, and in specialized self-powered lighting devices. Tritium has also been used in chemical and biological labeling experiments as a radiolabel.

Unique among the elements, distinct names are assigned to its isotopes in common use. During the early study of radioactivity, heavy radioactive isotopes were given their own names, but they are no longer used, except for deuterium and tritium. The symbols D and T (instead of and ) are sometimes used for deuterium and tritium, but the symbol P was already used for phosphorus and thus was not available for protium. In its nomenclatural guidelines, the International Union of Pure and Applied Chemistry (IUPAC) allows any of D, T,, and to be used, although  and  are preferred.

The exotic atom muonium (symbol Mu), composed of an antimuon and an electron, can also be considered a light radioisotope of hydrogen. Because muons decay with lifetime $2.2 µs$, muonium is too unstable for observable chemistry. Nevertheless, muonium compounds are important test cases for quantum simulation, due to the mass difference between the antimuon and the proton, and IUPAC nomenclature incorporates such hypothetical compounds as muonium chloride (MuCl) and sodium muonide (NaMu), analogous to hydrogen chloride and sodium hydride respectively.

Thermal and physical properties
Table of thermal and physical properties of hydrogen (H$2$) at atmospheric pressure:

Robert Boyle
In 1671, the Irish scientist Robert Boyle discovered and described the reaction between iron filings and dilute acids, which results in the production of hydrogen gas.

"Having provided a saline spirit [hydrochloric acid], which by an uncommon way of preparation was made exceeding sharp and piercing, we put into a vial, capable of containing three or four ounces of water, a convenient quantity of filings of steel, which were not such as are commonly sold in shops to Chymists and Apothecaries, (those being usually not free enough from rust) but such as I had a while before caus'd to be purposely fil'd off from a piece of good steel. This metalline powder being moistn'd in the viol with a little of the menstruum, was afterwards drench'd with more; whereupon the mixture grew very hot, and belch'd up copious and stinking fumes; which whether they consisted altogether of the volatile sulfur of the Mars [iron], or of metalline steams participating of a sulfureous nature, and join'd with the saline exhalations of the menstruum, is not necessary to be here discuss'd. But whencesoever this stinking smoak proceeded, so inflammable it was, that upon the approach of a lighted candle to it, it would readily enough take fire, and burn with a blewish and somewhat greenish flame at the mouth of the viol for a good while together; and that, though with little light, yet with more strength than one would easily suspect."

The word "sulfureous" may be somewhat confusing, especially since Boyle did a similar experiment with iron and sulfuric acid. However, in all likelihood, "sulfureous" should here be understood to mean combustible.

Henry Cavendish
In 1766, Henry Cavendish was the first to recognize hydrogen gas as a discrete substance, by naming the gas from a metal-acid reaction "inflammable air". He speculated that "inflammable air" was in fact identical to the hypothetical substance called "phlogiston" and further finding in 1781 that the gas produces water when burned. He is usually given credit for the discovery of hydrogen as an element.

Antoine Lavoisier
In 1783, Antoine Lavoisier identified the element that came to be known as hydrogen when he and Laplace reproduced Cavendish's finding that water is produced when hydrogen is burned. Lavoisier produced hydrogen for his experiments on mass conservation by reacting a flux of steam with metallic iron through an incandescent iron tube heated in a fire. Anaerobic oxidation of iron by the protons of water at high temperature can be schematically represented by the set of following reactions:
 * 1) Fe + H2O -> FeO + H2

 * 2) Fe + 3 H2O -> Fe2O3 + 3 H2

 * 3) Fe + 4 H2O -> Fe3O4 + 4 H2

Many metals such as zirconium undergo a similar reaction with water leading to the production of hydrogen.

19th century
François Isaac de Rivaz built the first de Rivaz engine, an internal combustion engine powered by a mixture of hydrogen and oxygen in 1806. Edward Daniel Clarke invented the hydrogen gas blowpipe in 1819. The Döbereiner's lamp and limelight were invented in 1823.

Hydrogen was liquefied for the first time by James Dewar in 1898 by using regenerative cooling and his invention, the vacuum flask. He produced solid hydrogen the next year.

Hydrogen-lifted airship
The first hydrogen-filled balloon was invented by Jacques Charles in 1783. Hydrogen provided the lift for the first reliable form of air-travel following the 1852 invention of the first hydrogen-lifted airship by Henri Giffard. German count Ferdinand von Zeppelin promoted the idea of rigid airships lifted by hydrogen that later were called Zeppelins; the first of which had its maiden flight in 1900. Regularly scheduled flights started in 1910 and by the outbreak of World War I in August 1914, they had carried 35,000 passengers without a serious incident. Hydrogen-lifted airships were used as observation platforms and bombers during the war.

The first non-stop transatlantic crossing was made by the British airship R34 in 1919. Regular passenger service resumed in the 1920s and the discovery of helium reserves in the United States promised increased safety, but the U.S. government refused to sell the gas for this purpose. Therefore, H2 was used in the Hindenburg airship, which was destroyed in a midair fire over New Jersey on 6 May 1937. The incident was broadcast live on radio and filmed. Ignition of leaking hydrogen is widely assumed to be the cause, but later investigations pointed to the ignition of the aluminized fabric coating by static electricity. But the damage to hydrogen's reputation as a lifting gas was already done and commercial hydrogen airship travel ceased. Hydrogen is still used, in preference to non-flammable but more expensive helium, as a lifting gas for weather balloons.

Deuterium and tritium
Deuterium was discovered in December 1931 by Harold Urey, and tritium was prepared in 1934 by Ernest Rutherford, Mark Oliphant, and Paul Harteck. Heavy water, which consists of deuterium in the place of regular hydrogen, was discovered by Urey's group in 1932.

Hydrogen-cooled turbogenerator
The first hydrogen-cooled turbogenerator went into service using gaseous hydrogen as a coolant in the rotor and the stator in 1937 at Dayton, Ohio, owned by the Dayton Power & Light Co. This was justified by the high thermal conductivity and very low viscosity of hydrogen gas, thus lower drag than air. This is the most common coolant used for generators 60 MW and larger; smaller generators are usually air-cooled.

Nickel–hydrogen battery
The nickel–hydrogen battery was used for the first time in 1977 aboard the U.S. Navy's Navigation technology satellite-2 (NTS-2). The International Space Station, Mars Odyssey and the Mars Global Surveyor are equipped with nickel-hydrogen batteries. In the dark part of its orbit, the Hubble Space Telescope is also powered by nickel-hydrogen batteries, which were finally replaced in May 2009, more than 19 years after launch and 13 years beyond their design life.

Role in quantum theory
Because of its simple atomic structure, consisting only of a proton and an electron, the hydrogen atom, together with the spectrum of light produced from it or absorbed by it, has been central to the development of the theory of atomic structure. Furthermore, study of the corresponding simplicity of the hydrogen molecule and the corresponding cation H2+ brought understanding of the nature of the chemical bond, which followed shortly after the quantum mechanical treatment of the hydrogen atom had been developed in the mid-1920s.

One of the first quantum effects to be explicitly noticed (but not understood at the time) was a Maxwell observation involving hydrogen, half a century before full quantum mechanical theory arrived. Maxwell observed that the specific heat capacity of H2 unaccountably departs from that of a diatomic gas below room temperature and begins to increasingly resemble that of a monatomic gas at cryogenic temperatures. According to quantum theory, this behavior arises from the spacing of the (quantized) rotational energy levels, which are particularly wide-spaced in H2 because of its low mass. These widely spaced levels inhibit equal partition of heat energy into rotational motion in hydrogen at low temperatures. Diatomic gases composed of heavier atoms do not have such widely spaced levels and do not exhibit the same effect.

Antihydrogen is the antimatter counterpart to hydrogen. It consists of an antiproton with a positron. Antihydrogen is the only type of antimatter atom to have been produced.

Cosmic prevalence and distribution
Hydrogen, as atomic H, is the most abundant chemical element in the universe, making up 75 percent of normal matter by mass and more than 90 percent by number of atoms. (Most of the mass of the universe, however, is not in the form of chemical-element type matter, but rather is postulated to occur as yet-undetected forms of mass such as dark matter and dark energy. )

Hydrogen is found in great abundance in stars and gas giant planets. Molecular clouds of H2 are associated with star formation. Hydrogen plays a vital role in powering stars through the proton-proton reaction in case of stars with very low to approximately 1 mass of the Sun and the CNO cycle of nuclear fusion in case of stars more massive than the Sun.

States
Throughout the universe, hydrogen is mostly found in the atomic and plasma states, with properties quite distinct from those of molecular hydrogen. As a plasma, hydrogen's electron and proton are not bound together, resulting in very high electrical conductivity and high emissivity (producing the light from the Sun and other stars). The charged particles are highly influenced by magnetic and electric fields. For example, in the solar wind they interact with the Earth's magnetosphere giving rise to Birkeland currents and the aurora.

Hydrogen is found in the neutral atomic state in the interstellar medium because the atoms seldom collide and combine. They are the source of the 21-cm hydrogen line at 1420 MHz that is detected in order to probe primordial hydrogen. The large amount of neutral hydrogen found in the damped Lyman-alpha systems is thought to dominate the cosmological baryonic density of the universe up to a redshift of z = 4.

Under ordinary conditions on Earth, elemental hydrogen exists as the diatomic gas, H2. Hydrogen gas is very rare in the Earth's atmosphere (around 0.53 ppm on a molar basis ) because of its light weight, which enables it to escape from the atmosphere more rapidly than heavier gases. However, hydrogen is the third most abundant element on the Earth's surface, mostly in the form of chemical compounds such as hydrocarbons and water.

A molecular form called protonated molecular hydrogen (H3+) is found in the interstellar medium, where it is generated by ionization of molecular hydrogen from cosmic rays. This ion has also been observed in the upper atmosphere of the planet Jupiter. The ion is relatively stable in the environment of outer space due to the low temperature and density. H3+ is one of the most abundant ions in the universe, and it plays a notable role in the chemistry of the interstellar medium. Neutral triatomic hydrogen H3 can exist only in an excited form and is unstable. By contrast, the positive hydrogen molecular ion (H2+) is a rare molecule in the universe.

Production
Many methods exist for producing H2, but three dominate commercially: steam reforming often coupled to water-gas shift, partial oxidation of hydrocarbons, and water electrolysis.

Steam reforming
Hydrogen is mainly produced by steam methane reforming (SMR), the reaction of water and methane. Thus, at high temperatures (1000–1400 K, 700–1100 °C or 1300–2000 °F), steam (water vapor) reacts with methane to yield carbon monoxide and H2.

 * CH4 + H2O → CO + 3 H2

Steam reforming is also used for the industrial preparation of ammonia.

This reaction is favored at low pressures, Nonetheless, conducted at high pressures (2.0 MPa, 20 atm or 600 inHg) because high-pressure H2 is the most marketable product, and pressure swing adsorption (PSA) purification systems work better at higher pressures. The product mixture is known as "synthesis gas" because it is often used directly for the production of methanol and many other compounds. Hydrocarbons other than methane can be used to produce synthesis gas with varying product ratios. One of the many complications to this highly optimized technology is the formation of coke or carbon:
 * CH4 → C + 2 H2

Consequently, steam reforming typically employs an excess of H2O. Additional hydrogen can be recovered from the steam by use of carbon monoxide through the water gas shift reaction (WGS). This process requires an iron oxide catalyst:
 * CO + H2O → CO2 + H2

Hydrogen is sometimes produced and consumed in the same industrial process, without being separated. In the Haber process for the production of ammonia, hydrogen is generated from natural gas.

Partial oxidation of hydrocarbons
Other methods for CO and H2 production include partial oxidation of hydrocarbons:

 * 2 CH4 + O2 → 2 CO + 4 H2

Although less important commercially, coal can serve as a prelude to the shift reaction above:

 * C + H2O → CO + H2

Olefin production units may produce substantial quantities of byproduct hydrogen particularly from cracking light feedstocks like ethane or propane.

Water electrolysis
The electrolysis of water is a conceptually simple method of producing hydrogen.
 * 2 H2O(l) → 2 H2(g) + O2(g)

Commercial electrolyzers use nickel-based catalysts in strongly alkaline solution. Platinum is a superior catalyst but is expensive.

Electrolysis of brine to yield chlorine also produces hydrogen as a co-product.

Methane pyrolysis
Hydrogen can be produced by pyrolysis of natural gas (methane).

This route has a lower carbon footprint than commercial hydrogen production processes. Developing a commercial methane pyrolysis process could expedite the expanded use of hydrogen in industrial and transportation applications. Methane pyrolysis is accomplished by passing methane through a molten metal catalyst containing dissolved nickel. Methane is converted to hydrogen gas and solid carbon.

 * CH4(g) → C(s) + 2 H2(g) (ΔH° = 74 kJ/mol)

The carbon may be sold as a manufacturing feedstock or fuel, or landfilled.

Further research continues in several laboratories, including at Karlsruhe Liquid-metal Laboratory and at University of California – Santa Barbara. BASF built a methane pyrolysis pilot plant.

Thermochemical
More than 200 thermochemical cycles can be used for water splitting. Many of these cycles such as the iron oxide cycle, cerium(IV) oxide–cerium(III) oxide cycle, zinc zinc-oxide cycle, sulfur-iodine cycle, copper-chlorine cycle and hybrid sulfur cycle have been evaluated for their commercial potential to produce hydrogen and oxygen from water and heat without using electricity. A number of laboratories (including in France, Germany, Greece, Japan, and the United States) are developing thermochemical methods to produce hydrogen from solar energy and water.

Laboratory methods
H2 is produced in laboratories, often as a by-product of other reactions. Many metals react with water to produce H2, but the rate of hydrogen evolution depends on the metal, the pH, and the presence of alloying agents. Most commonly, hydrogen evolution is induced by acids. The alkali and alkaline earth metals, aluminium, zinc, manganese, and iron react readily with aqueous acids. This reaction is the basis of the Kipp's apparatus, which once was used as a laboratory gas source:
 * Zn + 2 H+ → Zn(2+) + H2

In the absence of acid, the evolution of H2 is slower. Because iron is widely used structural material, its anaerobic corrosion is of technological significance:

 * Fe + 2 H2O → Fe(OH)2 + H2

Many metals, such as aluminium, are slow to react with water because they form passivated oxide coatings of oxides. An alloy of aluminium and gallium, however, does react with water. At high pH, aluminium can produce H2:

 * 2 Al + 6 H2O + 2 OH- → 2 [Al(OH)4]- + 3 H2

Some metal-containing compounds react with acids to evolve H2. Under anaerobic conditions, ferrous hydroxide can be oxidized by the protons of water to form magnetite and H2. This process is described by the Schikorr reaction:

 * 3 Fe(OH)2 → Fe3O4 + 2 H2O + H2

This process occurs during the anaerobic corrosion of iron and steel in oxygen-free groundwater and in reducing soils below the water table.

Biohydrogen
H2 is produced by hydrogenase enzymes in some fermentation.

Wells
There is a well in Mali and deposits in several other countries, such as France.

Petrochemical industry
Large quantities of H2 are used in the "upgrading" of fossil fuels. Key consumers of H2 include hydrodesulfurization, and hydrocracking. Many of these reactions can be classified as hydrogenolysis, i.e., the cleavage of bonds by hydrogen. Illustrative is the separation of sulfur from liquid fossil fuels:
 * R2S + 2 H2 → H2S + 2 RH

Hydrogenation
Hydrogenation, the addition of H2 to various substrates is conducted on a large scale. The hydrogenation of N2 to produce ammonia by the Haber–Bosch process consumes a few percent of the energy budget in the entire industry. The resulting ammonia is used to supply the majority of the protein consumed by humans. Hydrogenation is used to convert unsaturated fats and oils to saturated (trans) fats and oils. The major application is the production of margarine. Methanol is produced by hydrogenation of carbon dioxide. It is similarly the source of hydrogen in the manufacture of hydrochloric acid. H2 is also used as a reducing agent for the conversion of some ores to the metals.

Coolant
Hydrogen is commonly used in power stations as a coolant in generators due to a number of favorable properties that are a direct result of its light diatomic molecules. These include low density, low viscosity, and the highest specific heat and thermal conductivity of all gases.

Energy carrier
Elemental hydrogen is widely discussed in the context of energy as an energy carrier with potential to help the decarbonisation of economies and mitigate greenhouse gas emissions. This therefore requires hydrogen to be produced cleanly in quantities to be supplied in sectors and applications where cheaper and more energy-efficient mitigation alternatives are limited. These include heavy industry and long-distance transport. Hydrogen is a carrier of energy rather than an energy resource, because there is no naturally occurring source of hydrogen in useful quantities.

Hydrogen can be deployed as an energy source in fuel cells to produce electricity or via combustion to generate heat. When hydrogen is consumed in fuel cells, the only emission at the point of use is water vapour. Combustion of hydrogen can lead to the thermal formation of harmful nitrogen oxides. The overall lifecycle emissions of hydrogen depend on how it is produced. Nearly all of the world's current supply of hydrogen is created from fossil fuels. The main method is steam methane reforming, in which hydrogen is produced from a chemical reaction between steam and methane, the main component of natural gas. Producing one tonne of hydrogen through this process emits 6.6–9.3 tonnes of carbon dioxide. While carbon capture and storage (CCS) could remove a large fraction of these emissions, the overall carbon footprint of hydrogen from natural gas is difficult to assess, in part because of emissions (including vented and fugitive methane) created in the production of the natural gas itself.

Electricity can be used to split water molecules, producing sustainable hydrogen, provided the electricity was generated sustainably. However, this electrolysis process is currently more expensive than creating hydrogen from methane without CCS and the efficiency of energy conversion is inherently low. Hydrogen can be produced when there is a surplus of variable renewable electricity, then stored and used to generate heat or to re-generate electricity. Hydrogen created through electrolysis using renewable energy is commonly referred to as "green hydrogen." It can be further transformed into synthetic fuels such as ammonia and methanol.

Innovation in hydrogen electrolysers could make large-scale production of hydrogen from electricity more cost-competitive. There is potential for hydrogen produced this way to play a significant role in decarbonising energy systems where there are challenges and limitations to replacing fossil fuels with direct use of electricity.

Hydrogen fuel can produce the intense heat required for industrial production of steel, cement, glass, and chemicals, thus contributing to the decarbonisation of industry alongside other technologies, such as electric arc furnaces for steelmaking. However, it is likely to play a larger role in providing industrial feedstock for cleaner production of ammonia and organic chemicals. For example, in steelmaking, hydrogen could function as a clean energy carrier and also as a low-carbon catalyst, replacing coal-derived coke. Hydrogen used to decarbonise transportation is likely to find its largest applications in shipping, aviation and, to a lesser extent, heavy goods vehicles, through the use of hydrogen-derived synthetic fuels such as ammonia and methanol and fuel cell technology. For light-duty vehicles including passenger cars, hydrogen is far behind other alternative fuel vehicles, especially compared with the rate of adoption of battery electric vehicles, and may not play a significant role in future.

Disadvantages of hydrogen as an energy carrier include high costs of storage and distribution due to hydrogen's explosivity, its large volume compared to other fuels, and its tendency to make pipes brittle.

Semiconductor industry
Hydrogen is employed to saturate broken ("dangling") bonds of amorphous silicon and amorphous carbon that helps stabilizing material properties. It is also a potential electron donor in various oxide materials, including ZnO, SnO2, CdO, MgO, ZrO2, HfO2, La2O3, Y2O3, TiO2, SrTiO3, LaAlO3, SiO2, Al2O3, ZrSiO4, HfSiO4, and SrZrO3.

Niche and evolving uses

 * Shielding gas: Hydrogen is used as a shielding gas in welding methods such as atomic hydrogen welding.

 * Cryogenic research: Liquid H2 is used in cryogenic research, including superconductivity studies.

 * Buoyant lifting: Because H2 is lighter than air, having only 7% of the density of air, it was once widely used as a lifting gas in balloons and airships.
 * Leak detection: Pure or mixed with nitrogen (sometimes called forming gas), hydrogen is a tracer gas for detection of minute leaks. Applications can be found in the automotive, chemical, power generation, aerospace, and telecommunications industries. Hydrogen is an authorized food additive (E 949) that allows food package leak testing, as well as having anti-oxidizing properties.

 * Neutron moderation: Deuterium (hydrogen-2) is used in nuclear fission applications as a moderator to slow neutrons.
 * Nuclear fusion fuel: Deuterium is used in nuclear fusion reactions.
 * Isotopic labeling: Deuterium compounds have applications in chemistry and biology in studies of isotope effects on reaction rates.

 * Rocket propellant: Liquid hydrogen and liquid oxygen together serve as cryogenic propellants in liquid-propellant rockets, as in the Space Shuttle main engines. NASA has investigated the use of rocket propellant made from atomic hydrogen, boron or carbon that is frozen into solid molecular hydrogen particles that are suspended in liquid helium. Upon warming, the mixture vaporizes to allow the atomic species to recombine, heating the mixture to high temperature.
 * Tritium uses: Tritium (hydrogen-3), produced in nuclear reactors, is used in the production of hydrogen bombs, as an isotopic label in the biosciences, and as a source of beta radiation in radioluminescent paint for instrument dials and emergency signage.

Biological reactions
H2 is a product of some types of anaerobic metabolism and is produced by several microorganisms, usually via reactions catalyzed by iron- or nickel-containing enzymes called hydrogenases. These enzymes catalyze the reversible redox reaction between H2 and its component two protons and two electrons. Creation of hydrogen gas occurs in the transfer of reducing equivalents, produced during pyruvate fermentation, to water. The natural cycle of hydrogen production and consumption by organisms is called the hydrogen cycle. Bacteria such as Mycobacterium smegmatis can utilize the small amount of hydrogen in the atmosphere as a source of energy when other sources are lacking, using a hydrogenase with small channels that exclude oxygen and so permits the reaction to occur even though the hydrogen concentration is very low and the oxygen concentration is as in normal air.

Hydrogen is the most abundant element in the human body in terms of numbers of atoms of the element but the third most abundant element by mass. H2 occurs in the breath of humans due to the metabolic activity of hydrogenase-containing microorganisms in the large intestine and is a natural component of flatus. The concentration in the breath of fasting people at rest is typically less than 5 parts per million (ppm) but can be 50 ppm when people with intestinal disorders consume molecules they cannot absorb during diagnostic hydrogen breath tests.

Water splitting, in which water is decomposed into its component protons, electrons, and oxygen, occurs in the light reactions in all photosynthetic organisms. Some such organisms, including the alga Chlamydomonas reinhardtii and cyanobacteria, have evolved a second step in the dark reactions in which protons and electrons are reduced to form H2 gas by specialized hydrogenases in the chloroplast. Efforts have been undertaken to genetically modify cyanobacterial hydrogenases to efficiently synthesize H2 gas even in the presence of oxygen. Efforts have also been undertaken with genetically modified alga in a bioreactor.

Safety and precautions
Hydrogen poses a number of hazards to human safety, from potential detonations and fires when mixed with air to being an asphyxiant in its pure, oxygen-free form. In addition, liquid hydrogen is a cryogen and presents dangers (such as frostbite) associated with very cold liquids. Hydrogen dissolves in many metals and in addition to leaking out, may have adverse effects on them, such as hydrogen embrittlement, leading to cracks and explosions. Hydrogen gas leaking into external air may spontaneously ignite. Moreover, hydrogen fire, while being extremely hot, is almost invisible, and thus can lead to accidental burns.

Even interpreting the hydrogen data (including safety data) is confounded by a number of phenomena. Many physical and chemical properties of hydrogen depend on the parahydrogen/orthohydrogen ratio (it often takes days or weeks at a given temperature to reach the equilibrium ratio, for which the data is usually given). Hydrogen detonation parameters, such as critical detonation pressure and temperature, strongly depend on the container geometry.

title: Hydrogen