The United States spends more on health care than anyone "but unfortunately the quality of care is going down," said Health and Human Services Secretary Kathleen Sebelius in a conference call with regional reporters yesterday.

As part of the Obama administration's push for health-care reform, Ms. Sebelius released "health care status quo" reports on each of the 50 states in conjunction with the conference call.

Pennsylvania's numbers, compiled from several different sources, paint a picture reflective of what Ms. Sebelius said is happening nationwide: One in 10 state residents are without health insurance and, for those fortunate to have coverage, insurance premiums have doubled since 2000.

The numbers "represent real people and families across the country," she said. "Americans are demanding reform."

She believes that they will get it. Democrats enjoy a healthy majority in the House and, with developments this week in the Senate finance committee, she said, "I'm confident that we'll get a bill passed and to the president's desk."

The form it may take is already stirring lively debate from all sides, with physicians' groups, drug companies and many other interested parties trying to help shape the outcome.

Responding to questions, the secretary said a public option for health coverage to compete with private insurers "is definitely part of the strategy," and that she believed that health-care reform would help small business owners who have been facing ever-rising premiums.

Ms. Sebelius said the 50 reports released yesterday -- available at www.healthreform.gov -- are "a clear demonstration that there are problems with health care in every state."