US health reform gains momentum

by Lesley Politi on December 11, 2008

US health reform gains momentum

Well, apart from the obvious that they all occupied the Oval Office, they also all proposed some kind of universal health coverage programme – and they all failed to deliver.

With their failure in mind, Barack Obama has been more cautious.

He has not gone as far as to promise universal health care – but that is clearly his goal.

Reduce costs

So what are President-elect Obama’s proposals?

He wants to increase health coverage by reducing medical costs.

He also wants to improve quality.

How? Well, on the campaign trail he promised to cut the average American family’s healthcare bill by $2,500 a year.

He is also promising mandatory healthcare coverage for all children, financial assistance for people who cannot afford health insurance and for small businesses to help meet the costs of giving their employees cover.

He also wants to bring down the costs of medication.

The challenge is huge.

Around 50 million Americans have no health insurance – millions more are under-insured.

His administration will have to tackle a complex system of private health insurance, vested interests and the mountains of paperwork involved in getting healthcare to those Americans who rely on government support through Medicare (for the elderly) and Medicaid (for the poor).

Barack Obama hopes to make savings of billions of dollars by cutting through red tape and computerising the system, but not everyone believes that it is going to be as easy as it sounds.

And there are more pressing domestic problems – namely the state of the US economy.

Crisis or opportunity?

While Barack Obama, Hillary Clinton and John McCain may have seen healthcare as a priority in the middle of the election campaign, it has been eclipsed by the financial meltdown.

The question now is – can America afford it?

And can the president-elect give it the attention it needs?

The US already spends 15% of its wealth on healthcare – a greater proportion than most developed nations.

Can it afford to spend more?

Henry Aaron, a healthcare expert at the Brookings Institution, says that initially he was sceptical that a new Obama administration would be able to deliver.

But now he argues the economic crisis could make it easier.

He believes it is now possible to link healthcare reform to an economic stimulus.

If the US is already spending a trillion dollars on an economic bail-out, then throwing money at healthcare is no longer such a problem.

Mr Aaron says it would cost about $100bn a year to cover the uninsured.

Politically too, there may never be a better time to take on the issue.


Barack Obama is not alone in promising to tackle healthcare reform.

The Democratic party has strengthened its grip on Congress and that can only help his efforts.

Mr Obama is expected to appoint a former majority leader of the Senate – Tom Dashcle – as his health secretary.

He is someone who knows his way round Congress and, just importantly, is seen as a consensus-builder.

He has the necessary skills to bang heads together and reach a deal.

And Tom Dashcle will not have to work on his own.

The Democratic Senate Finance Committee Chairman – Max Baucus – has just published his own 89-page plan.

It calls for a mandate on all Americans to carry health insurance – more than Mr Obama is proposing.

But he is already consulting the president-elect.

As is the veteran Senator Ted Kennedy, who, after surgery to remove a tumour on his brain, is now promising to put together a health bill within months.

It remains an enormous task, however.

And the past shows that good intentions are not enough.

Getting politicians from both parties, as well as state governments, private health insurers and the pharmaceutical companies all on side will not be easy.

But there is at least a consensus that America’s healthcare system is in dire need of reform.

As to what it will look like, Henry Aaron says: “Expect evolution not revolution”.

Barack Obama’s opponents may call him a socialist, but no American politician is advocating a British-style nationalised health service.


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