US healthcare reform next on Obama hit list
President Barack Obama walks with daughters Sasha and Malia, far left, at Cape Coast Castle in Ghana
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Monday July 13 2009
President Barack Obama yesterday returned from his overseas tour to a struggle over his most important domestic promise: to reform America's healthcare system.
He has promised to succeed where Bill and Hillary Clinton failed in the early 1990s and sign legislation this year guaranteeing health insurance for almost all the 47 million Americans without cover. Sharp disagreements have emerged over how to pay the bill of at least $1tn (€717m) over 10 years.
Conservative Democrats in the House of Representatives oppose plans to raise taxes on the rich. Meanwhile, some left-wing Democratic senators, who are working on their own version of the law, are wary of a proposed new tax on the health insurance benefits provided by some employers.
An overhaul of healthcare, which would usher in a wide new role for government, could become the defining issue of Mr Obama's first term, and help determine whether he wins a second. "I'm confident that we're going to get it done," he said last week. "It is going to be hard, though.
Scaring
"As dissatisfied as Americans may be with the healthcare system, they're also afraid of the unknown and we have a long history of scaring people that they're going to lose their doctor, they're going to lose their healthcare plans, they're going to be stuck with some bureaucratic government system that's not responsive to their needs."
Bringing the legislation to a vote this year is crucial because Congressmen may be reluctant to consider such a charged issue next year, when there are mid-term elections.
There is widespread agreement that reform is essential and, for the first time, hospitals, health insurance companies and doctors' associations are broadly supportive -- making some form of legislation much more likely.
Healthcare spending in the US has risen faster than inflation for years, and in 2008 accounted for $2.14tn (€1.53tn), a sixth of the nation's gross domestic product.
America spends more per capita on health than any other country, yet 15pc of its 304 million people remain uninsured and millions find their policies deficient in the event of severe illness.
Guaranteed insurance would make a significant difference to people like Valerie Goodness, a firefighter in Corvallis, Oregon, who was forced to leave her job because of her 13-year-old son's autism. When her employer changed insurance companies, the new one refused to cover his "pre-existing condition" -- a common dodge regarded as one of the system's great iniquities.
Now, if she earns more than $1,000 (€717) a month, she will lose the insurance provided by Medicaid, a state programme for the poor.
"And there is no way I could earn a job that would pay enough for private nursing at $20 to $30 an hour," said Mrs Goodness. "I feel like I am forced into poverty just so I can get insurance." Most Americans get medical insurance from their employers, who choose from competing companies.
The system has spurred innovation, helping American hospitals and specialists to become the best in the world, but it has also driven up costs.
Analysis
- Alex Spillius in Washington
