Health care reform: what we can expect from Obama

18 Dec 2008

THE RECENT US presidential election galvanised and fascinated many Australians. Health care reform was a major issue, as it was in last year’s federal Australian election. Many Australians are eager to understand the health issues as they play out in the United States, and those who work in health policy are keen to learn about the challenges, problems, successes and failures in both countries. This is also an opportunity to look in some detail at the issues in health care that are currently playing out in the United States and Australia (and internationally) - reforming the health care system for the needs of the 21st century, prevention, management of chronic illnesses, workforce, obesity, mental health, quality and safety, the impact of global warming on health and how to achieve equitable access - and consider what both countries can learn from each other about how to successfully tackle these issues. In a new paper on health care reform I examine the health reform proposals likely to come from the Obama Administration in 2009. The aim is to present a succinct and current overview of the current state of performance and costs of the US health care system/s, public opinions (especially as they played out during the primary and general election campaigns), and assessments and analyses of the Democrat and Republican proposals by US think tanks, health policy experts and commentators. The divergent opinions of the US public on health care priorities and reforms, how these should be achieved and who should pay for them, offer ample ammunition for both reformers and their opponents. While presidential campaigns are ill-suited to the task of designing policy reforms, they represent critical periods for setting an incoming administration’s agenda. President-elect Obama has moved quickly to out his Administration in place, and has nominated former Senator Tom Daschle as both the Secretary of Health and Human Services and head of health policy in the White House. At the same time, the Democrats in the Congress are undertaking preliminary work to assist the passage of legislation, hopefully learning from the problems encountered by the Clinton proposal in 1993-94. The passage of President Obama’s health reform proposals will be facilitated by the surge of public support for reforms, and by the strong Democrat majorities in both houses of the Congress. With at least four committees in the Congress having a role in the passage of this legislation, strong leadership from the White House and the ability to develop broad agreement by those in power on the critical details of reform will be essential, and considerably more important than the polls. The US Medicare scheme was enacted in 1965 despite only 46 per cent support from the public. While economic issues will be the primary focus of the new president’s first 100 days in office, we can expect that Obama will begin the process of outlining his health care reform plans soon after he is inaugurated. While he is not required to give a State of the Union speech, we should expect such an address before the end of January, and his first budget is due in the middle of February. In order to see timely progress on health care reforms, it will be essential that Obama doesn’t hold the attainable goals of universal coverage and quality improvement hostage to the less attainable goal of health cost control.

Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/ Australian National University, and a research associate of the United States Studies Centre, University of Sydney.

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