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What is in the pipeline for reform of health care?

The new Administration is taking over facing an unprecedented economic crisis. The country is already deep in debt and proposes to spend billions more to help prevent a long-lasting recession. Looking overseas, the war in Iraq still has eighteen months to run and there is no end to the war in Afghanistan in sight. So some would argue this is not a good time to start proposing major changes to the health care system. The last time this was tried under the Clinton Administration, the economy was doing well and the momentum for change was lost. Trying it again now is inviting a battle over the legislation when the country would be better served if its leader was focussed on the economic problems. Well, the nay-sayers would be wrong. This is the right time to talk about it again.

According to the latest figures, it is estimated that out of a population of about 305 million, some 45 million people in the US do not have health care cover. They are entirely dependent on the emergency rooms and the public hospital system subsidized by local, state and federal bodies. Why are so many people without insurance? The answer is, as everyone is all too painfully aware, that the premiums have been rising faster than inflation for the last five years and more. Now that unemployment is rising at a fast rate, more people will be unable to afford the instalment payments. The Administration's own estimate is that someone is driven into bankruptcy every thirty seconds (for the record, it is also predicted that approximately 1.5 million will be driven out of their homes in 2009 for non-payment of mortgage or rent). If fewer people pay their health plan premiums, the premiums must rise for everyone else. Treatments remain expensive and have to be paid for. If the hospitals cannot collect any money from their uninsured patients, the costs for all the insured must rise. Businesses are now passing on these increased costs to the members of their health plans. In effect, this is a pay cut. That is why this Administration wants to see a more fair system with affordable care and cover for everyone.

This means a halfway house. The current Administration would probably prefer to move to a single payer system of health insurance immediately, but there is too much invested in the current private insurance market. So the government is proposing a state-based system for all those without private insurance, allowing those with insurance policies to change over if they wish. Health care coverage for children is already here. The budget has $634 billion earmarked for preventative medicine and the provision of more affordable services. This is going to put a lot of pressure on private health insurance companies to respond with their own cost-cutting measures. Failure to stay competitive with a growing efficiency in public provision could lead down the slippery slope into a single payer system. That this is the standard model in most of the rest of the world, does not make it right for the US. Or does it? We can only wait and see what happens.

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