President Barack Obama has put his efforts to tackle reform of the American health-care system into high gear, saying he wants a health-care reform Bill on his desk by the end of the year.
In the past month he has named Governor Kathleen Sebelius as his new nominee for Secretary of Health and Human Services, and Nancy Ann DeParle as the Director of the White House Office on Health Reform, filling the vacuum left by the withdrawal of Senator Tom Daschle as the candidate for both positions.
He has included $US634billion ($A990billion) in his budget as a down payment on providing universal coverage, and he has convened all the major stakeholders at a White House Health Care Summit.
Obama's approach to health-care reform is a mix of bold new moves and pragmatism, and it is interesting to note the key role that Peter Orszag, Director of the Office of Management and Budget, is currently playing. His prominence as a spokesman on health reform may fade when Sebelius is confirmed, or it may continue, signifying that for the Obama administration, this is not so much a moral imperative as a fiscal imperative.
The President has taken two large political risks by moving forward in this area at the same time as he is tackling the deepening economic crisis and energy and environmental reforms, and by suggesting that health reforms could be paid for in part by limiting taxation deductions to upper-income Americans. But at the same time, he and Orszag have made it clear they would be willing to look at other cost offsets aside from tax impositions. This is something that will need to be done in any case, as the full cost of Obama's proposals could be as high as $ 1trillion over 10 years.
There are plenty of places to look for more money. It is estimated that as much as one-third of health-care dollars is spent on activities that have little to do with health outcomes. A recent report from the Commonwealth Fund estimates that savings of $3billion in US health-care costs could be made over the next decade, concomitant with the expansion of coverage to all Americans.
The conservatives who oppose substantial government involvement in funding and managing health care find themselves in opposition not just to the new administration, but to their constituents.
Currently 14,000 people lose their health cover every day. In 2007, 57million Americans had difficulty paying their medical bills, up from 14million in 2003. On average these people owed US$2000 in medical costs and had been contacted by a collection agency at least once. Access to services is also an issue, with 50million people living in areas where health-care workers are in short supply.
However despite the urgency he has given this task, Obama is also being quite pragmatic about the final shape of the reforms which will come from the Congress. He has stepped back from his election policies and simply provided a set of quite simplistic working guidelines.
At the same time he has moved to ensure that the process is inclusive from the beginning. The Health Care Summit which he convened last week brought together the major players from the Congress, labour, consumer groups and medical groups, the pharmaceutical and insurance industries, and business. The discussions could have come from any similar Australian summit. The topics included prevention, chronic illness, obesity, quality and safety, coordinated care, better access to primary care, workforce, health IT and of course, costs.
But it was different than the Australian debate, in part because it was a new experience for many of these stakeholders, who are used to being consulted only after legislation has been drafted, and because the final alliances that will bring reform to fruition have yet to be forged.
The White House Domestic Policy Office must now continue this dialogue and bring together the work and commitments of a range of other groups which have been meeting on health reform. At the moment it seems that the most problematic issue is time. If the President's deadline for reforms is to be met, time is in really short supply.
Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University and a research associate at the US Studies Centre, University of Sydney.
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