what is the current US health system?
Currently 66.7% of US citizens receive healthcare through private insurance, provided mostly by employers or by directly approaching insurance companies. There are also government-funded insurance programs for specific groups: Medicare (for individuals 65 years and above, and some under 65 with long-term disabilities), Medicaid (for those in financial need who fulfil certain criteria), SCHIP (for children in low-income families who are not eligible for Medicaid), military health plans, state-specific health plans, and Indian Health Service (for eligible American Indians). Despite these programs, approximately 15.4% of Americans (46.3 million) are uninsured.
what are Obama's healthcare reforms?
President Obama outlined his 'Obama Plan' in a speech to Congress in September. It outlines a number of proposed reforms, which include:
- Making it illegal for insurance companies to deny cover to an individual because of a pre-existing medical condition
- Requiring insurance companies to include cover for preventative care (eg mammograms) at no extra charge
- Creating a new marketplace ('The Exchange') where people without insurance can compare plans and buy them at competitive prices
- Reforming medical malpractice laws so that doctors can focus more on healthcare delivery
- Providing a new, voluntary public health insurance option
Under these plans every American would be required to obtain insurance. It is proposed that these reforms would be paid for by finding savings in the current healthcare system, which Obama described as 'full of waste and abuse'; an independent commission would be created to identify such areas.
what do people think?
Liberal members of Obama's party, the Democrats, would rather the reforms go further, including a greater regulation of insurance companies and more generous subsidies to those less well-off. Some conservative members of his party, however, advocate removing a publicly run insurance option altogether.
The Republicans oppose government-run healthcare and have been staunchly opposed to his reforms; one Republican senator has, however, voted in support of some of Obama's proposals. Insurance companies originally supported many aspects of the reforms but have since published a report suggesting that premiums would increase under the reforms; fears of loss of business due to a public health insurance option have also been expressed. However, the mandate for every American to have insurance will create new customers for insurance companies.
Doctors and hospitals generally back the proposals but express fears that a publicly run insurance scheme may result in a decrease in their earnings.M.o
(Student BMJ 2009;17:b1488, US Census Bureau. CPS Health Insurance Definitions; census.gov, The Obama Plan; whitehouse.gov, bbc.co.uk 2009; 10 September, ibid; 13 October, ibid; 13 October, Health Care; gop.com, timesonline.co.uk 2009; 14 October)
