July 23, 2009 7:57 pm
In recent days the momentum of Barack Obama’s drive to reform US healthcare has seemed to fade. Congressional committees have produced bills which broadly follow White House specification. Yet these proposals remain unfinished work because the crucial questions – who pays, and how? – await answers. Raising the stakes of his own personal commitment to the project, the president went on television this week to persuade the country that the reform was needed, and still on track.
Much of what Mr Obama said was right. The US does need to get a grip on fast-growing healthcare costs, which already absorb 17 per cent of the country’s output. The president is right that quality of care is not as good as it should be, given this vast outlay. It is shameful that more than 40m Americans are uninsured, and that people with insurance are anxious about losing it should they become ill or unemployed.
Mr Obama was right, too, when he said that a new consensus on the need for reform has been reached. Key elements of reform command wide support: an individual mandate to buy insurance, subsidies for the poor and a regulated insurance exchange, with rules to stop insurance companies denying coverage to buyers who are already ill. As far as they go, these would be welcome innovations.
Nonetheless, the president gave an uninspiring performance. His points may have been true but they were not new, and he restated them in an uncharacteristically lacklustre way. Worse, he continues to emphasise cost control, even though the bills held up in Congress fail to grapple with that issue. This makes his pitch for reform seem hollow. Most important, the president has chosen not to advance a plan of his own, except in the very broadest terms, but to promise support for almost whatever Congress comes up with.
Since US voters are understandably fearful of what might come out of Congress, this is far from reassuring. Perhaps as a result, the proportion of voters who think that the president is doing a good job on health policy has fallen below 50 per cent for the first time.
Despite everything, health reform this year still looks likely, and if it only widens coverage, it will be better than nothing. But making all the changes the broken US system requires – on payment methods, cost control, the role of employers and, above all, on taxes – will require much bolder action. It will also call for the kind of leadership that, so far, Mr Obama has chosen not to exercise.
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