Intended for healthcare professionals


US health reform: Obama’s top priority

BMJ 2009; 338 doi: (Published 03 June 2009) Cite this as: BMJ 2009;338:b2143
  1. Bob Roehr, freelance journalist
  1. 1Washington, DC
  1. bobroehr{at}

    How will the US reduce costs while expanding healthcare coverage for all? Bob Roehr reports

    Bill Clinton tried to implement health reform in 1993 by sending Congress a 1342 page document. It included something that everyone could hate, and they did. It died a slow painful death.

    Barack Obama has taken the opposite approach with his number one domestic priority: it can be stated on a single sheet of paper with room to spare. His goals are to lower costs and extend coverage to the uninsured, according to the White House health tsar Nancy-Ann DeParle.

    The Democratic leadership in Congress has taken its cue from the president and has not given potential opponents anything to snipe at. Their activities to date, while extensive, have focused on broad principles for change rather than concrete legislative language of what that reform will be.

    Senator Ted Kennedy, an iconic figure on health matters and in US politics, has convened a regular series of private meetings, where his staff and a small number of invited people from key interest groups have been trying to hammer out a version of reform legislation. But so far none of it has been made public.

    Max Baucus, chairman of the Senate finance committee, has taken the public route, hosting a series of round table discussions to explore policy options. He says that his draft legislation, scheduled to be unveiled in mid-June, will reflect compromises designed to garner bipartisan support. But he is not tipping his hand as to which options he favours, except to say that a Canadian style “single payer” approach is not in the mix.

    Outlines of consensus

    There is broad agreement to contain costs. The consensus is that reimbursement must shift from the current system based on the quantity of interventions to one that rewards disease prevention and …

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