Intended for healthcare professionals

Observations Yankee Doodling

Who will pay and who will say no?

BMJ 2009; 339 doi: (Published 29 July 2009) Cite this as: BMJ 2009;339:b3042
  1. Douglas Kamerow, chief scientist, RTI International, and associate editor, BMJ

    Not everyone can get what they want from the US healthcare reforms

    We are now in a difficult period in the attempt to reform the healthcare “system” in the United States. Initial optimism has waned, President Obama’s popularity has plummeted, and the doomsayers are hanging the burial crepe. Shades of 1994 (the year of Hillary Clinton’s failed attempt at healthcare reform).

    Earlier this year there was unprecedented cooperation not only between Democrats and (some) Republicans but also within the ruling Democratic party. This has now splintered. And most of the powerful special interest groups—doctors, hospitals, big pharma, and the insurance and health plan industry—were on board as well, falling over themselves to make public concessions so as to maintain a place at the negotiating table. But those days of bonhomie are gone.

    The problem is that no one is willing to give up much. And no one is willing to admit that someone will have to say no to the sometimes extravagant ways of the past. The hard part is still ahead, and two related issues loom …

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