Intended for healthcare professionals

Feature US health reform

Obama’s health dream: reality at last?

BMJ 2010; 340 doi: (Published 23 March 2010) Cite this as: BMJ 2010;340:c1576
  1. Susan Dentzer, editor in chief
  1. 1Health Affairs, Bethesda, Maryland, USA
  1. sdentzer{at}

    A historic vote in Congress has propelled US healthcare reform toward a conclusion. Susan Dentzer looks at what went wrong over the year of debate and what finally went right

    After at least five decades of consideration, a presidential election that turned partly on the subject, and more than a year of debate in a divided Congress, the United States finally stands on the brink of sweeping health reform.

    In a historic vote minutes before midnight on Sunday 21 March, a majority of Democrats in the House of Representatives passed a package that would expand health insurance coverage to an estimated 32 million Americans and unleash other reforms throughout the US health system. In so doing, they set the stage for President Obama to sign a preliminary version of the package into law—and paved the way for final Senate action on the measure in the days to come.

    The action capped an extraordinary year of debate marked by harrowing twists and turns. The number of uninsured people in the United States, estimated in 2008 at 46.3 million, is widely believed to be rising. As thousands of unemployed Americans have been forced to drop coverage, health insurance companies have begun to notify some of their remaining policy holders of double digit increases in premiums. Yet Republicans in Congress were overwhelming opposed to reform, and public opinion polls backed them up. Even as Democrats now hope to persuade the public otherwise, pundits say voters are so disenchanted that Republicans will seize control of the House of Representatives in November’s mid-term elections.

    An outside observer might well ask how the reform movement came to this pass. Here is a capsule summary of what went wrong and what finally went right.

    Learning the wrong lessons?

    The philosopher George Santayana famously wrote that those who forget the past are …

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