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Time to control the costs

BMJ 2012; 345 doi: (Published 15 November 2012) Cite this as: BMJ 2012;345:e7770
  1. Edward Davies, US news and features editor
  1. edavies{at}

With last week’s election already fading into a distant memory, the business of healthcare reform awakens from a brief hibernation to look at the new landscape. And with the president re-elected, it looks not too dissimilar from the old.

In his editorial this week, Professor Robert Steinbrook, from the Department of Internal Medicine at Yale, reflects on the fact that the vast sums spent on electioneering in recent months have done little to alter the basic outlook: “Despite billions of dollars spent on campaigning, the balance of power in the US government remains essentially the same. The Obama administration’s policies will go forward. There will be new senators and representatives, but the Democrats retained control of the Senate, with a slightly larger majority than before. The Republicans maintained a majority in the House of Representatives, but a slightly smaller one” (doi:10.1136/bmj.e7591).

But while Professor Steinbrook claims that Obama’s re-election means “the implementation of the Patient Protection and Affordable Care Act in the United States is secure,” our news report from New York journalist Janice Hopkins Tanne is rather less optimistic: “Although widespread health insurance is now a certainty for the United States, implementing the health reform act may not be smooth and easy. It will face lawsuits from groups that object to some of its provisions and objections from states that do not want to participate in parts of health reform” (doi:10.1136/bmj.e7587).

Where there seems to be agreement between all commentators, however, is that any reform is battling against healthcare costs that are spiraling out of control. Our recent Data Briefing from healthcare economist John Appleby pointed out that the US not only spends a greater proportion of its GDP on health than any other nation, but “in total the US spends almost the same on health as all other [33] countries in the Organisation for Economic Cooperation and Development (OECD) put together” (doi:10.1136/bmj.e7127).

Professor Steinbrook concludes: “Within 10 years, healthcare is projected to account for nearly 20% of the US economy. The Obama administration has not pushed for the types of cost containment approaches that work in other nations. Ultimately, fulfilling the promise of healthcare reform may depend not only on implementing the Affordable Care Act but also on continuing to extend insurance coverage and bringing healthcare spending under control.”


Cite this as: BMJ 2012;345:e7770


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