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Health-Care Reform Could Be Obama's Toughest Challenge

But experts say time could be right to succeed where others have failed

MONDAY, June 22 (HealthDay News) -- President Barack Obama's efforts to reform health care in the United States could prove to be the toughest challenge of his already-ambitious young presidency.

But if Obama can reach that long-elusive goal, it would not only guarantee his legacy but prove to be a watershed in American history, experts say.

"Assuming that President Obama gets real health-care reform, it will be an amazing moment in American history," said Linda Fentiman, an expert in health-care law at Pace Law School in New York City. "It will bring us into the rest of the developed world, providing meaningful health-care access to all of the nation's citizens, which every other Western and several non-Western nations do. We are so far behind the rest of the world in terms of health-care access."

Added Mary Mundinger, dean of the Columbia University School of Nursing in New York City: "I think our president's focus on health reform is going to be a centerpiece of his legacy."

Few would disagree that the U.S. health-care system is in need of radical surgery.

"When you pull back far enough, you can't help but be in dismay over the gross inequity and the gross inefficiency of the system," said Thomas R. Oliver, an associate professor of population health sciences at the University of Wisconsin School of Medicine and Public Health. "Even those of us who have pretty good health-care coverage still find it extremely difficult and confusing to navigate. It's very, very bad."

"The system has acknowledged flaws," continued Oliver, who also serves as associate director for health policy at the University of Wisconsin Population Health Institute. "Nobody is really out there defending that we have the best system in the world."

"Most of America understands that we're in financial distress and that our health-care system doesn't work, but what may not be as apparent to people is that without health reform our health-care costs in this country are going to be out of control in the decade ahead," Mundinger added.

According to the White House Office of Management and Budget, the United States spends $2.2 trillion on health care annually, or almost $8,000 per person, a number likely to swell to $4 trillion by 2017 if costs aren't contained.

"The cost of our health care is a threat to our economy," Obama bluntly stated last week while addressing the American Medical Association (AMA) annual meeting in Chicago. "It is a ticking time bomb for the federal budget. And it is unsustainable for the United States of America."

The reforms currently being debated in Washington, D.C., and around the country will cost an estimated $1 trillion over the next decade -- and possibly more.

What, exactly, is that $1 trillion supposed to buy America?

Several committees in the U.S. Senate and the House of Representatives are aggressively debating both the larger and the finer points of a reform plan.

But the push seems to consist of three major components, explained David Cutler, a professor of applied economics at Harvard's Kennedy School of Government and a health-care advisor to Obama's presidential campaign. They are: providing health insurance coverage to all Americans; changing medical care so it's less expensive and of better quality; and investing in public health prevention.

Obama isn't the first president to attempt sweeping health-care reform: As he himself acknowledged in his recent Chicago speech, Theodore Roosevelt, Harry Truman, Richard Nixon and Jimmy Carter all tried -- and failed -- before him.

Then there was Hillary Clinton's ill-fated effort back in the early 1990s, which, according to the Chicago Tribune, set the reform effort back by 15 years.

"While significant individual reforms have been made -- such as Medicare, Medicaid and the children's health insurance program -- efforts at comprehensive reform that covers everyone and brings down costs have largely failed," Obama said in his speech to the AMA.

So what makes some people think that sweeping change can be achieved now?

Timing, mostly -- and economic pain, experts said.

"I think the American people are in a very different place than they were in the early 1990s when Hillary Clinton had her health plan. Americans now know firsthand that managed care often doesn't deliver what it promises, that people are paying more out-of-pocket so even the middle class is feeling that the current situation cannot continue," Fentiman said.

"To some degree, it's the American way. This is the third or fourth time in my 30-year career we've talked about this, but, until the pain becomes great enough, we tend not to want to make change," said Dr. Nancy W. Dickey, president of the Texas A&M Health Science Center and vice chancellor for Health Affairs in the Texas A&M System.

"Change is frightening. Perhaps we're at a point where the pain is great enough and the leader articulate enough that we may be able to do it this time," she said.

But change won't happen overnight.

"It'll probably transform over the course of a decade or two," Cutler said. "The hope is that within 10 to 15 years, we will have health care that's cheaper and higher quality."

More information

For more on health-care reform, read this HealthDay story, and this fact sheet from the Office of Management and Budget.

SOURCES: Thomas R. Oliver, Ph.D., associate professor, population health sciences, University of Wisconsin School of Medicine and Public Health, and associate director, health policy, University of Wisconsin Population Health Institute, Madison; David Cutler, Ph.D., professor, applied economics, Harvard University's Kennedy School of Government; Linda Fentiman, professor, law, Pace Law School, New York City; Mary Mundinger, Dr.PH, dean, Columbia University School of Nursing, New York City; Nancy W. Dickey, M.D., president, Texas A&M Health Science Center, and vice chancellor, Health Affairs, Texas A&M System; White House Office of Management and Budget fact sheet

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