News / US to learn from past

The next US president must learn from earlier healthcare reform failures by showing flexibility in pushing towards wider healthcare coverage for the US population, according to US healthcare expert Gail Wilensky.

Latest census figures suggest that despite two ‘safety net’ social insurance schemes – Medicare and Medicaid – nearly 46 million US residents were uninsured in 2007. Both US presidential candidates, Barack Obama and John McCain, have plans to reduce the number of people with no healthcare cover.

Writing in the October issue of hfm (the US HFMA’s magazine), former Medicare administrator Gail Wilensky sets out the key differences in the Democrat and Republican candidates’ proposals.

To increase coverage Senator Obama has focused on subsidies to individuals and small business, while Senator McCain prefers tax code changes and creating a national insurance market to make lower-cost cover available.

Neither candidate has assured universal coverage – the goal of the failed Clinton reforms in 1993. But, even with more modest proposals, Ms Wilensky said the key to success was flexibility to ensure proposals gained the support of Congress.

She said the Clinton plan had failed because of a fixation with universal coverage. ‘[Without this lack of flexibility] I am convinced this could have provided a federally funded benefit for at least all poor and some low-income Americans,’ she said. ‘Because the administration would not support anything that did not involve universal coverage, nothing else was considered.’

The ‘critical lesson’ was the failure to assess the best package that could win Congress support.