Barack Obama has put everything into the battle for healthcare reform, fighting Republicans as well as wavering members of his own Democrat camp.
The sweeping overhaul would offer coverage to almost all Americans and reduce the enormous cost healthcare represents in the United States.
If the reform does not get through, it will be a bitter blow for a president who has not hesitated in tugging at heartstrings.
“I am here because of my own mother’s story,” he has said. “She died of cancer. And, in the last six months of her life, she was on the phone in her hospital room arguing with insurance companies instead of focussing on getting well and spending time with her family.”
The over 65s, just over 15 per cent of the US population, are covered by Medicare. Medicaid goes to 13 per cent, those with lowest incomes. Both schemes are government-funded. Some 58 per cent have employer-funded insurance, while 15 per cent have no coverage at all.
The United States spends more than 2 trillion dollars a year on healthcare. Representing 16 per cent of GDP in 2007, it could rise to 20 per cent by 2015.
Central to the problem is the exorbitant and fluctuating level of contributions. An average American who falls ill can be ruined by the cost of treatment. No longer able to pay, they become dependant on Medicaid. If they are not on a low enough income to qualify, they could find themselves reliant on the goodwill of charities.
The reform sets out to cover an extra 31 million uninsured Americans. It will cost 940 billion dollars over 10 years. But, by tackling waste, fraud and abuse, it should reduce the federal deficit by 138 billion dollars over the same length of time.
As part of the overhaul, insurers would be barred from excluding people for pre-existing conditions and prevented from arbitrarily dropping policy holders.
Insurance exchanges would be created where small businesses and individuals without work-related provision would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.
The package may yet prove a difficult pill to swallow for Congress. It is viewed as a possible make or break milestone for Barack Obama’s legislative agenda.