Towards medical insurance for every American?

Almost one year to the day after the election of Mr. comfortable Barack Obama in the White House (53% against 46% for Republican Senator John McCain) and the consolidation of a Democratic majority in both assemblies, the House of Representatives voted November 7 in the snatch (220 votes against 215), a major reform of U.S. health care system.

Its provisions represent a major social advance for the country, indicating a political victory for President of the United States. Most of the 47 million Americans currently have private health insurance - those who are neither old enough nor poor enough to be covered by a public system (Medicare for the first, Medicaid for the latter), the employees that their employer no does not ensure the unemployed whose numbers continue to grow (1) - No longer live in fear of disease may ruin them.

The state will expand the public system already in place for the poor (Medicaid) to approximately 11 million Americans a little better pay than current beneficiaries. It will subsidize insurance for most others in proportion to their income. And a public system reserved for their uninsured will not pass under the yoke of private insurers and their outrageous prices.

Estimated 1 100 billion for the next ten years, new government spending under this bill will be partly financed by higher taxes paid by the richest. The employers themselves, will in most cases, choose to cover their employees (38% of U.S. companies do not currently) and pay a fine.

In the light of social protection systems exist in other rich countries, Canada and Europe in particular, the text voted by the House of Representatives may seem very modest. It effectively leaves most of the "health market" for private insurance companies whose maximum profit is the name. While they may not refuse to cover patients at risk, but they will flock to their counters millions of new customers previously without health coverage - and now subsidized by the state.

Even after the final vote to reform the U.S. health system remain the most expensive in the world (2 400 billion in 2008, or 16.5% of gross national product) and one of the least developed countries protectors ( according to a study by the World Health published in 2000, the United States arrived at the thirty-seventh place in public health). Moreover, the decision of the House of Representatives has been at the price of concessions to anti-abortion lobby, which required no penny of public money to fund abortions.

At a time when almost everywhere in the world, welfare is at stake, and where the state is withdrawing, it is refreshing - and unusual - that the opposite trend is evident ... in the U.S. (as it True, a state places much more degraded than elsewhere).

Yet nothing is certain. The margin of the vote in the House of Representatives is very narrow thirty-nine elected Democrats have stood up against the main thrust of domestic politics of their president, and associated with trying to obstruct Republican (2). This means that the next parliamentary stage does not look like a walk in the park. The obstacle course will indeed pass a successively likely attempt to obstruct Republican in the Senate (where forty percent can elect to postpone indefinitely the adoption of a text); the vote by the House itself to a project likely different from that the House of Representatives has just passed, adopting a Joint Conciliation Committee of a text identical to the two assemblies, which finally will be voted by each ...

It is not certain that this path crosses will be completed before the end of this year, as had been hoped President Obama. It is not assumed that some of the most progressive contributions of the project which has just reached the cap of the House of Representatives - in particular the creation of a new public system ("Public option") Reserved for the uninsured - will survive the parliamentary maze. The insurance lobby opposes violence as a "competition", and supports a profusion of advertisements intended to cause trouble with tens of millions of viewers legitimately confused by the complexity of the texts under discussion (the one the House of Representatives has adopted included nearly 2 000 pages). Result: 39% of Americans believe that "The state should not meddle with Medicare then it is a fully public program ...

Beyond reforming the health system, the vote on November 7 points rather than the "launch window" of the President of the United States becomes closer as the months pass and the halo of victory fades . Obama was probably too late to get involved and for the sake of appearing non-partisan, he lost time by negotiating with Republican lawmakers. But they, heedless of compromise with the president they hate political practice scorched earth against what they describe as "socialism" paving the way for new taxes and a bankrupt state. Sensitive to the impact of such diatribes, dozens of Democratic lawmakers elected in conservative districts concerned primarily their re-election next year. President Obama can not count on them. Last but not least, the conservative media - Fox News and the Wall Street Journal in particular - are fueling an ongoing climate of opposition almost paranoid initiatives the White House.

In a lengthy editorial published on 1 November 2009 and titled "The worst legislation ever proposed," the Wall Street Journal, U.S. national newspaper (2 million copies) has lashed out at a "Epic level of spending and taxes, insurance whose price will rise to heaven, all of rationing care, screenings dishonest." The complex, which "Lead to a rate of structural unemployment as high as in Europe since the welfare state it is developed"Would be destructive "At all levels: for the health system for the public finances and, ultimately, freedom and prosperity."

The weight of money and industrial lobbies in the political system, judiciary and media of the United States is such that it is always easier for a Republican president to lower taxes of the richest for a Democratic president to improve welfare of all others. Indeed, the results of the first year of the Obama presidency remains significantly behind that of the first year of President Reagan (1981) or Mr. George W. Bush (2001). In the latter two cases, significant tax cuts combined with a substantial increase in military spending had gone smoothly on course Congress and the minimum wage was frozen, the right to strike in question.

The adoption of an ambitious reform of the health care system would signal so that a Democratic president may also change - in a very different meaning - the social balance of the United States. Since Lyndon Johnson (1963-1969), the demonstration remains to be done. It is all the more necessary on the front of the foreign policy (Iraq, Afghanistan, Middle East) the change promised by Obama really slow to emerge.