Expansion Likely for State Children's Health Insurance Program
Experts interviewed by WebMD agreed that expansion of the children's insurance program SCHIP is likely to be the first of the proposed reforms to be considered.
Last December, Democrats in Congress lost a yearlong fight to boost federal spending that would have expanded the program after two separate vetoes by Bush.
The program will be up for congressional review next March, and experts say it will probably be the Obama administration's first chance to make good on a health care promise.
"SCHIP is one of the big success stories in health policy over the last 20 years," Buckmueller says. "It has succeeded in getting kids the preventive care they need to keep them out of the ERs."
Medicare Reform More Problematic
Many of Obama's other proposals -- from the expansion of Medicare to his National Health Insurance Exchange -- will be much harder to win support for, even with a largely friendly Congress behind him.
Buckmueller believes the best chance for major reform lies in seeking bipartisan support for his proposals.
He says a key reason for the failure of President Clinton's 1993 health care reform effort is that his administration did not reach across the aisle. "Assuming that Obama has learned from the Clinton debacle, I think he would be wise to say, 'Here are the basic principles of my plan. You work out the details, get bipartisan support, and I'll sign it.'"
Health Spending 'Not Sustainable'
While sweeping reform may not come soon, experts contacted by WebMD agreed that the nation's broken health care system must be addressed and that this must happen sooner rather than later.
The statistics bear this out:
- 45 million Americans have no health insurance.
- 25 million more have health plans but are considered underinsured because their policies offer only minimal coverage, according to the Commonwealth Fund.
- 42% of U.S. adults under age 65 are uninsured or underinsured, up from 33% in 2003.
Total spending on health care represented around 16% of the gross domestic product in 2007, and the Congressional Budget Office says spending will rise to a quarter of gross domestic product by 2025.
"We are not going to reduce health care spending," says former Congressional Budget Office Director Alice Rivlin, PhD, who is now a scholar with the Brookings Institution. "The best we can do is reduce the rate of health care spending growth. That should be the No. 1 priority of any health care reform."
If jobs are the next thing to go in the current economic crisis, as many economists are predicting, the number of Americans without health insurance will quickly increase beyond projections.
"Something has to happen over the next few years, because the cost of doing nothing is too great," Rivlin says.
Davis echoes the thought. "We can't afford to stay on the path we are on with regard to total health spending," she says. "Employers can't afford it, the government can't afford it, and individuals can't afford it. It is just not sustainable."