The United States House of Representatives recently passed the Affordable Health Care for America Act by 220 votes to 215. The bill, which is expected to cost $1.1 trillion over ten years, constitutes the greatest reform of U.S. health care since 1965 — when Medicare, a tax-funded single-payer system for those aged 65 or over and those with particular medical conditions, was created as part of the Johnson administration’s ‘Great Society’ programme. If passed into law, the new bill will extend health cover to 96 per cent of legally resident Americans. This it will do by widening the federally funded Medicaid system to include the 36 million Americans who currently cannot afford health insurance or whose employers do not provide it. The low-paid will be able to buy subsidised insurance or get cover from a government plan. Employers will have to provide insurance or pay a payroll tax of up to eight per cent. Significantly, insurers will be banned from rejecting those with pre-existing conditions and from dropping those whose needs increase; age limits will also be abolished.

The House vote is testimony to determined work by the House Speaker, Nancy Pelosi, and to President Barack Obama’s intensive liaison with Democrat Representatives, including the doubters. The President made serious concessions, for example by accepting that insurers who provide abortion services will not receive federal funding. This could affect a large number of women who are currently uninsured. Fierce controversy continues, with ferocious lobbying and television advertising by corporate insurers and others against the bill. Even mainstream Republicans make claims that the Nobel-winning economist Paul Krugman calls paranoid. Fears about the likely costs are outweighed by evidence that administration and screening account for 30 per cent of private insurance costs (as against 17 per cent in neighbouring Canada’s single-payer system). The Congressional Budget Office also estimates that the bill’s procedures will reduce costs. For example, financial relationships between medical manufacturers and doctors will be monitored by the federal government. The bill’s prospects in the Senate are uncertain. But after all the qualifications are made, President Obama deserves applause at this stage for winning where several Presidents — Theodore Roosevelt, Harry Truman, Richard Nixon, Jimmy Carter, and Bill Clinton — lost. Independent of the discord, the vigour of the U.S. health policy debate is a signal example for all countries where health coverage is less than universal.

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