Millions await Obama's action on health insurance

A reader has promised to buy Goroncy insurance after she was profiled this fall in The Inquirer, and she hopes to have hernia surgery in the New Year.

But short of the generosity of readers - not a good national solution - Goroncy and millions like her are awaiting the sweeping health reform now being considered by President-elect Barack Obama.

Obama's plan, which has not been formally announced, could mark the biggest change in health care in 40 years. A central goal will be to cover 50 million Americans who don't have insurance. It is conceivable that all Americans will be required by law to have health insurance.

A principal architect of Obama's reform - Tom Daschle, nominated to become secretary of the Health and Human Services Department - has written at length about creating a powerful new board that would control health-care spending much like the Federal Reserve Board influences the nation's monetary policy.

Experts say for any plan to pass, it must contain soaring medical costs.

Obama's reform will almost certainly attract criticism that it overly expands the role of government in health care. And American history is littered with failures to revamp the system - recently Hillary Clinton's effort in 1993.

Less in dispute are the inadequacies of the current system. More than 45 million Americans had no health insurance in 2007, according to the U.S. Census Bureau, and that was before the current recession.

In Pennsylvania, for example, 145,800 working adults - an all-time high - were on a waiting list for state-subsidized health insurance in December, an increase of 15,000 since November, the Insurance Department reported.

The uninsured often struggle harder for care; they face longer waits for treatment and on average die sooner than those with insurance, studies show. And in at least two examples in this series, a lack of access to care earlier has led to more expensive treatment later.

Spending on health care, 17 percent of the nation's gross domestic product in 2009, will reach 20 percent by 2017 and "poses a serious threat" to the nation's fiscal health, said a report last week by the Congressional Budget Office.

What's more, said the report, much of that spending is of questionable benefit.

"Up to one-third of that spending - more than $700 billion - does not improve Americans' health outcomes," wrote Sen. Max Baucus (D., Mont.), chairman of the Senate Finance Committee, in a recent 89-page health policy paper that many see as an important Democratic blueprint for health reform.

Baucus added that "in addition to the uninsured, another 25 million Americans are underinsured, without enough coverage to keep their medical bills manageable."

The health-care system is often ridiculed as no system at all. "Kafka could not have designed a more bizarre system," said Robert Field, head of health policy at the University of the Sciences.

Field, among many others, says he is optimistic that some reform will be passed by Congress, helped along by the recession and huge bailouts of the financial and auto industries.

"Our frame of reference has changed," said Field. "Programs in the billions of dollars seemed like a lot of money . . . that's beginning to look like pocket change."

"I do think in a funny way, the economy's demise has forced people to think about what's really important," said Len Nichols, director of the health policy program at the New America Foundation, a centrist group in Washington. "So when people began to realize we're going to have to restructure a whole lot of our economy, how can you do that and ignore health care?"

The Inquirer in the last few months has chronicled the stories of people whose situations highlight a number of problems:

Too many young Americans - 30 percent between 18 and 24, and nearly that many between 24 and 30 - don't buy insurance. They feel that they don't need it or can't afford it.