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Barack Obama's ambitious plan to provide every American with health insurance, the first attempt since Hillary Clinton's effort as First Lady ended in disaster 15 years ago, officially began yesterday on Capitol Hill.
Tom Daschle, the former Democratic Senate leader and the man tasked by Mr Obama to spearhead the push for health care reform, appeared before the US Senate as the first confirmation hearings for Mr Obama's incoming Cabinet began.
Mr Daschle, nominated to become health secretary, is expected to easily win confirmation. But his task in getting hugely expensive health care legislation through Congress, even as Mr Obama tries to win quick passage of a separate $775 billion economic rescue plan, will prove far more difficult. The health care plan will cost at least $60 billion a year if it is passed.
More than 46 million Americans are without health insurance. According to the Commonwealth Fund, a Washington-based charity aimed at improving health care for individuals, the US ranks last among 19 industrialised nations in health care efficiency and quality.
When Bill Clinton came to office in 1993, he made the issue a priority, but committed several tactical blunders that condemned his plan to ignominious defeat - mistakes that Mr Daschle has closely studied.
Mr Clinton first put his wife in charge of the project. She kept the drafting of the legislation inside the White House - cutting out Congress - and by the time her massive 1,342-page bill arrived on Capitol Hill in November 1993, it was already doomed.
Mr Daschle intends to get Congress closely involved from the outset and wants to get a Bill presented within three months of Mr Obama taking office. Yet aides to the Democratic committee chairman who will be responsible for passage of the Bill are already calling such quick timing highly unlikely and warn that health care reform could be pushed beyond the summer recess. By then, it risks being subsumed by other priorities.
Mr Obama wants to create a government-funded public health insurance plan that will compete with private insurers. Yet the proposal is fiercely opposed by most Republicans, many employers and the very powerful health insurance sector.
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I am an american who have work since t was 14, now 44 and unemployed. I need an emergency surgery to remove an ovarian cysts but I do not have health insurance. I've been looking for insurance, I can't afford it.
marlene, Newfoundland, PA, U.S.A
OK, I live in Canada where we've had government funded health care for years. I don't see it as "forced insurance", remember, the government is paying not me. All I know is that when I need to go to the doctor, I don't try and decide whether or not I can afford it, I just go. Isn't that the point?
Andre, Otawa, Canada
In 1986 I opened my own business. I have paid CASH for all medical bills since then. The cost averages less than one third of an insured patient's cost. I would agree to medical savings accounts, but not to forced insurance.
emmanuel , hudson, usa
The rhetoric is wrong as I have verified the data with the authors of the study. There are NOT 46 million uninsured Americans but rather 46 million uninsured consumers of American healthcare. This is a big difference as this figure includes up to 30 million illegal aliens that are raping the system.
Marge Wooe, Atlanta, USA
60 BILLION to insure 46 MILLION?? Someone is getting a good cut...US govt really doesnt understand economics. Oh yeah, they gave BILLIONS to the banksters for bonuses and so forth...Billion...Million...what's the difference? And here I am worrying about a couple hundreds dollars for feeding my kids.
Tom, Idaho, US
Why do you keep forgetting that if any government ran the Sahara there would be a shortage of sand?
For my money, any government controlled/imposed health care scheme is a thinly disguised eugenics program. I want the government to keep its grubby paws off my body and my medical records.
Paula, New Mexico, USA
Our US "health care" system is really a "disease care" system. Congress can best improve our health by making all over-the-counter natural supplements tax deductible. Universal insurance will only perpetuate the obscenely high prices presently charged by health care providers and drug companies.
Joan X, M.D. in Seattle, Seattle, USA
When will the government finally get around to reigning in the costs from the medical and drug suppliers???
Joe Black, New York City,
Healthcare is a right, not a privilege. To turn a blind-eye to the fact that tens of millions of Americans lack sufficient is abhorrent crime that should be remedied.
And please visit a British hospital before you criticise them. The NHS treats anyone including holidaying Americans.
Chris, New York, USA
The NHS may have its fault but its the one thing I miss about the Uk now I live in the US. Here in the States if you are struck by bad luck and fall between the cracks you are on your own, I would never wish that on anyone in such a great country.
Ronny, Boston, USA
Congratulations Obama on his plan to provide every American with health insurance. I think that the best system that the United States could follow is the British after ironing out its faults. If you go to war to protect your people from outside enemy's then isn't disease a number one inside enemy?
John Santilli, Rome , Italy
"The comments about the illegal immigrants are truly shocking. The purpose is to ensure all US citizens"
Penny, why shocking ? You say it yourself, care for *citizens*, not every freeloader non-citizen who shows up at the county hosp. my taxes pay for.
Stan(expat for now), USA, USA
Truly shocking how persistent drug companies have persuaded US citizens that universal coverage is 'socialism' or represents 'lowering' of standards. The NHS has many faults, but by and large, it is the gold standard for health care in the UK, and costs a fraction per citizen compared to US options
Steve Jones, London, UK
We dont understand in the UK, people pulling their own teath, getting medicines from Phamacies, dying two years before on average. Will the USA do it, I hope they do but it will be a point of no return. 1% of GDP at least. Good Luck
Eric, Brighton, England
Having traveled to many countries with universal coverage, I have been staggered by the poor quality of services--- they may be free but there is no comparison to the service most US citizens get. Agree that the illegal immigration problem is disastrous but universal coverage is NOT the answer.
Robin Willcourt, Newport Beach, USA
American's have a very limited view of their system. if you have good insurance and are linked to a good healthcare provider it is very good, but for many the experience is very disconnected and expensive. Standards are generally higher than in UK, but that is more of a UK management issue.
Mark Peterson, San Jose, CA, USA (ex UK)
Bill, can you explain how a family on $40K a year who is asked for $1K a month to insure their family, or who has any major medical event in their history and is automatically denied coverage is chosing not to have it?
Mark Peterson, San Jose, CA, USA
Ignorance is not bliss-it leads to socialism.
Any US dweller can walk into an emergency room & get stabilized without regard to costs. "Illegal" immigrant ,means just that -they are NOT citizens & have broken the law. The US cannot afford to give away healthcare to all of the world's population .
wilfred knight, orange county, usa
The comments about the illegal immigrants are truly shocking. The purpose is to ensure all US citizens get healthcare when they need it, which is highly likely just that time when people can least afford it.
Penny, London,
This will be the same sort of colossally expensive, bureaucratic disaster as the UK's National Health scheme.
250 + million Americans have perfectly good healthcare.
about 15% of them do not; which is their choice, and should be left that way.
bill martin, new york, usa
Then Canada must not be an industrialized nation since those Canadians that can go to the US for any serious treatment. And our hospitals are not havens for infections like the UKs. Another poorly written propaganda piece.
Rich, Louisville, KY
The US healthcare "system" is a national disgrace, negatively impacting every aspect of American society. National health care is so much better than nothing, which is how much the first two people seem to care about those who keep the US economy alive, "illegals" or not.
Warren, Cambridge, UK
Nevermind the illegal immigrants, what about the millions of Americans who will benefit!! Let me guess you two have medical insurance. How's about looking after people less fortunate than yourselves!!
Colin, ellesmere port, uk
Tsk tsk. Do some research, please. That forty-odd million figure includes around 30-odd million illegal aliens. Obama's pledge is to provide, at taxpayer expense, health benefits to those illegals as well. It's a clever ruse of statistics to omit inconvenient facts surrounding those numbers.
mike, Dallas, USA
Does that 46 million figure include all the illegal immigrants in the U.S. ??
JENNIFER, CLEVELAND, USA