Americans are a proud people. They take great pride in their national wealth, their number of Nobel Prizes and their military might. They have enormously profitable pharmaceutical and technological industries, some of the world’s best health and health care researchers and institutions, and they pump US$2 trillion each year into health care — that is, about US$6400 per person, far in excess of that spent by any other country.
Despite this, the health of Americans ranks poorly when measured against almost every benchmark. Furthermore, more than 40 million US citizens have no health cover at all, and a considerable proportion of those who are insured live in fear of bankruptcy should they become seriously ill.
It comes as no surprise that newly elected US President Barack Obama, in his inaugural speech to the Joint Session of Congress, received a standing ovation for his commitment to reform US health care, delivered with his “Yes we can!” resolve. But, as Niccolò Machiavelli wrote in 1513: “There is nothing more difficult to manage, more dubious to accomplish, nor more doubtful of success ... than to initiate a new order of things. The reformer has enemies in all those who profit from the old order and only lukewarm defenders in all those who would profit from the new order.”
The Clinton Administration’s attempts to reform US health care in the early 1990s fell foul of Machiavelli’s “Law of Reform”, and the vested interests that dashed Clinton’s dreams remain entrenched today.
However, Obama won the presidency on the back of widespread community expectations of reform, and his “Yes we can!” mantra resonated with the American people. It will be interesting to see whether health care reform becomes a reality. Making it happen eluded not only Bill Clinton but Franklin Roosevelt, Harry Truman and Richard Nixon before him. The “Yes we can!” approach may well triumph this time.
The Medical Journal of AustraliaMartin B Van Der Weyden, Editor.
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