It was decisive for his first election, the reform of the health system that Barack Obama must put in place is eagerly awaited by the people … and the conservatives.
Barack Obama undoubtedly won his second ticket to the White House on June 28, 2012. And he missed it with one voice. That day, the Supreme Court of the United States adopted by five votes to four its reform of the health system. Four years earlier, during his first election campaign, the candidate had made a promise to provide health coverage to the 32 million Americans excluded from care. According to a poll conducted at the time by the University of Michigan, 61% of Democratic voters said health issues would determine their vote. And in general, the expectations of the American people in this matter were high. On the list of their concerns, health came third behind the economic crisis and the war in Iraq. No wonder this when we know that in 2004, 54% of personal bankruptcies were due to medical bills!
But paradoxically, this beautiful victory obtained with the “Afforable Care Act” almost turned against him during his race for re-election. Too federal, too expensive, too redistributive, Mitt Romney found shocking arguments to denounce “Obamacare”. The attack hit the mark as the country is struggling to recover economically.
Especially since the American health care system is among the most expensive in the world, 17% of GDP (10% on average for OECD countries). And despite the $ 7,000 that each inhabitant spends on it each year, the quality of care leaves much to be desired. The most powerful nation in the world is ranked 27th in the world for infant mortality and 23rd for life expectancy at birth. Result: the United States occupies the 37th position in the ranking of the most efficient health systems established by the WHO.
The reform of the health care system will be fully effective in 2014. But until then, the Obama administration will have to fight on three fronts.
Fund the system by combating waste. An estimated 50 to 100 billion dollars go up in smoke because of waste and poor quality of care. The American president wants to computerize the health system with the creation of an electronic medical record, develop the prescription of generics and make compulsory “disease management” programs for chronically ill patients. During his first term, the former Illinois senator had the firm intention of allowing the reimportation of drugs from other developed countries. And for the good and simple reason that in the absence of any regulation, drug prices are 67% more expensive in the United States than in Europe or Canada.
Relieve doctors from judicial pressure . To observe with a magnifying glass the various contracts offered by the insurance organizations is the national sport of the American liberal doctors. “I signed a dozen contracts, testified in 2008 Dr. Colette Gordon, general practitioner in Chicago. It’s a complicated system. For a basic consultation, the price can vary between 35 and 55 dollars. Within the same organization, such as the Blue Cross Blue Shield, there are 5 or 6 different plans, or as many reimbursement variants. ”Not to mention that the amounts advanced by patients vary depending on the contract. “Fortunately the ‘co pay’ is written in black and white on their insurance card, sighs Dr. Gordon, who shares with a colleague the expenses of a secretary dedicated to these administrative matters.
Across the Atlantic, city doctors are less than a third to practice alone. They tend to come together in a group practice to share their fixed costs and provide more services to patients. The fear of lawsuits also pushes them to work together. “We practice defensive medicine,” said Dr. Gordon. If I see a patient who has a migraine, I always order a CT scan to cover me. The fear of lawsuits pushes insurers to increase premiums. “Mine costs $ 35,000 a year,” Dr. Colette Gordon testified. They can amount to more than 100,000 dollars depending on the specialties. To limit this increase in insurance premiums which weighs on doctors, Barack Obama wanted to encourage the reporting of medical errors while protecting doctors from professional liability claims.
Develop a culture of good practicesThe big black point of the American system remains the quality of care. Benefiting from the latest technologies, such as cutting-edge imaging (26.6 MRI units per million Americans against 3.2 units in France), the system remains “inefficient”, according to the Institute of Medicine. The infant mortality rate is 5 per 1,000 in 2006, and among black Americans it is 9 per 1,000.
The 700,000 physicians in activity in 2008 in the United States had to renew their license by justifying training sessions, reading publications, training via the Internet. An American study has shown that the repositories of good practices are used in cities in only 55% of cases. Barack Obama has proposed the creation of an “Best Practices Institute” responsible for enlightening insurance and patient choices. A way of indirectly forcing doctors to respect standards that should not please American doctors either.
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