The lead Editorial is this week's Lancet applauds the US Health Care Reform Bill for extending access to health care and for intending to narrow the gap between expenditure and health outcomes—stating it is an 'excellent start in the right direction'.
The big winners are, says the Editorial, the currently uninsured—32 million uninsured Americans, previously too sick or poor to qualify, will be have cover by 2014. By 2019, coverage will extend to 95% of the population. The new law forces insurers to accept all applicants irrespective of health status. While increased coverage will benefit the private health industry, the Editorial highlights that Medicare and Medicaid—the government's insurance programmes for elderly people and low-income citizens, which currently cover 28% of US residents—'will have a catastrophic additional operational and financial burden for which solutions are not clearly defined within the current bill'.
Also highlighted are the various factors that could further increase America's health costs—currently 19% of GDP, or US$2.5 trillion. These include the switch from blockbuster drugs for all to personalised medicine, and the country's ageing population. The Editorial says: "The proposed cost-saving options, such as the initiative to pay for quality and not quantity of delivered care (so-called pay-for-performance instead of fee-for-service), as well as the initiative to penalise hospitals for high readmission rates, are very welcome but will probably not reduce health-care costs."
Preventive health care, including more exercise and healthier eating, are key to the bill's success. The Editorial says: "Preventive behavioural changes, necessary for the wellbeing of the entire society, are not only the most difficult to bring about but are also those that, if unaddressed, will have a heavy toll on the cost of the country's health care. The bill begins to address this issue, for example, by mandating labelling of food with calorie counts in chain restaurants and vending machines. The burden of success should also fall onto medical academic centres, where education of primary-care physicians must place greater emphasis on routine care and preventive medicine."
It adds: "The success of the health-care reform bill will greatly depend on its acceptance by the public. Most Americans remain worried about the increased tax that will be imposed on them to cover the costs of the bill, and are sceptical about the government's right to intrude into the private choices of its citizens. Americans, unlike most Europeans, believe that a basic human right is the freedom to choose, whereas to have health coverage is a reward that should be earned (through work). The Obama administration still needs to convince its citizens that health coverage is a human right and not a privilege. In that respect, the current bill provides a basic minimum of coverage for the poor, while wealthy individuals will still have the option to choose additional coverage."
It concludes: "The US health-care reform legislation is to be applauded for extending access to health care and for intending to narrow the gap between expenditure and health outcomes. It represents an excellent start in the right direction."
Lancet Press Office. T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com
For full Editorial, see: http://press.thelancet.com/editorials0304.pdf
Journal
The Lancet