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| Version 1 | Version 2 |
|---|---|
| US healthcare: Who wants what? | US healthcare: Who wants what? |
| (about 1 hour later) | |
| Can the White House broker a deal on healthcare reform? | Can the White House broker a deal on healthcare reform? |
| Passing a healthcare reform bill is proving tricky for US President Barack Obama, as different groups mobilise to remove the parts of the plan that they dislike. | Passing a healthcare reform bill is proving tricky for US President Barack Obama, as different groups mobilise to remove the parts of the plan that they dislike. |
| The various players in the healthcare debate - from the White House to the insurance companies - all want different things from the reform process. | The various players in the healthcare debate - from the White House to the insurance companies - all want different things from the reform process. |
| THE WHITE HOUSE | THE WHITE HOUSE |
| President Obama is due to lay out more detailed proposals in an address to both chambers of Congress on Wednesday but he has established three overriding principles for healthcare reform. | President Obama is due to lay out more detailed proposals in an address to both chambers of Congress on Wednesday but he has established three overriding principles for healthcare reform. |
| Any reform bill, the White House says, will need to reduce the overall costs of the system, extend healthcare to every American and ensure that healthcare is affordable for all. | Any reform bill, the White House says, will need to reduce the overall costs of the system, extend healthcare to every American and ensure that healthcare is affordable for all. |
| Alongside these broad principles, Mr Obama has also set out a number of specific reforms to the industry that he wants to see implemented. | Alongside these broad principles, Mr Obama has also set out a number of specific reforms to the industry that he wants to see implemented. |
| He wants to: | He wants to: |
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| At the beginning of the legislative process, Mr Obama deliberately chose to leave the specifics of reform for Congress to work out, but - with reform stalling in the Senate - he has decided to adopt a "more prescriptive" approach, according to aides. | At the beginning of the legislative process, Mr Obama deliberately chose to leave the specifics of reform for Congress to work out, but - with reform stalling in the Senate - he has decided to adopt a "more prescriptive" approach, according to aides. |
| LIBERAL DEMOCRATS | LIBERAL DEMOCRATS |
| Many American liberals would like Mr Obama's healthcare reform proposals to go much further, but are prepared to support his plans as long as they are not watered down too much in Congress. | Many American liberals would like Mr Obama's healthcare reform proposals to go much further, but are prepared to support his plans as long as they are not watered down too much in Congress. |
| They favour the increased regulation of the insurance industry that Mr Obama has proposed and support efforts to extend coverage to all Americans by offering generous subsidies to the less well-off. | They favour the increased regulation of the insurance industry that Mr Obama has proposed and support efforts to extend coverage to all Americans by offering generous subsidies to the less well-off. |
| For many liberals, both in Congress and in trade unions like the Service Employees International Union (SEIU), the most cherished feature of healthcare reform is the "public option" - the government-run insurance plan that will be available to Americans who do not have access to employer-provided coverage. | For many liberals, both in Congress and in trade unions like the Service Employees International Union (SEIU), the most cherished feature of healthcare reform is the "public option" - the government-run insurance plan that will be available to Americans who do not have access to employer-provided coverage. |
| But Republicans and some moderate Democrats are threatening to remove the "public option" from the Senate's version of the bill, setting up a clash with liberal Democrats. | But Republicans and some moderate Democrats are threatening to remove the "public option" from the Senate's version of the bill, setting up a clash with liberal Democrats. |
| CONSERVATIVE DEMOCRATS | CONSERVATIVE DEMOCRATS |
| Moderate and conservative Democrats in the House of Representatives belong to a grouping called the Blue Dog Caucus. | Moderate and conservative Democrats in the House of Representatives belong to a grouping called the Blue Dog Caucus. |
| During the healthcare reform bill's passage through the House Energy and Commerce Committee, the Blue Dogs threatened to block the bill unless its price-tag was cut by $100bn. | During the healthcare reform bill's passage through the House Energy and Commerce Committee, the Blue Dogs threatened to block the bill unless its price-tag was cut by $100bn. |
| They also demanded that more small businesses be exempted from the requirement to provide healthcare for their employees and insisted that any public scheme would be barred from paying the same (low) rates to doctors and drug companies as the government-run Medicare programme. | They also demanded that more small businesses be exempted from the requirement to provide healthcare for their employees and insisted that any public scheme would be barred from paying the same (low) rates to doctors and drug companies as the government-run Medicare programme. |
| Democratic leaders agreed to the Blue Dogs' requests, and the deal appeared to smooth the way for a healthcare reform bill - including a public option - to pass in the House. | Democratic leaders agreed to the Blue Dogs' requests, and the deal appeared to smooth the way for a healthcare reform bill - including a public option - to pass in the House. |
| In the Senate, however, conservative Democrats like Kent Conrad of North Dakota and Ben Nelson of Nebraska have expressed opposition to the public option. | In the Senate, however, conservative Democrats like Kent Conrad of North Dakota and Ben Nelson of Nebraska have expressed opposition to the public option. |
| Mr Conrad has suggested that a network of healthcare co-ops could be established instead of a publicly-run scheme. | Mr Conrad has suggested that a network of healthcare co-ops could be established instead of a publicly-run scheme. |
| REPUBLICANS | REPUBLICANS |
| Republicans in the House and the Senate have been staunchly opposed to the Democrats' healthcare proposals. If Mr Obama's reform bid fails, the Republicans will benefit politically, so they may be calculating that outright opposition is their best strategic option. | Republicans in the House and the Senate have been staunchly opposed to the Democrats' healthcare proposals. If Mr Obama's reform bid fails, the Republicans will benefit politically, so they may be calculating that outright opposition is their best strategic option. |
| During the 2008 presidential campaign, Republican candidate John McCain outlined a healthcare reform plan: end the tax-free status of employee health benefits, and give all Americans tax credits for the purchase of health insurance. | During the 2008 presidential campaign, Republican candidate John McCain outlined a healthcare reform plan: end the tax-free status of employee health benefits, and give all Americans tax credits for the purchase of health insurance. |
| Moderate Republican Chuck Grassley may support a compromise bill | Moderate Republican Chuck Grassley may support a compromise bill |
| This would remove the incentives for Americans to keep their employer-provided health coverage, so more Americans would shop around for private insurance. The power of the free market would then force costs down, Mr McCain argued. | This would remove the incentives for Americans to keep their employer-provided health coverage, so more Americans would shop around for private insurance. The power of the free market would then force costs down, Mr McCain argued. |
| Some Republicans have described similar proposals when asked to outline their plans for healthcare reform, but the party's strategy appears to be geared more towards defeating the Democrats' policies than coming up with alternatives. | Some Republicans have described similar proposals when asked to outline their plans for healthcare reform, but the party's strategy appears to be geared more towards defeating the Democrats' policies than coming up with alternatives. |
| Many of the feature of reform that Republicans have been attacking - like the so-called "death-panels" or coverage for illegal immigrants - are not actually being proposed in any of the plans put forward by Democrats. | Many of the feature of reform that Republicans have been attacking - like the so-called "death-panels" or coverage for illegal immigrants - are not actually being proposed in any of the plans put forward by Democrats. |
| INSURANCE COMPANIES | INSURANCE COMPANIES |
| Although they have been vilified by many liberals as the enemy of reform, health insurers have - in public - actually been fairly supportive of the Democrats' efforts. | Although they have been vilified by many liberals as the enemy of reform, health insurers have - in public - actually been fairly supportive of the Democrats' efforts. |
| In part, this is because the reforms could benefit insurers. | In part, this is because the reforms could benefit insurers. |
| In particular, the "individual mandate" (the rule forcing all Americans to take out health insurance or face a fine) will create a lot of new customers for insurance companies, and many of the newly-enrolled members will be young, healthy people who have previously opted not to get insurance. | In particular, the "individual mandate" (the rule forcing all Americans to take out health insurance or face a fine) will create a lot of new customers for insurance companies, and many of the newly-enrolled members will be young, healthy people who have previously opted not to get insurance. |
| The insurance companies - represented by the industry body AHIP - are less sanguine about the prospect of a government-run public insurance option. They fear that a strong public option will drive them out of business. | The insurance companies - represented by the industry body AHIP - are less sanguine about the prospect of a government-run public insurance option. They fear that a strong public option will drive them out of business. |
| DOCTORS AND HOSPITALS | DOCTORS AND HOSPITALS |
| US doctors (represented by the American Medical Association or AMA), and hospitals (represented by various organisations, including the American Hospital Association and the Federation of American Hospitals) broadly back the Democrats' reform proposals. | US doctors (represented by the American Medical Association or AMA), and hospitals (represented by various organisations, including the American Hospital Association and the Federation of American Hospitals) broadly back the Democrats' reform proposals. |
| Their biggest fear is that the government will create a powerful publicly-run insurance scheme that will - like the government programme for the elderly, Medicare - use its bargaining power to cut the amount of money it pays to doctors. | Their biggest fear is that the government will create a powerful publicly-run insurance scheme that will - like the government programme for the elderly, Medicare - use its bargaining power to cut the amount of money it pays to doctors. |
| The three biggest hospital groups in the US have offered to reduce their costs by $155bn over 10 years in an attempt to make health reform more affordable. | The three biggest hospital groups in the US have offered to reduce their costs by $155bn over 10 years in an attempt to make health reform more affordable. |
| The reductions will be achieved by cutting the amount of subsidies that hospitals receive from the government to cover uninsured people in emergency rooms. As more and more people get insurance, the hospitals reason, the need for the subsidies will be reduced. | The reductions will be achieved by cutting the amount of subsidies that hospitals receive from the government to cover uninsured people in emergency rooms. As more and more people get insurance, the hospitals reason, the need for the subsidies will be reduced. |
| But the hospitals have warned that they will only make the full $155bn reduction if the government meets its target of extending coverage. | But the hospitals have warned that they will only make the full $155bn reduction if the government meets its target of extending coverage. |
| PHARMACEUTICAL COMPANIES | PHARMACEUTICAL COMPANIES |
| Manufacturers of drugs and medical equipment are not very supportive of the Democrats' reform plans. | Manufacturers of drugs and medical equipment are not very supportive of the Democrats' reform plans. |
| The industry - represented by the Pharmaceutical Research and Manufacturers of America (PhRMA) - is concerned that the Democrats' proposed publicly option could use its negotiating power to start bargaining down drug prices. | The industry - represented by the Pharmaceutical Research and Manufacturers of America (PhRMA) - is concerned that the Democrats' proposed publicly option could use its negotiating power to start bargaining down drug prices. |
| It is also opposed to the reformers' proposal to establish a government body to conduct research into the relative effectiveness of different treatments. | It is also opposed to the reformers' proposal to establish a government body to conduct research into the relative effectiveness of different treatments. |
| Drug companies argue that this could eventually lead to a situation in which government bureaucrats dictate to doctors which drugs they are allowed to prescribe. | Drug companies argue that this could eventually lead to a situation in which government bureaucrats dictate to doctors which drugs they are allowed to prescribe. |
| Supporters of the proposal insist that "comparative effectiveness research" is simply a useful tool to help doctors avoid prescribing expensive drugs that work no better than cheaper treatments. | Supporters of the proposal insist that "comparative effectiveness research" is simply a useful tool to help doctors avoid prescribing expensive drugs that work no better than cheaper treatments. |