But it can no longer say that Barack Obama does not take its schedule

Mission accomplished. The American President and the "First Family" are gone, on the eve of Christmas, for ten days of vacation in Hawaii, the relieved spirit. A month and a half after the vote of the House of representatives, the Senate adopted December 24 by 60 votes to 39, the most important reform of American health care system since the creation of the Medicare program for retirees in 1965, under the Presidency of Lyndon Johnson. Unlike the version in the lower House, the text of the Senate, of course, had to give up the creation of a "public option" (for federal funding) for accession democratic moderate to a reform which the overall cost is estimated at 871 billion over ten years. But the new device will not expand health coverage to more than 30 million people still lack insurance today, either in total to 94 of Americans.

"If it passes, it will be the text of the most significant social policy since the adoption of the"Social Security Act"in the 1930s and reform the most important of our system of health since the creation of Medicare in the 1960s," noted Barack Obama in recalling only less than 7 Presidents (Democrats and Republicans alike), since Theodore Roosevelt in 1912to were already broken teeth up to now. Before Barack Obama could affix his signature on the final, just text prior to the speech on the State of the Union, at the end of next January, the Democratic majority however will have to reconcile the two versions of the reform adopted by the House and the Senate, still significantly different. Despite these hazards even if, according to some estimates, the device will let still some 24 million people without insurance (including illegal immigrants), it is the first time that the American health care system (18 of GDP) is approaching to more almost a model of "universal coverage" to the European.

"The harder still to come"

Despite the frustrations of the Liberal (from left) wing of the Democratic Party which deplores the abandonment of a "public option" funded by the State and the fact that the device leaves a significant fringe of the population not covered, the vote of the Senate is generally regarded as the first significant success of the Democratic President in the Congress since the adoption of its February $ 787 billion stimulus plan, into recession. What regain its bearings after the fall of popularity under the 50 mark the end of November. However, "Although that this vote Vienna close a chapter of the legislative process, the harder still to come", found James Rohack, President of the influential American Medical Association (AMA), which recently agreed to the reform project. If the texts of the House and the Senate are converging on the essential: establishment of a compulsory health insurance ("individual mandate") requiring individuals to purchase insurance and use of a "Exchange bourse" where individuals not covered by their employers can obtain insurance through grants, three major differences (on financing, the public option and abortion) exist between the two versions. While the House plans to finance reform by the creation of a surcharge of 5.4 households having annual revenues greater than $ 1 million, the Senate opted instead for a levy on the most expensive insurance plans. Also the abandonment of the "public option" advocated by the Chamber, the Senate leaves for the Federated States the possibility to prohibit reimbursement of the cost of abortion by the mutual insurance companies. However, one as the other include "the toughest measures ever taken to make management accountable insurance companies" including prohibiting them to refuse to support on the basis of pre-existing diseases, said the White House.

Paying pragmatism

Pragmatism has paid. Refusing to make the "public option" a sine qua non of the reform, Barack Obama made primer the objective on the terms and conditions... and received the green light that the Congress had refused to Bill Clinton in 1993. In the end, his health reform will be probably less ambitious than expected. But it can no longer say that Barack Obama does not take its schedule.