Obama's health plan faces fiscal realism

Ambitious promises made during the 2008 US presidential election are being modified to account for the reality of a global recession and  fiscal difficulties. President Barack Obama set as one of his main goals  for his administration that of achieving universal health insurance  coverage for all uninsured US residents, a figure estimated at between  45 million and 47 million uninsured people.

Peter Orszag, the White House budget director, gave an indication of the  new mood, telling the UK's Financial Times that "we have been very clear  that a deficit-increasing health care reform is neither practical nor  desirable." Liberal factions of the Democratic party, massively  supported the then Senator Obama from Illinois over his main rivals, Sen  Hillary Clinton (New York) and former Sen John Edwards (North Carolina),  hoping that he would make greater changes than the more centrist  candidates. Former backers now fear that cost concerns will lead to a  more timid reform package.

The FT reports that the program would need to be "deficit-neutral" over  10 years and provide large-scale savings after that. At present, there  is considerable hope that electronic patient records and prescribing  will provide significant efficiency gains, as well as the calculation  that more patients receiving preventative care will lead to a drop in  expensive emergency room admissions that are charged to Medicare or  Medicaid.