How Obama Can Effect Health Care Reform

An editorial published in this week's Lancet
is highly optimistic regarding President-elect Obama's ability to
influence real change in health care policy - one of the United
States' most divisive political issues.



"Health system
strengthening must be a top priority for the new administration if 46
million uninsured US residents are to have access to health care," say
the writers of the editorial. "Obama's plans to offer a range of
payment
choices, his commitment to ensure that all children have health
insurance, and the requirement that insurance companies cover
pre-existing conditions are positive steps towards an inclusive health
system. In addition, Medicaid and Medicare must be rebuilt, reinforced,
and fully supported."



They add that, "It was encouraging to hear UK Prime
Minister Gordon Brown say at last week's international conference on
the Social Determinants of Health in London that Barack Obama is
committed to tackling domestic and global inequality."



According to the editorial, Obama's plan for global health
must consider climate change, two ongoing wars, and trade relations.
The writers propose six steps with which Obama can effect meaningful
change:


"Health equity and human
security should be a stated objective of foreign policy."
"The
DHHS Director of Global Health Affairs, Bill Steiger - who has badly
hurt
America's reputation in global health - should be replaced with a more
experienced and appropriate politician."
"Mark Dybul, the head of
PEPFAR - the President's Emergency Plan for AIDS Relief, undoubtedly
the
biggest triumph of the Bush administration despite its
controversies - will likely be swiftly replaced. Strong leadership from
a
respected international expert, such as Jim Kim, could help to negate
PEPFAR's dogmatic and damaging policies - for example, its preference
for
abstinence-until-marriage programmes."
"Just as George W Bush
reinstated the global gag rule - a law that forces recipients
of federal
funding to agree that they will not perform or promote abortion as a
method of family planning - in his first day in office, Obama could
reverse this decision as soon as he is inaugurated and so improve
women's access to sexual and reproductive health in a single stroke."
"A public commitment to agree to spend the internationally
agreed
target of 0.7% of gross national income on aid by 2015 would set a good
example to the international community."
"As a signal that the USA
is committed to human rights, Obama could bring the USA in line with
most other UN member states by ratifying the UN Convention on the
Rights of the Child and the International Covenant on Economic, Social
and Cultural Rights."

The writers also hope that Obama will not be as antagonistic towards
the UN system as the Bush administration was.



"The choice of
the next UN Ambassador is
pivotal to improving these relationships, in health as well as in other
domains," concludes the editorial. "An increase in support - including
financial support - for WHO
would be a sign that the USA wishes to re-engage with the global health
community. President-elect Obama is a reminder about what is great
about the USA and that, indeed, 'change can happen'. The fruits of that
change will be judged by tangible improvements to the welfare and
health of Americans - and those affected by American foreign policy."



Obama and health: change can happen

The Lancet (2008). 372[9651]:
p. 1708.

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: Peter M Crosta