US President Barack Obama issued an urgent call yesterday for quick action on sweeping health-care reforms in an attempt to deliver on his most important domestic policy promise from last year's campaign, against fierce opposition from Republicans and much of the medical industry. It "cannot wait", he said.
After months of behind-doors drafting on Capitol Hill, the first committee hearings on an 852-page bill will begin in the House of Representatives today, marking the start of what promises to be a long, hot summer of tumultuous debate that could decide the course of the Obama presidency.
With so much at stake, the administration is readying a full-on campaign in support of the reforms. It has been boosted by new opinion polls showing strong public support for an overhaul of a system that leaves 47 million Americans without coverage and where premiums and drug costs are increasing. In a New York Times poll, 72 per cent of those surveyed said they were ready for government to take a greater role.
Health-care reform will be a key focus of a rare Rose Garden press conference with Mr Obama today and an unprecedented town hall-style discussion of experts and members of the public to be broadcast by ABC News from the White House tomorrow.
"Everyone in the health-care community is going to have to come together and do their job. Our families, our businesses and our long-term fiscal health demand that we act now," Mr Obama said, before wryly adding: "To revive an old saying from the campaign, 'yes we can'. We can get this done."
Mr Obama was speaking at a White House event to trumpet an important fillip to the cause: a promise by the pharmaceutical industry to contribute $80bn (£49bn) towards lowering the cost of prescription medicines for older Americans, on condition that the wider reform legislation makes it into law.
It has taken more than 15 years since the disastrous reform effort of 1993 – spearheaded by Hillary Clinton on behalf of her husband – for Washington to have the stomach to consider a new overhaul of a system that by most reckonings is a national scandal.
But even opponents recognise that Americans are hungry for it and that the people elected Mr Obama in part because he was promising it.
That does not mean that the trenches that are already being dug in Washington by all sides – members of both parties in Congress and lobbyists for the $2 trillion industry – will not be deep and treacherous.
Even moderate Democrats suggest that passing all the reforms that Mr Obama wants may not be feasible this year. "I think there's a lot of concern in the Democratic caucus," Senator Dianne Feinstein of California said.
The draft bill in the House hews closely to Mr Obama's own vision and adheres to the main goals of cutting costs and extending coverage to as many uninsured Americans as possible. However, like the President himself, it makes no explicit promise of universal coverage, where no one would fall through the cracks.
Nonetheless, it would create a public insurance entity to compete with private insurers and, hopefully, bring costs of health insurance down. Individual Americans would be obliged to buy some form of insurance with large subsidies for those who were less well off, while employers would face tough penalties for not insuring workers.
The obstacles are many, however, not least the rhetoric from conservatives that will shortly blow up into a fully-fledged tempest telling Americans that Mr Obama is trying to create a "socialised" and "European" health system that will reduce options for patients and adversely affect and even ration care.
"We can make incredible improvements in American health care, but I don't think having more government – in effect putting Washington between you and your doctor – is the way to go," Mitch McConnell, the Senate minority leader said at the weekend, calling the Obama approach a "non-starter".
There is also the matter of cost, which comes as Mr Obama fights a growing perception among the public that all his actions, notably the bailouts of Wall Street and the car industry, are building a new federal deficit hole from which America will have a hard time climbing out. The House draft bill unveiled on Friday notably does not include any kind of price tag.
A different version of the reform devised inside the Senate Finance Committee was sent back to the drawing board last week after it emerged that enacting it would cost a staggering $1.6 trillion over 10 years. That number was seized upon by Republicans and even scared Mr Obama's closest supporters.
Not everyone in the industry was so surprised, however.
"The shocker to me is that anyone is shocked," said Drew Altman, the president of the Kaiser Family Foundation, a health-care policy and research group. "With the details on the table, it has finally gotten real."
Don't forget climate change: Scientists' plea
Twenty leading climate scientists have written an open letter to President Obama and the US Congress urging them to take stronger action on carbon dioxide emissions to avert "ruinous climate change". They say that current plans on cutting emissions are not going to be enough to prevent potentially catastrophic change.
The scientists, including some of the biggest names in climate science, said it is widely thought in political circles that cutting emission to limit carbon dioxide concentrations to 450 parts per million, and global temperature rises to C, will be enough, when the evidence suggests otherwise.
"We and many others are of the view that these objectives are inadequate to sustain the integrity of global climate and to hold the risk of ruinous climate change to an acceptably low level," say the authors, who include George Woodwell of Woods Hole Research Centre, Massachusetts, and Michael Mann of Pennsylvania State University.Reuse content