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The Obama Plan for Health Care Reform – About to Unfold?
By William Herbert, Ph.D., FACSM

President-elect Obama has made clear that health care is one of his top priorities. ACSM is pleased that health care reform appears to be both a prominent and urgent issue on the “Change” agenda. In fact, ACSM is taking steps already to work with the Obama transition team on health resources and policy development. (Look for more information on ACSM’s policy activities in future issues of Sports Medicine Bulletin.)

During his campaign, Obama expressed concern on a personal level about an existing health system that hindered his efforts to secure adequate medical services for his ailing mother. His passion is evident and his determination to improve the system seems genuine. Yet, he faces many urgent large-scale problems that cannot wait. The media draw attention to these every day: an economy in significant recession, instability in the banking industry, auto manufacturers at risk of failure, soaring unemployment, and military occupation forces in both Iraq and Afghanistan.

Collectively, these problems are expected to create a $1.2 trillion U.S. budget deficit this year - by some calculations, the largest since World War II. Then, there is the Obama economic stimulus package, designed to help Main Street America get moving again economically, and carrying a price tag of $675 to $775 billion. Despite these challenges and even before inauguration, the Obama team is already working for bipartisan support in the House of Representatives to move legislation forward for renewal of the SCHIP program (State Children's Health Insurance Program). SCHIP funding is but one piece of comprehensive health care reform, but without timely action it will expire soon. SCHIP provides much needed support to some six million children who otherwise have no health insurance coverage.

Tom Daschle, designate for Secretary of the Department of Health & Human Services, will lead the overall effort for Obama. The issues are extraordinarily complex and expensive. On the political front is the need to shepherd legislation through a Congress with sharply divided views on what and how to fix health care. For decades, the outlook in Congress has not been to increase expenditures for health care, but instead look for ways to "save money" through such measures as cutting Medicare and avoiding a single payer insurance system. For the top 10 concerns likely to shape the debate, see the Wonk Room. Consumer choice, costs of care, and degree of governmental regulation will be fundamental to the debate. Costs are the core concern. Health care spending already accounts for 17% of our current economy, so the key will be finding the means to extend coverage to those who now can’t afford it and, at the same time, reduce inefficiencies and be more prudent in selecting and delivering services to those already insured.

At this early juncture, we can only see the most general features of Obama’s plan. Driving the plan is the goal of “affordable, accessible health care for every single American.” Reports suggest the strategy will be to retain the best of our current system, rather than dismantle what we have. Prevention and chronic disease management will be one of the three cardinal areas for improvement. We are still many months away from knowing how this aim of bolstering preventive services may translate into policies and an infrastructure that might deliver truly efficacious services. But the media commentary generally suggests a long-term goal would be to help contain the growing numbers of patients with multiple morbidities that today require our most expensive high-tech services.

Obama’s election has generated a renewed sense of national unity and optimism for many Americans. Others cautiously wait to see if meaningful change will follow campaign rhetoric. Still others remain highly skeptical. Given the great expectations for this new administration, timing couldn’t be better for broad and vigorous debate in the formative period before legislative action. Relative to preventive services, the ways and means to make physical activity part of everyday life for Americans surely must become integral to the plan. In this regard, ACSM, through its Activity & Health Policy Network and other outreach functions, should be well positioned to advocate solutions and offer technical assistance to help enable this objective.

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