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The Obama presidency: what may happen, what needs to happen in health policies in the USA
  1. Barbara Starfield
  1. Johns Hopkins University, Baltimore, Maryland, USA
  1. Professor B Starfield, Johns Hopkins University, 624 North Broadway, Room 452, Baltimore, MD 21205, USA; bstarfie{at}

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Expectations are high for the Obama presidency. People worked hard on his campaign, more because of his perceived integrity than his platforms (which were not well defined). Is it realistic to expect Obama to make a real difference?

The primary health policy focus of the presidential campaign was on achieving universal coverage with health insurance. It is an international scandal that the USA has between 50 and 100 million people (between 15% and 30% of its population) without adequate coverage for their healthcare costs—the leading cause of bankruptcy in the country and a postulated major cause of excess deaths among the socially deprived. In the Democratic presidential primaries, there were only relatively minor differences having to do with methods of financing and whether obtaining insurance would be mandatory. No one asked whether universal insurance would measurably improve population health statistics or disparities in health (the US ranking has fallen to between 20th and 30th in the world on major health indicators, with increasing inequities).

Since his election, the nomination of Tom Daschle for the cabinet position of Secretary of Health and Human Services signals what “reforms” might be sought. Daschle’s recent book1 is noteworthy in its precise and detailed history of …

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  • Competing interests: None declared.

  • Author's note Since my commentary was written, Daschle withdrew his nomination for Secretary of Health and Human Services. In conjunction with his Senate confirmation hearing, it was disclosed that he had received large sums of money for advising various health industry companies and lobbyists, thus raising a possible conflict of interest in his position as Secretary. In fact, one company sent him a letter, after his nomination, reminding him that they had paid him $14 000 for a lecture. It is possible to speculate that his failure to address the issue of avoiding conflict of interest in his proposed positions on health care reform was associated with this history.