Universal and affordable health care: how can we achieve it?

I was watching a live TV broadcast of the US House of Representatives voting for the health care reform bill (Affordable Health Care for America Act) in a hotel room on November 7th when I was visiting Philadel-phia to participate in the annual meeting of the Ameri-can Public Health Association. The voting continued, despite it being late on a Saturday night. When the House passed the bill at a narrow margin, I naturally imagined that the opening conference ceremony the next day would be full of excitement and enthusiasm, reflecting the long-held support of APHA members in favor of the national health insurance program. As a regular participant of APHA, I vividly remember the opening ceremony of the APHA annual meeting in 1992 in Washington DC, shortly after the victory of Bill Clinton. " We got the president we have been waiting for! " shouted a speaker, followed by calls from the audience, " Universal coverage! Single payer! ". The atmosphere was so overwhelming that I felt that the time had finally come for the US to achieve a universal coverage. Unfortunately, the reform did not happen in the subsequent eight years under the Clinton administration. However, the bill that was passed resembled what the APHA members had expected 17 years ago: a single payer. The bill included a provision requiring the federal government to create a public health insurance plan to cover the otherwise uncovered population. The non-elderly population will be given a choice between private and public plans, thereby stimulating a competition between them. A large, single payer will have bargaining power in controlling the price of health care. In the course of policy discussion, the Obama administration proposed an alternative to the single public health insurance plan: health insurance cooperatives (coops). Proponents of coops might have hoped that they would be able to provide better quality of care while avoiding too much governmental involvement and thereby making the reform more acceptable to other stakeholders. A decisive factor determining the eventual fate of the newly passed bill will be finance. According to the Congressional Budget Office, if implemented, the new bill would cost over one trillion dollars in ten years (2010–2019). Even considering the increased tax revenue ($583 billion) and $219 billion savings over the ten years, it will accumulate a deficit of $239 billion. In other words, more savings must be achieved to sustain the universal coverage …