The Independent: The Big Question: Why is US health care in such a mess, and what can Obama do about it? - by David Usborne

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The Big Question: Why is US health care in such a mess, and what can Obama do about it? - by David Usborne

The issues on President Obama's plate as he prepares to take a summer break on Martha's Vineyard range from the stumbling economy to Afghanistan and the Middle East, but it is domestic policy and his pledge to enact health care reform that keeps him awake at night. He has reason to be worried. Months ago, he made himself a hostage to fortune – or to Republicans and some conservative Democrats – by insisting that both the US Senate and the House of Representatives pass their particular versions of health care reform before the August recess. That has not happened and lawmakers are already trickling out of Washington to return only in September. This is an industry that accounts for one-fifth of the total US economy.

When a charity offered a free medical and dental clinic in a field in Virginia 10 days ago, 2,700 desperate and ill people showed up. Yes, America has some of the world's best doctors, hospitals and clinics, but the system as a whole is nothing short of a national scandal. And it is not just that almost 50 million people in the country have no health care coverage at all. Even those who have insurance find more often than not that what they thought was covered actually isn't, or they struggle to keep up with premiums that continue to rise at a pace far ahead of inflation. The system now is glutted with specialists who are obscenely well-paid while there is a dearth of primary care doctors who earn much less.

So where does it all stand now? - All the relevant committees in the House have adopted versions of a bill. The Senate is not there yet, but is in Washington through to the end of this week. After the summer break, the Democratic leadership must synthesise these committee-passed versions into one bill for adoption on the floor of their respective chambers. Only then can the Senate and the House begin reconciling those two versions to draft the law that will go to Mr Obama's desk. No wonder it takes for ever. Probably they'll be at it until Christmas. And, by the way, if it does get accepted it would take about eight years to get all the proposed reforms up and running.