5 in France record federal deficit of 11

From Truman to Clinton, it is the reform which have encountered most of American Presidents. In full debate on the out of the crisis, Barack Obama will play tonight, "prime time", an essential part of its credibility in a message televised in Congress on health reform. This may seem surprising. But both figures are sufficient to understand the urgency of reform that is not only the 46 million Americans still lack of medical coverage. It is sufficient to bring the exorbitant cost of U.S. health care system, 18 of GDP (compared to 11.5 in France), record federal deficit of 11.2 of GDP planned for 2009, the most important since the second world war. Untenable in the term. This is why Barack Obama in fact still the absolute priority of re-entry policy, despite a difficult summer debate that cost him several points in the polls. Which can therefore still oppose that compelling as necessary reform

First, the lobbies of private insurers and pharmaceutical firms. "The special interests that are part of the status quo", says Barack Obama in denouncing the "ridiculous rumours" to scare the American opinion. The answer is more complex and more profound. There is no doubt that private insurers and the influential American Medical Association (AMA) are ready to do anything to combat the creation of a "public option" at the perfume of "socialized medicine", as they had done in the creation of the Medicare program for more than 65 years under the Presidency of Lyndon Johnson in 1965. But the lobbying of the "special interests" and Republicans are not sufficient to explain the unease generated by the reform project. Since Tocqueville, it is in the visceral distrust of much of the American people to any extension of the sphere of public intervention. Despite objective mismanagement that today represents the American system of private insurance to the direct origin of the hyperinflation of the medical expenses (700 to 7,000 dollars colonoscopy doctors), the public meetings of the summer have shown that a simple spark is enough to wake up anti-Government fever.

In reality, it is this deep distrust of a large part of American opinion against the "mutual solidarity" that will have to overcome Barack Obama to obtain the support of the Congress. He knows that he plays roughly. Because, before him, almost all his predecessors, since Franklin Roosevelt to Bill Clinton in 1993, passing by Harry Truman, Richard Nixon and Jimmy Carter, is there are broken teeth. The notable exception of Lyndon Johnson and... George w. Bush who managed to extend the system of coverage for the benefit of pensioners. The debate on reforming Obama Paradox, is that it deals with a much more modest than the previous project. Unlike the cartoon that were intended to make Republicans this summer, the "plan Obama" - which was careful to leave Congress a broad margin of manoeuvre to establish the conditions - is far from the ambitious project of "universal coverage" defended by Hillary Clinton. The counsel to the health of Barack Obama, David Blumenthal, acknowledged in a recent book ("the heart of Power", University of California Press): by leaving the choice between a "public option" and coverage plans entrusted to insurers or employers, the current reform advocated by the Democratic majority is more akin to the mixed model of Eisenhower or Nixon to the solution of the "unique coverage" ("single pay") advocated by Lyndon Johnson. Is the solution "Medicare for all" (compulsory public insurance) intended by the founder of Medicare.

"Health insurance reform cannot wait, should not wait, and will not wait a year more", said Barack Obama in his speech to the Congress of February 24. Yes, but what reform Many observers provide already a retreat or a compromise. In leaving it to the two chambers to reconcile their "partitions", the Democratic President learned the lessons of the failure of the reform of Bill Clinton in 1993 in part linked to too strong control of the White House on its preparation. On fuzziness of his project still allows him to amend it. But leave the flange on the neck to a traditionally dominated by the lobbies Congress would also bury reform. It remains to be Barack Obama until the end of October to convince public opinion that it has everything to gain to the reduction of the costs of that ineffective also unequal system.