NEARLY 37 million people in the United States have no health insurance at all. Meanwhile, the money spent on health care has been rising steadily till last year, it touched $800 billion -- more than 14 per cent of the country's gross domestic product. But all that will be a thing of the past if US President Bill Clinton's proposed reforms are implemented.

In his most impassioned speech yet as President, Clinton told a joint session of Congress in late September, "This health care system of ours is badly broken and it is time to fix it. We must make this our most urgent priority, give every American health care security that can never be taken away, health care that is always there."

Universal coverage
Clinton's ambitious and complex proposal aims at universal coverage by 1997 and seeks to curb skyrocketing costs. It guarantees a package of minimum benefits to all US citizens that would continue despite illness or changes in employment.

US citizens would be enrolled in regional entities called health alliances, which would offer a range of services and collect premiums from companies and individuals. These premiums would not be related to age, medical history or health threatening personal habits. It would be mandatory for all companies with less than 5,000 employees to join the alliances, while the rest would have the option of creating their own alliances to negotiate directly with health care providers. The states would ensure all areas were adequately covered and insurers would be barred from denying coverage to sick or high-risk people.

The standard package would cost $1, 800 per year for individuals. Employers would be required to pay 80 per cent of this cost, and the employees would contribute the rest. The government will, however, subsidise small low-wage firms and individuals with low incomes. Self-employed or unemployed people, who do not qualify for the subsidy, would have to pay the full amount. Part of the expenses will be covered by increasing taxes -- Clinton's "sin taxes" -- on tobacco and possibly alcohol.

Though a Los Angeles Times poll showed that more than 65 per cent of Americans supported Clinton's plan, the public is not totally convinced it will improve the quality of health care they receive or reduce the medical costs -- the worry uppermost in their minds.

Besides, even the Republicans who are traditionally opposed to expanding social welfare programmes, now believe in extending medical benefits to all Americans.

Interest groups are trying to influence the final structuring of the reform programme. Groups representing the elderly, people with AIDS, mental health patients and women want more generous reforms than those proposed. Conservatives are worried it will ease abortion. Tobacco manufacturers, breweries and distilleries are mounting strategies against the sin taxes, though these have been supported by the Republicans.

Roping in doctors
And, the American Medical Association (AMA) is urging doctors to oppose some elements of the plan, including regulation of insurance premiums and cuts in growth of Medicare and Medicaid. It sent a letter to 107,000 medical personnel -- a section that exerts considerable influence -- saying it would "activate an unprecedented national network of physicians" to persuade Congress to make substantial changes in the plan.

The proposal is also strongly opposed by the Health Insurance Association of America, which aired television commercials that preyed on the public's fears that the reforms could curtail their right to choose their own doctor. The Democratic National Committee countered with its own advertisement, which said, "After years of denying people coverage and jacking up prices, the insurance industry is scared that change is coming."

US pharmaceutical companies added sting to the opposition when they warned that the health reform plan could force them to cut spending on research into drug development. Drug company executives object to monitoring of the prices of new drugs, the requirement to offer larger rebates to Medicare and the overall spending on health care expenditure. This would "increase the corporate tax burden by billions of dollars a year, taking money from new drug research projects", said Ray Egan, senior vice-president of Bristol-Meyers Squibb. The firms claim that market pressure for lower health care costs had already led to a sharp fall in drug price inflation and this should be allowed to continue unhindered by regulation.