Focus of debate 

Currently, the health care debate in the United States focuses on two issues: whether to provide a public option for health insurance and how to control costs.

If the two issues remain unsolved, it is hard for "Obamacare" to move forward.

Some analysts pointed out an important factor blocking expansion of health care coverage in the United States is that the premiums are too high and grow too fast.

The big private insurance companies often dictate the terms and left a large number of consumers defenseless.

To solve this problem, Obama and his allies in the Congress came up with an idea to establish a government-run insurance institution known as the public option, to compete with private insurers, on the assumptions that the premiums can thus be reduced and more people can afford insurance.

Seeing the danger of shrinking profit margins, big insurers and their powerful lobby groups launched a fierce counterattack on the idea.

Doctors' associations allied with them.

Republicans seized the opportunity to paint the proposal as "a plot for big government" and stirred up nationwide protests.

Under pressure, the Obama administration softened its position on the issue, saying Monday that the "public option" is not an "essential part" of the reform. However, liberal Democrats vowed not to give in to Republican pressure.

The second and more important issue of the debate is cost control.

The congressional budget office has estimated that the Obamacare may cost one trillion dollars over next decade, arousing fears among the public who have already been worried about the country's rising deficits.

However, Obama and his allies in Congress haven't charted a clear course on how to offset the mammoth costs of the reform.

Obama once said he plans to finance the reform with savings from administrative costs, and by reducing Medicare funds and raising taxes on the wealthy class.

But analysts said that using savings to cover the huge costs of reform is unrealistic while reducing Medicare funds and raising taxes will bring more political risks.

In all three different versions of Obamacare legislation drafted by five congressional committees, there are no concrete limits on budget or spending control.

Taboos for reform 

Political analyst David Paul Kuhn pointed out that the obstacles facing Obamacare are not only the ones that are on the surface, they also go deeply down to the nation's unique political rules and traditional public mindset.

For every politician who aimed to overhaul the US health care system over the decades, he or she would probably confront two sets of taboos.

One is the political donation system in which every politician can't survive without it and the health industry happens to be a key player.

In an economic sense, most of the health costs become the incomes of the health industry.

In other words, the health industry controls 16 percent of the US economy and thus is a key source for political donation.

It is obvious that Obama and lawmakers are trying their best not to raise the ire of the health industry.

However, if the health industry doesn't make important concessions, there is no way that health care costs can be effectively controlled.

Secondly, multiple polls find that although the majority of Americans support a major structural change of the health care system, they don't welcome Obama's plan.

An explanation is that most Americans, who usually have health insurance coverage, think the Obamacare won't improve their own lives although it may help those uninsured.

"Americans generally only support the policy that support themselves," said Kuhn.

That mentality partly explains why Obamacare is now becoming less popular.

Analyst Oberlander predicts that with a strong Democratic majority in Congress, Obama still has good chances to enact his health care reform plan within this year.

However, it won't be an even path before he gets to that point and more importantly, he may miss some of his original goals.

Theodore Marmor, a scholar at Yale University, said once the final plan is enacted, the number of the insured will be gradually reduced, but it's still less convincing that Obama can do it without increasing costs and deficits.

(Xinhua News Agency August 19, 2009)