President Barack Obama made it a central point of his campaign, Americans of all hues want it yet how to provide an affordable health care system has divided the nation down the middle.

With nearly 46 million Americans having no insurance, and 25 million more underinsured, more and more people cannot afford good medical care as many employers too have stopped offering insurance to employees because of the high cost.

In 2007, the United States spent a total of $2.4 trillion - or $7,900 per person - on health care or 52 percent more per person than the next most costly nation, Norway, according to the Kaiser Family Foundation.

Thus there's little debate that health care reform is necessary. President Obama, Republican and Democratic members of Congress, the American Medical Association and America's Health Insurance Plans, which represents the insurance industry, all have agreed the system needs to be changed, although they disagree on how to do it.

A central point of Obama's plan is to create a government-sponsored health insurance program that would be an option for all Americans, similar to how Medicare is now an option for Americans over age 65. He has also said he'd "like to see" prohibitions against insurers discriminating against people with pre-existing conditions, and incentives for people to use preventive services and wellness plans.

Obama has said he's already identified "hundreds of billions of dollars" worth of savings in the federal budget that could help finance health care reform, such as rooting out waste, fraud and abuse in Medicare and Medicaid. He's also proposed reducing tax deductions for high-income Americans.

But Republicans don't like the idea of having a government-sponsored health insurance program for all Americans. They fear employers would opt for the government-run insurance over private insurance because the government option would most likely be less expensive, but Republicans say it would also be of lower quality.

Another impediment to implementing any reform that does not benefit insurance companies or the private health care industry is the power of insurance company and health care industry lobbyists in the United States.

However, with the important power players - doctors, insurance companies, pharmaceutical manufacturers - apparently on board this time unlike in 1993 when then first lady Hillary Clinton tried her hand at changing the medical system, there is a good chance of doing it.

The Democrat chairman of the Senate Finance Committee, Max Baucus, introduced his long-awaited plan to remake the health care system and insure millions of Americans last week. Yet despite tailoring his proposal to be less costly and less intrusive, he did not win support from a single Republican.
The bill closely resembles what Obama said he wanted, except that it does not include a new government insurance plan to compete with private insurers.

Baucus's bill is the least expensive of five major health care bills moving through Congress. The Congressional Budget Office said the expansion of coverage would cost $774 billion over 10 years, compared with price tags of more than $1 trillion for the other measures.

As they scoured the 223-page document, many of the most influential players found elements to dislike, but the prospect of gaining 30 million new customers may yet win the day for Obama, analysts suggested.

(Arun Kumar can be contacted at arun.kumar@ians.in)