WASHINGTON (AFP) — The United States is the only rich industrial nation with no universal health care -- and whoever wins the race for the White House, it's likely to stay that way, health policy experts say.
Hillary Clinton's bold but failed attempt during her husband's presidency to guarantee health care for every American is history, leaving Barack Obama and John McCain to propose little more than tweaking the current system.
"I don't think either plan will fix what's wrong with health care in the United States," said John Sheils, vice president of the Lewin Group consultancy and an expert on analyzing health care proposals.
"The biggest problem is that we don't really face the cost of health care. The doctor prescribes something, we say, 'OK, let's get it,' and neither of the people in the room is paying for it," Sheils told AFP.
"As a consequence, people overuse healthcare services that are not providing any benefit and are wasting money."
That is, if they are insured. Some 45.7 million Americans have no health insurance at all, according to the US Census Bureau, a number sure to grow as the economy flags and workers lose jobs that include health benefits.
That is slightly down from 47 million in 2006, a figure still used by the Obama and McCain campaigns.
Obama's regulation-oriented proposals would oblige insurers to provide cover to everyone -- even if they already sick -- and compel employers without their own staff health schemes to pay into a national health care plan.
"We're going to make sure that insurance companies can't discriminate on basis of pre-existing conditions," said the Democratic contender during the campaign's final televised debate on Wednesday.
McCain would not make health cover mandatory, but it would replace a tax break on employer-sponsored health plans with a tax credit -- 2,500 dollars for individuals, 5,000 dollars for families -- enabling working Americans to shop around for cover.
"It is the cost, the escalating cost of health care that are inflicting such pain on working families and people across this country," the Republican hopeful, who is a robust 72, said at the debate.
"I am convinced we need to do a lot of things," he said, adding that he wants to see more gym classes and better food in schools to confront an "alarming" rise in obesity among young Americans.
Either way, big money is at stake.
The United States this year is spending an estimated 16.3 percent of GDP on health care, a figure that it 10 years should grow to 19.5 percent, or 4.3 trillion dollars, according to Department of Health figures.
Limiting the wiggle room for real change for the incoming administration is the ballooning federal deficit, which tripled in fiscal 2007-2008 to a record 455 billion dollars.
In the main, most working Americans depend on health insurance that is typically 75 percent paid for by their employers -- fine, so long as they suddenly do not find themselves jobless, as many will in the economic downtown.
Those over 65 depend on Medicare, a government-funded scheme that covers most, but not all medical costs. Medicaid is there for 55 million poorer Americans, but eligibility and coverage varies wildly from state to state.
"The 50-somethings are really in trouble," said Frank Settipani, a oncologist in working-class Pueblo, Colorado who, as a matter of principle, opens his clinic to all -- whether they can pay or not.
"You're walking a tightrope. You're hoping you stay healthy enough to get to 65 when all the doors (to Medicare) open, sort of."
Giving an example of how health care in America is skewed, Settipani told AFP about spanking new hospitals in Colorado Springs, Colorado offering hot tubs and lobster meals to well-to-do patients.
Those who cannot afford such top-grade attention, he said, "just end up in ER" -- the emergency room -- and hope they will not be turned away.
"People without insurance access the health care system less regularly," said Diane Rowland, executive vice president of the Kaiser Familly Foundation, a health policy research institute.
"They get diagnosed later, often sicker, and end up dying earlier than they should," she told AFP, citing estimates that 20,000 people die every year for lack of care because they are uninsured.
With the cost of insuring a family of four exceeding 12,000 dollars a year, according to Kaiser research, and premiums due to rise 5.9 percent, some large employers are styling their own response to the health crisis.
They are rewarding staff with cash and other incentives to get check-ups and work out -- not only to have healthier workers, but also to bring down premiums, the Washington Post reported this week.
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