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What Now, Mr President?

Hilary Andersson on the inequalities of the US healthcare system and the challenge reforming it poses for Barack Obama

It has been called the inbox from Hell - the to-do list which awaits President-elect Barack Obama when he takes office on Tuesday morning.

After his inauguration Mr Obama will inherit all of America's problems - a collapsed economy, soaring unemployment, troops engaged in Iraq and Afghanistan, and a country so unequal that despite being the richest in the world an estimated 23,000 people die every year because they cannot afford basic healthcare.

Barack Obama
Mr Obama has vowed to cut the average family's annual health bill by $2,500

Despite these enormous challenges both Mr Obama and his legions of supporters believe that he can bring about the change he promised in his election campaign to make America a fairer place.

But can Mr Obama really close the gap between rich and poor when to do so he will have to take on the might of corporate America? And how does the current economic crisis affect what his course of action?

In What Now, Mr President? Panorama examines those questions and takes a closer look at the road ahead - a road which Mr Obama himself has warned will be "long" and "steep".

As the programme reports, the country that Mr Obama is promising to reform has in recent years become increasingly polarised, divided between an exploding class called the super-rich and another class - the new poor.

Turning up en masse

Nowhere is that yawning gap more evident than in the healthcare system.

Some 45m Americans have no health insurance and millions more are under-insured.

Though there are schemes to help those who cannot pay - Medicare and Medicaid - millions are being failed by the system.

US hospital
The US spends about 15% of its GDP on healthcare

Panorama shows just how badly they are being failed when it travels to rural Kentucky to visit a temporary free clinic which has been set up in a football stadium by a medical charity.

Remote Area Medical (RAM) started work providing medical care to people in hard to reach parts of the developing world, but now 60% of its effort is devoted to helping America's poor.

In a scene which you would not expect to see in the world's richest country, hundreds of people, suffering from everything from toothache to cancer, turnout in sub-zero temperatures to see the volunteer doctors, optometrists and dentists on hand inside the stadium.

Lobby power

Those seeking treatment include Jessica, a young mother, who told the doctors that she had had three types of cancer and can hardly see out of one eye.

Jessica is sufficiently poor to qualify for assistance but despite her vision problems she says she has not had a pair of glasses for the past six years because the scheme does not cover their cost.

If Mr Obama has his way scenes like those at the stadium will be a thing of the past.

In his election campaign Mr Obama promised that one of his key priorities as president would be reform of the US healthcare system.

He has pledged to cut the average family's annual health bill by $2,500.

Inside a Remote Area Medical free US clinic

He is promising mandatory healthcare coverage for all children, and financial assistance for people who cannot afford health insurance and for small businesses to help meet the costs of giving their employees cover.

But as Panorama reports, if Mr Obama's ambitious plans are to succeed he will have to take on the might of powerful drug and insurance companies, companies which wield enormous influence in Washington.

The programme takes a look at the murky business of lobbying in which political contributions are traded for political favour.

One Washington insider Richard Kirsch describes it as "a system of legalised bribery", but the lobbyists say they are exercising their legitimate right to petition their government.

Panorama also looks at the wider economic crisis in America, which is raising questions about whether the US can even afford radical healthcare reform.

With the economic crisis biting, ten million Americans are expected to this year join the thirty seven million Americans already below the poverty line.

Some say the scale of the crisis presents an opportunity for drastic change. Others advocate caution in a time of turbulence.

Panorama: What Now, Mr President? Monday 19 January at 8.30pm on BBC One

Medical charity helping US poor
Thursday, 29 May 2008, 00:19 GMT |  Americas

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