Australians have probably been hearing that the U.S, with a new, dynamic President and a strong majority for his party in Congress, is about to enact major healthcare reform that will finally, like the rest of the industrialized world, guarantee care for all.

Unfortunately, when all the ink is dry, our new system will probably look a lot like the old one, with yet another historic opportunity for real change missed.

Certainly there’s good reason for fundamental change, for both U.S residents and those affected by U.S policies across the world.

Not only is our healthcare system an international embarrassment, the World Health Organization ranks the U.S as just 54th in healthcare “fairness” behind Bangladesh, and just barely ahead of Rwanda.

It also, through its inefficiencies, inequities, and waste, contributes mightily to the staggering condition of the U.S economy, thus aggravating the worldwide recession.

But though a bill will surely be signed, the basic, dysfunctional framework of a system dominated by profit-making private insurance companies will likely remain firmly in place.

One reason is the uniquely American system of the suffocating influence of the corporate healthcare industry in Washington, and the revolving door between Congress and the lobbyists’ offices.

In the first quarter of this year, as the reform plan was being formulated, 20 of the largest health insurance, drug companies and their trade groups spent nearly $35 million in lobbying. Meanwhile, those same corporate interests have hired more than 350 former government staffers and retired members of Congress to help them protect their considerable clout.

As a result, the final plan is expected to include such elements as a mandate forcing everyone who is uninsured to buy private health insurance and public subsidies for low income individuals who can’t afford the high cost, subsidies that amount to a bailout for an insurance industry whose 18 biggest companies made over $44 billion in profits the last three years.

The insurance giants will be expected to make some concessions for all that public cash, including a requirement that for the first time they will agree to sell policies to people who have been sick in the past, or are likely candidates because of age or past history to get sick in the future.

Imagine that. Sick people are presently unable to even buy private insurance, just because insurance companies don’t think they can make enough money from them.

That reflects everything that is wrong with our present system. As Geri Jenkins, RN, co-president of the nation’s largest nurses’ union, the California Nurses Association/National Nurses Organizing Committee, said in recent testimony to Congress, the U.S. has the distinction of being “the only nation on earth that barters human life for money.”

What has been ruled off the table is a genuine national system, as exists in most other countries with our wealth and resources, where people are not denied medical care because they can’t afford it, or have to choose between buying food for their family or going to the doctor.

Our new President Barack Obama said a few years ago that he was a proponent of a national system similar to what exists in Australia and many other nations.

Now he worries it would be too disruptive to our present system which is rapidly unravelling anyway. Some 45 million Americans have no health coverage, 20,000 of them die every year as a result, medical bills account for 62 percent of personal bankruptcies, and half of Americans skip routine medical visits because of the high out of pocket costs.

And, the private insurers who hold the reins of our system divert one-third of every dollar for profits, executive compensation, and paperwork, mostly spent on finding excuses for denying medical care they don’t want to pay for.

While a number of liberal groups in the U.S have given up the fight for broader change, nurses, who most directly experience what it does to patients, have not.

Ties are strong with nurses and healthcare activists in Australia and other countries, and American nurses understand the benefits and advantages of those systems. It’s an effort we know we dare not lose.

Rose Ann DeMoro is executive director of the 86,000 member National Nurses Organizing Committee/California Nurses Association, and a national vice-president of the AFL-CIO.