That Barack Obama is one optimistic guy.
Despite all the conventional wisdom indicating that he wouldnt stand a chance, the junior senator from Illinois entered the presidential race nearly two years ago and defeated some of the biggest names in politics to win the White House.
What really stunned some of us from Chicago was his scheduling of a post-election outdoor rally near the Lake Michigan shore in November. Talk about the audacity of hope. But in a year in which most every obstacle collapsed before Obama, even the unpredictable Windy City weather turned warm and mild for the favorite-son candidate.
The president-elect is going to need all the pluck and luck that served him during the campaign as he confronts the massive problems of a nation in need of repair. Rescuing the economy, saving the environment and managing wars in Iraq and Afghanistan would present challenges enough for 10 chief executives. Obama will need the wisdom and skills of 10 more presidents to tackle healthcare reform.
Thats because about that many presidents in the past 100 years have tried to overhaul U.S. medical care. The notion of universal healthcare and national insurance was first proposed by Theodore Roosevelt when he ran on the Bull Moose ticket. Since then, presidents have attempted to secure universal or near-universal coverage for Americans with limited success or none at all.
During the campaign, Obama offered a healthcare reform plan that would create a hybrid of a government-run system with a market-based order. It bears some similarity to the Massachusetts overhaul. The plan is weighted toward the goal of decreasing the number of uninsured by closing gaps in the current system. For example, children would be required to have health insurance; that would be aided by expansion of the State Childrens Health Insurance Program and Medicaid. Employers who dont provide insurance would have to contribute to the cost of covering the uninsured. Some businesses or people who dont have coverage at work could turn to a federally run insurance pool. Obamas national health-insurance exchange would set coverage standards for participating insurers.
Among the potential problems is the requirement that any insurer in the exchange must not deny coverage to anyone because of illness or pre-existing conditions. This will not be well-received by most U.S. companies, which traditionally have been able to cherry-pick the best risks in the individual coverage market.
And then there are costs. While Obama estimated his proposal would cost $50 billion to $65 billion a year, the Massachusetts experience suggests it might cost considerably more. Obama hoped to raise federal revenue by taxing incomes of those making more than $250,000 a year and reducing spending on the Iraq war. The Washington-based Tax Policy Center has estimated the price tag at $1.6 trillion over 10 years. Obama, like many of his fellow candidates, envisioned big savings stemming from more information technology and preventive care. While the expansion of IT might boost computer companies revenue, its doubtful that efficiencies from automation or better care management will compensate for all the extra costs.
So the new president has a lot of persuading to do. He will have to convince a financially ailing and tax-averse nation that it should make a big cash commitment to redoing the healthcare system. He will have to overcome the warring and well-funded interest groups that shot down the Clinton plan as well as ideologues wedded to dogmatic solutions.
History says that no American president can accomplish this. Then again, we have to remember that Obama has been busy making history.