Can Obama reform America's health-care system?

I was a guest recently on a CBC Radio show from Montreal and one of the callers asked: With so many people losing their jobs and their health-care plans, wouldn't this be the right time for the U.S. government to introduce universal health care?

"You'd think so," I replied. "But the opposition will be ferocious."

I remember well the first Bill Clinton campaign in 1991. I was with NBC News at the time and travelled almost non-stop with the Arkansas governor. In fact, I still grab for my travel bag when I hear his Fleetwood Mac theme song, Don't Stop Thinking About Tomorrow.

That song serenaded Clinton when he arrived at a venue and served as the signal for the press corps to get back on the bus when it was time to leave.

On that campaign, Clinton's main message was universal health care and the audiences lapped it up in towns big and small, morning and night. The health issue and the economy won the election against an incumbent, the first President Bush, George. H.

Health care was also the first big challenge the White House took on after the election and, yes, the Clintons bungled it.

Hillary Clinton was given the leadership role and she refused to bring legislators on Capitol Hill into the negotiations early enough to give them some real political ownership of the cause.

But the real knockout blows were delivered by the private health-care industry, the medical profession and the drug manufacturers. They bombarded the country with a misleading campaign about costs, efficiencies and the existing level of care, which they described as the best in the world.

What's best?

All these claims were made despite the fact that 37 million people in the U.S. had no health insurance at all at that time.

The emergency wards were also being overrun by people seeking fairly standard treatment because they had nowhere else to go, while those who had insurance were paying ever-increasing premiums for ever-shrinking care. But so brutal was their political defeat that the Clintons never went near the health-care issue again in the remaining seven years of his presidency.

As for Democrat Barack Obama succeeding where the Clintons failed, I'm not an optimist and that's what I told the Montreal caller.

The very next day in Chicago, the president-elect introduced his proposed new health and human services secretary, the former Democratic Senate majority leader, Tom Daschle.

Daschle is no pussycat and Obama said the health-care fight will be joined and that health care is a key ingredient of economic recovery.

"Year after year, our leaders offer up detailed health-care plans with great fanfare and promise, only to see them fail, derailed by Washington politics and influence peddling," Obama said, adding, "the runaway cost of health care is punishing families and businesses across our country."

By the numbers

Obama's aides rapidly handed out releases to reporters about the state of the health economy. Among them:

• Polls show four out of five Americans are dissatisfied with health costs.
• Health-care premiums have risen at four times the rate of inflation in the past decade alone.

Jacob S, Hacker, an authority on health care at the University of California at Berkeley, told the New York Times, "Most Americans are troubled by the lack of universal insurance, but what really frightens them is the prospect that their own insurance won't protect their health or family finances.

"That's a fear that more and more Americans are facing as health costs skyrocket and job security plummets."

Adding to their campaign, Obama's team is circulating a Georgetown University report that says 4.1 million people lost their employer-sponsored health insurance over the last year and that two million of them have been unable to come up with a replacement program.

The cascading impact of this, the report says, is that states are facing unsustainable increases for public insurance programs and are cutting benefits, eligibility levels and provider payments simply to balance their budgets (which many must do by law).

Health insurance is also being portrayed as a drag on struggling U.S. manufacturers, like automakers where employee health plans are said to add $1,500 to the cost of each vehicle, more expensive than the cost of steel.

An opportunity

There is no question that Obama believes there is an opportunity to sell health-care reform to the public as a necessity to bring about economic recovery.

When president, one of his first tasks will be to sign off on a $50-billion program to help states with their health budget struggles.

He is clearly hoping that effort will gain support for the next step: the establishment of a Federal Health Board, which would "reduce or deny payment for new drugs and procedures that aren't as effective as current ones." (Obama argues the FHB "holds great promise" for "giving this nation the health care it deserves.")

A third expected proposal being studied is the creation of a separate government-run health insurance program that would compete with the private sector. Both Obama and Daschle favour such an effort and it has strong Democratic support in Congress.

The presidential push will come early in the administration and may well be spelled out in more detail in the inaugural address on Jan. 20.

As Canadians, we will inevitably be drawn into the debate.

Supporters will say Canadians live longer than Americans and that Canada's infant mortality rate is lower. The American media will search for Canadian doctors now living in the U.S. and making more money, and for Canadians who can't get their hip replacements as quickly as they do in Seattle.

The political fight may not be pleasant for Canadians living in the United States. Like most of them, I want the Canadian system improved but not replaced and, after living here for many years, there is no doubt in my mind Canadians are better served.

But going back to my Montreal caller and his question, I would refer him to Jonathon B. Oberlander, who teaches health politics at the University of North Carolina.

I agree with what he told the media here, that the pressures of a recession have raised the possibility of health-care reform here from nil to possible.

The question, he said, is whether Obama and Daschle can harness that new urgency and marginalize the opposition that will inevitably come. "The history of health reform is replete with instances of reformers believing this time it is inevitable," Oberlander said. "Those prior tipping points all turned out to be mirages."

That's certainly what I saw in the Clinton White House. This time won't be easy either.