WASHINGTON President-elect Barack Obama has promised broad changes to U.S. health care, pledging to bring health insurance to millions of Americans and to spend $50 billion to take American health records electronic, but he must struggle to find the money to do it.
Polls show more than 80 percent of Americans want health care reform. But even with a Democratic-controlled Congress, Obama, who won a solid victory in Tuesday's U.S. election and takes power in January, has hard work ahead of him, health experts agree.
"This isn't the classic crisis that lets someone show his greatness," said Brookings Institution Senior Fellow Henry Aaron.
Aaron noted that Congress will be wary of spending money on anything, having just given a $700 billion stimulus package to the financial industry and struggling with a $455 billion budget deficit.
"It is a bunch of messy problems that really are political minefields," Aaron said in a telephone interview.
Voters put health care reform as their third biggest concern, after the economy and the war in Iraq. Some 47 million people in the United States do not have health insurance.
Obama wants to create a National Health Insurance Exchange to help individuals and small businesses buy private insurance.
He promised to require health care for all children, and expand Medicaid, the government-run health program for the poor, and the State Children's Health Insurance Program or SCHIP.
"I do think that health reform will be a major priority in the new administration," Commonwealth Fund president Karen Davis said in a telephone interview.
"It's something that he personally feels needs to be addressed," added Davis, whose private foundation advocates better U.S. health care.
"It's a campaign that has set up the conditions for action on health reform. It would be very hard for him to run for re-election in four years not having acted on that commitment."
Although not all congressional races have been finally decided, Democrats do not appear to have a filibuster-proof 60-seat majority in the Senate and in any case, some new members of Congress will be keenly aware that they do not have strongly Democratic bases.
"Some of those newly elected members will be from marginal districts and consequently they are going to have to be very careful," Aaron said. He noted that money would be very tight with a widely predicted recession cutting into revenues.
RECESSION AND ALLIGATORS
But Senate Majority Leader Harry Reid predicted the momentum for change would be there. "We have no alternative," Reid told National Public Radio on Wednesday morning. "A wave of hope has swept the country."
Reid said Republicans would not dare to block legislation, given Tuesday's voter mandate.
Former U.S. surgeon general Dr. Richard Carmona said he did not see much trouble ahead for health care legislation. "We feel that it is truly a bipartisan agenda," he said.
The work may have to be done one bit at a time, however, experts agreed. "If the health care reform issue is White House driven, my guess is it is going to be piecemeal, step by step," Aaron said.
"But it could be led from the Senate because Senator (Edward) Kennedy is reliably reported to be working on developing a major bill. He will have a lot of support," Aaron added.
The Massachusetts Democrat will have backing not only because of his seniority but because such legislation is likely to be the "last major action from one of the more highly regarded and respected members of the U.S. Senate."
Kennedy, 76, was diagnosed with a brain tumor in May.
SCHIP might offer a first opportunity for Obama to take a bite at health care, Davis and Aaron agreed.
"Congress passed a very extensive expansion of the program this year -- twice it was vetoed by President (George W.) Bush," Davis said. "That is going to be the first health policy debate," he said. SCHIP must be reauthorized in March 2009.
(Editing by David Storey)