WASHINGTON -- Now for the hard part.
Even if the national credit card is maxed out and partisanship remains the rule for Washington's political tribes, President Barack Obama and Congress are plunging ahead with a health care overhaul.
In the week ahead, Obama will start the dialogue on how to increase coverage, restrain costs and improve quality.
Whether a bill can get through Congress and to Obama this year is uncertain. For half a century, the track record on health care has been one of missed opportunities, spectacular failures and hard-won incremental gains.
In his address to Congress on Tuesday, Obama plans to stress the need for major changes, administration officials say. He will follow up with a budget that includes a commitment to expand coverage for the uninsured. A White House summit on health care is being planned in coming weeks.
People in the U.S. spend $2.4 trillion a year on health care, or about $7,900 per person. That's more than twice as much per capita as in other developed countries. The costs are a burden for taxpayers, employers and families, and the recession is leaving more people without insurance.
In the 1990s, President Bill Clinton took the better part of a year to deliver a 1,300-page health care bill to Congress and later waved his veto pen at lawmakers who might have given him half a loaf. He got nothing. Obama has shown a tendency to be more pragmatic.
As he moves forward, Obama will follow the plan laid out in his campaign.
It calls for government, employers, families and individuals to keep sharing financial responsibility for health care. The approach would overhaul the health insurance market, particularly for self-employed people and small businesses. It would set up a national insurance purchasing "exchange" through which people would be guaranteed access to private health insurance or the choice of a new public plan.
Obama sees coverage for all as a goal to be reached in steps. His plan would not require every individual to purchase insurance. The estimated cost is about $90 billion a year, to start with.
The plan might sound simple in a brief summary, but it's not. Potential dealbreakers lurk at every turn.
Many liberals can't get excited about doing battle for just a promise -- not an immediate guarantee -- of coverage for all.
Conservatives and insurance companies fear that a public plan offered to workers and their families could become the gateway for Canada-style government health care.
Employers, hospitals, doctors, and drug companies worry that the government's already pervasive influence in health care will become stifling.
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