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Obama has said he wants energy and environmental legislation to be his and Congress second order of business, but Daschle reportedly is pushing for health reform to take priority. So is Kennedy, who is suffering from incurable brain cancer and wants universal health insurance to be his legacy.
Democratic leaders all favor maintaining the current employer-based health insurance system, and the likelihood is that a plan passed next year will require that every American have coverage a device designed to bring down the average cost of a policy.
The idea of mandatory coverage, which Obama resisted during the campaign, has been endorsed by Americas Health Insurance Plans, the insurance lobby that fought and defeated the 1994 Clinton health reform plan.
AHIP has agreed if everyone is covered to Democratic proposals barring insurance companies from refusing coverage based on a patients medical history and requiring that all people in a geographic area are charged the same premium.
Despite those concessions, Democrats still plan to offer a government-run competitive plan like Medicare. AHIP complains that, because Medicare underpays doctors, they shift costs to privately insured patients, driving up premiums.
If that continues and the costs of the public plan are low enough, people could flood out of private insurance, eventually leaving the government as Americas dominant health insurer.
If thats bad news, the good news is that at long last action is likely to come on a bevy of health reforms that have been delayed despite broad bipartisan support.
They include investments in health information technology, greater emphasis on disease prevention, steps to pay doctors for keeping people healthy instead of just treating ailments and better management of chronic diseases.
These are eventual cost-savers but will require investment and time to take effect. An idea of Daschles creation of a National Health Board to evaluate best practices and diminish waste is another eventual cost-saver.
Some studies indicate that between a third and half of all health outlays in the U.S. are unnecessary or ineffective. Daschles board is designed to reduce that cost, but it may be accused of rationing care.
And theres one final problem: If 50 million or more people have health insurance, the nation needs more primary care doctors and nurses. The government is going to have to offer aid to reduce the $140,000 average debt incurred by medical school graduates.
Its all going to cost a lot of money, but it will be worth it if no one lacks for insurance and if Democrats can correct the anomaly that the United States pays more per capita than any other country on health care, but ranks 48th in the world in life expectancy.