Barack Obama ran his campaign promising to implement progressive programs and govern with progressive values. One of these programs is an ambitious health care reform package which promises to expand insurance coverage to hundreds of thousands of families and individuals. This admirable goal will be very difficult to achieve. But it is worth the fight.

Bill Clinton made health care reform one of the priorities of his first term. This plan was largely overshadowed by a number of scandals including sexual digressions and strategic mistakes in the President's first two years. The reforms were also spearheaded by Ira Magaziner, who was largely responsible for their failure. Grasping the political opportunity, Republicans were determined to kill the health care proposal, claiming that it was an overly bureaucratic and inefficient government-run solution to a problem that concerned a small minority of the population. Clinton spent much of his political capital on a health care plan and lived with the consequences when the Republicans took control of the House and Senate in 1994. Timeline

Obama will face similar hurdles when it comes to passing his ambitious health care plan. On Thursday, Robert Dallek argued that President-elect Obama should follow President Lyndon Johnson's example passing the Voting Rights Act in 1965: "Johnson in a sense sold civil rights to the country as a program of national well being. And that's what I think needs to be done now with national health care."

See the video, courtesy of Think Progress:


This is the kind of leadership we need right now on many issues, the most important being health care. The fact is that the majority of the country already has health care insurance. So that population could abandon this priority in favor of other (also necessary) economic recovery programs. In that case, the President needs to step in and fight for universal health care, even if it is not the most popular option. Lyndon Johnson lost the South for the Democrats because of the Civil Rights Act and the Voting Rights Act. But there is no doubt that he took the right stances on important issues. And our country is better off for it. President-elect Obama has the chance to provide similarly effective leadership on health care.

This reminds me of a 2006 Malcolm Gladwell article published in the New Yorker. It discusses an experimental program in Denver, CO dealing with the city's homelessness problem. The article points out that Denver spends an alarming portion of the budget on health care and shelter services for its homeless and mentally ill population. Since hospitals are required to help all patients, regardless of their insurance status, "the kind of money it would take to solve the homeless problem could well be less than the kind of money it took to ignore it."

The experimental program targeted the chronically homeless who had a history of injury and costly medical bills picked up by the state. The study found that

Clearly there are problems with this model. It favors only a small portion of the city's homeless and mentally ill population when everyone needs help. And where do you draw the line? Why do some homeless people deserve help and not others?

But the program best serves as a symbol for the benefits of creative governance. In general terms, liberals can support the program because it provides services to an at-risk population, and conservatives can support it because it saved the city a fortune in medical and shelter funds.

So when Obama begins crafting a strategy for health care reform, he should think outside the box. As Dallek suggests, he should not shy away from a fight and he should provide real leadership to pass a health care program that could save the federal government a bundle in the long run and provide health care services to hundreds of thousands of families and individuals who need it the most.

It looks like Obama's newly-announced Health and Human Services Secretary Tom Daschle welcomes the fight and has already embraced a creative approach to the health care problem. Let's hope that desire remains and the Obama Administration makes some serious progress on health care early on.