President Obama's health care plan is thoughtful and would be a great improvement over the current system. And, as I explain here, it's more politically viable than Clinton-care in the 1990s and several other reform attempts in the past. So far, Obama has made the right moves, inviting everybody to the table and reaching out to all stakeholders.
But now comes the hard, but inevitable part: taking on the insurance companies. The medical-industrial complex won't tolerate any reforms that seek to reduce cost, make health care more affordable or hold caregivers accountable -- it just isn't profitable for them. Their lobbies, like the Health Insurance Association of America (HIAA), are extraordinarily resourceful, well-funded and well-organized. They'll fight these reforms with every fiber of their being, as they always have.
This will be a challenge for Obama, because his game is cooperation and not confrontation; he promised to bring everybody together to find solutions. But on this issue, cooperation with the big boys in the insurance industry isn't an option if Obama wants to fix health care. He's done his part in reaching out; now he going to have to get serious and fend off the imminent onslaught if he wants to secure a legacy on this issue. For more on this, read Paul Krugman's recent column.
The big part of his plan, which the medical establishment opposes, is the alternative public option -- which is by far the most important component. Without that, the Obama plan hardly qualifies as a rearrangement of the deck chairs on the Titanic.
The New York Times recently ran a story pointing out that Obama intends to assert himself more in the upcoming debate. And he's doing so -- he mentioned it in his recent weekly address, and it's been all over the news lately. Without him, the establishment will steamroll over Democrats (they already have Republicans in the bag) and let the rotten system prevail and the expense of the populace.
An important and under-discussed reason Obama why must succeed on health care is because it's one of very few jars that he, upon promising drastic change, has put all his marbles in. He's already buckled to the right on issues like same-sex marriage, gun control, legalizing marijuana and wiretapping. Health care is possibly the most urgent domestic issue, so failure here will have a huge impact. It'll sink his popularity and create more distrust toward Democrats, undermining everything progressives wanted in the Obama era.