Healthcare overhaul would be risky for a President Obama

WASHINGTON - The news last week that Democratic senators, led by an ailing but determined Ted Kennedy, are already laying the groundwork for a major revamping of the national health system may or may not be welcome news to Barack Obama.

On the one hand, the move clearly indicates that the senators are expecting an Obama victory, with their party controlling Congress. And Obama, whose Senate aides have participated in Kennedy's planning sessions, has promised to provide universal coverage by the end of his first term.

But on the other hand, the presumptive Democratic nominee knows that the last time the Democrats controlled the White House and Congress, in 1993-94, the party's agenda got so bogged down in healthcare that it not only failed to deliver on some other promises, it suffered an epic defeat in the midterm elections.

Nonetheless, opportunities to reshape the nation's health system pop up only once every two decades or so. The Democrats sense that the combination of skyrocketing costs, insufficient coverage, and a growing realization that healthcare obligations are making American companies less competitive may be enough to erase traditional fears of a government-sponsored overhaul.

Or maybe not.

The choice for a President Obama, like Clinton in 1993, would be whether to gamble his agenda - and much of his credibility - by pressing immediately for a transformation of healthcare. He could just as easily hold off a bit, realizing it will be a tough fight, and focus on more deliverable priorities for his first few months.

Kennedy, who has made universal healthcare the focus of his 45-year Senate career, believes it is crucial for the party to move quickly to capitalize on the momentum of a new administration, and he may be right: The conventional wisdom is that new administrations should do their toughest work first.

But not everyone accepts that wisdom. Thomas Mann of the liberal-leaning Brookings Institution suggested in the Los Angeles Times that Obama might consider "racking up a series of midlevel accomplishments to set the stage for more ambitious projects later in his term."

And there is at least one domestic priority that's arguably more pressing than healthcare: energy. With motorists shocked by the surge in gas prices and a long, cold winter ahead, the time is ripe for an energy policy focused on conservation and investment in alternative fuels.

Obama, it so happens, has a sweeping plan to do just that. He has long bragged about telling off a group of auto industry executives ("When I am president, there will be no more excuses"), and has stressed the need to double fuel-efficiency standards within 18 years. He also wants to shovel $150 billion over 10 years into biofuels, institute a "cap and trade" program to provide incentives for industries to reduce carbon emissions, and double government spending on energy research and development.

It's a tall order, but some states, including most recently Massachusetts, have capitalized on the immediate concerns about energy costs to institute ambitious plans of their own; in this political climate, there has been little blowback for even the more costly or intrusive measures.

Obama could bring about historic changes in energy policy more easily than he could revolutionize healthcare. But the energy fight, while eminently winnable, would probably draw some attention to the potential costs of Obama's programs, and what increased spending would do to the federal deficit, which could end up weakening Democratic spines for the costly debate over healthcare.

It's not clear where Obama's heart is. Early in the primary season, he regularly invoked the failure to provide universal coverage as a symbol of what's wrong with the political system, of how special interests and spineless politicians combine to thwart even the highest priorities of the American people.

The reality is more complicated. Most Americans are pleased with their health coverage, even as they acknowledge the flaws in the national system. Every previous attempt to revamp healthcare has begun with a political consensus that change is necessary and ended with a political consensus that change is too risky.

Lately, Obama has spoken movingly of the fight for universal healthcare as a long march, almost like the civil rights movement, with many fathers and mothers. When the dream is realized, he says, many marchers, including Kennedy and the Clintons, will share in the credit. But it may yet be a struggle, and Obama, if elected, will have to decide how much he's willing to risk.

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