Even if President Barack Obama's drive to reform the US health care system can answer every challenge that has been raised, many Americans probably will still oppose a major overhaul of how they receive and pay for medical care. Special interest groups -the health insurance industry in particular - are fighting changes they believe will damage the business.
Many Americans, their fears voiced by representatives in Congress, worry that fundamental changes will cost too much, and will raise an already staggering public debt in troubled economic times.
Some doctors and their patients oppose changes that they believe will give government bureaucrats a say in how physicians treat those who are ill.
But at root, opposition to changing the system may truly lie with Americans' nearly primal distrust of government, especially when it involves anything so personal as decisions about personal health. Many Americans are convinced that reforms will only put the country on what they feel is the slippery slope toward "socialized" medicine, and that's political dynamite. And it appears that a large percentage of Americans, most of whom have health insurance through their workplace, are comfortable with that system and are wary of any tinkering.
Reforming the health care system was a top Obama domestic policy promise as he ran for president, and, after ramming through emergency measures to rescue the recession-stricken economy, the new administration moved quickly to tackle reforming a system that amounts to 20 percent of American spending.
The president has staked a major portion of the massive political capital he brought to the White House on health care reform. Some Republicans are intent on blocking the big changes he seeks, banking on a defeat to mar Obama's still robust popularity with Americans. Failing to deliver on health care, opponents contend, may boost the chances of the Republicans in Congressional elections next year. Obama contends the system as it exists will bankrupt the country in the future, as the price of health care continues to far outpace the rate of inflation and wage increases for consumers. That argument, polls showed as little as three months ago, was broadly supported by Americans, who approved of Obama's handling of the health care issue by a margin of about 57 percent to 29 percent who disapproved. As of the end of last month, the approval rating had fallen below 50 percent with those who disapprove approaching 40 percent.
The president, obviously remembering former President Bill Clinton's failure to reform the system 16 years ago, decided to put forward the broad outlines acceptable to him but to leave the nuts and bolts work of writing the legislation to Congress, where his Democrats now hold sizable majorities.
Many observers blamed Clinton's failure on his having sent Congress a finished piece of proposed legislation that shut senators and representatives out of the process. The former president's wife, now-Secretary of State Hillary Rodham Clinton, played a major role in what was seen as a secretive White House process that went down in flames when it reached Congress, even though the legislature was controlled by the Democrats then as well.
Obama, however, is now faulted by some for taking a too hands-off approach, of doing too little to define and sell the specifics of the reforms he wants.
Broadly, the president has insisted that the cost of reforms not add to the trillion-dollar plus national debt. He also has pushed for establishing a government-sponsored insurance program that would provide affordable health coverage to the nation's estimated 50 million uninsured. A possible side benefit, as the administration sees it, would be an alternative health care source for those who now have insurance but find the government plan more affordable. That competition, Obama argues, would force insurance companies to lower rates.
One area that seems to have found majority backing is the administration's insistence that insurance companies no longer will be able to deny coverage to those who have so-called "pre-existing conditions." Beyond that, Obama is supported in his insistence that health insurers no longer be allowed to rescind their coverage of customers who fall seriously ill.
Republicans and some conservative Democrats in Congress, largely based on political and ideological motives, appear ready to vote against a thorough overhaul of the system that would include a government plan. Obama has been unsuccessful, so far, in convincing the public that they would benefit.
Thus, Obama's initial deadline of having health care legislation on his desk before the August congressional recess has slid now into September at the earliest, leaving the president with a major job of reinvigorating the initial support for his overhaul plan. And some in his administration are now suggesting reform may require a tax increase to insure it does not further inflate the budget deficit. Americans have a deep aversion to handing money to their government for most everything except the national highway system and defense. Raising taxes to pay for what many fear will lead to government-managed health care will be a supreme test of Obama's energy and communications skills.
The irony, of course, is that vast numbers of Americans - despite heavy objections when the reforms were proposed - now feel comfortable with and depend on some decades-old major government plans, such Medicaid and Medicare, which provide health care coverage for the elderly, disabled and impoverished, and Social Security, which amounts to a government pension plan.