A National Health Care Debate

Still, the political reality of reshaping the complex medical system is certain to intervene as the broad discussion about the need for reform gives way to the details. Those may well conflict with the priorities of a host of stakeholders, including patients, doctors, labor unions, drug companies, businesses and employers, insurers and lawmakers up for re-election next year.

There is also a fault line between Democrats and Republicans over the role of government in the health care system -- and that could complicate Obama's push to ensure health care for everyone.

Signaling likely areas of contention ahead, Senate Republican leader Mitch McConnell of Kentucky told Obama in a letter that his party was ready to work with the administration on health care but he also warned that the GOP would bristle at changes that lead to a government-run system and coverage expansions that don't come with curbs on costs.

In office just six weeks, Obama already has made one big move on health care. He proposed a budget that has a $634 billion "down payment" for expanded coverage over a 10-year period. The government will spend trillions on health care over the same period.

Broadly, Obama is seeking to use his popularity as a new president and the public's high level of frustration with medical costs to generate momentum for universal coverage.

In hindsight, both supporters and opponents agree that Clinton made a series of missteps and miscalculations that doomed his plan from the outset.