The Problem and the Question

Seven times in the last century presidents have attempted to guide the United States legislature to adopt some form of comprehensive health care reform. 

Seven times they have failed. 

At the Iowa Caucus in 2008, President Barack Obama promised by the end of his first term he would deliver exactly that—comprehensive health care reform. The obstacles he faces are not easy to understand, let alone negotiate.             

Navigating the health care issue in the United States is perilous on the best days. Powerful special interest lobbies dominate almost every facet of the health care system, from insurance companies and doctors to pharmaceutical conglomerates and medical device manufacturers. 

A powerful social stigma that labels universal health care as “socialism” doesn’t help either—a problem that arose in the early ‘50s and is now considered as American as muscle cars and fast food. Even America's consumer culture where more and new is better stands in his way. 

The president has pointed to rare economic circumstances, a unified Congress and a health care system that is not simply broken but falling apart at the seams as strong indicators that he can deliver on his promise. 

But it is not solely in his hands. Rather, how he responds to a collection of barriers entrenched in American politics and society will determine his political fate and the future of health care reform in the United States.