Even with mandate, Obama still faces health care pain

President-elect Barack Obama has promised great changes to U.S. health care, promising to bring health insurance to millions of Americans and to spend $50 billion to take American health records electronic, but he must struggle to find the money to do it.

Polls show more than 80 percent of Americans want health care reform. But even with a Democratic-controlled Congress, Obama, who won a solid victory in Tuesday's U.S. election and takes power in January, has hard work in front of him, health experts agree.

"This isn't the classic crisis that lets someone show his greatness," said Brookings Institution Senior Fellow Henry Aaron.

Aaron noted that Congress will be cautious of spending money on anything, having just given a $700 billion stimulus package to the financial industry and struggling with a $455 billion budget deficit.” It is a bunch of messy problems that really are political minefields," Aaron said in a telephone interview.

Health care, one of biggest concern

Voters placed health care reform as their third biggest concern, after the economy and the war in Iraq. Some 47 million people in the United States do not have health insurance.

Obama wants to create a National Health Insurance Exchange to help individuals and small businesses buy private insurance. He pledged to require health care for all children, and expand Medicaid, the government-run health program for the poor, and the State Children's Health Insurance Program or SCHIP.

"I do think that health reform will be a major priority in the new administration," Commonwealth Fund president Karen Davis said in a telephone interview.” It’s something that he personally feels needs to be addressed," added Davis, whose private foundation advocates better U.S. health care."It's a campaign that has set up the conditions for action on health reform. It would be very hard for him to run for re-election in four years not having acted on that commitment."

Although not all congressional races have been finally decided, Democrats do not appear to have a 60-seat majority in the Senate and in any case, some new members of Congress will be aware that they do not have strongly Democratic bases.

"Some of those newly elected members will be from marginal districts and consequently they are going to have to be very careful," Aaron said. He noted that money would be very tight with a widely predicted recession cutting into revenues.