Can Obama overhaul health care?

WASHINGTON -- Now for the hard part.

Even if the national credit card is maxed out and partisanship remains the rule for Washington's political tribes, President Barack Obama and Congress are plunging ahead with a health care overhaul.

In the week ahead, Obama will start the dialogue on how to increase coverage, restrain costs and improve quality.

Whether a bill can get through Congress and to Obama this year is uncertain. For half a century, the track record on health care has been one of missed opportunities, spectacular failures and hard-won incremental gains.

Obama plans to stress the need for major changes in his address to Congress on Tuesday, administration officials say. He quickly will follow up with a budget that includes a commitment to expand coverage for the uninsured. A White House summit on health care is being planned in coming weeks.

"They don't intend to blink. They intend to plow ahead," said health economist Len Nichols of the nonpartisan New America Foundation. "Health reform is seen as essential to balancing the federal budget and economic recovery in the long run."

People in the U.S. spend $2.4 trillion a year on health care, or about $7,900 per person. That's more than twice as much per capita as in other advanced countries. But few would claim those dollars are buying good value. The costs are a staggering burden for taxpayers, employers and families, and the recession is leaving more people without insurance.

Yet even a self-described optimist such as Sen. Mike Enzi, R-Wyo., says he has doubts about prospects for overhauling health care. "It needs to be done up front and quickly," said Enzi, the senior Republican on the Senate Health, Education, Labor and Pensions Committee. "I'm not so sure that we haven't already lost that, with so many other things coming in and weighing us down."

In the 1990s, President Bill Clinton took the better part of a year to deliver a 1,300-page health care bill to Congress and later waved his veto pen at lawmakers who might have given him half a loaf. He got nothing. Obama has shown a tendency to be more pragmatic.