Obama Wins U.S. Presidential Race, Faces ‘Hard Choices’ on Enacting His Campaign Promises, Including Health Care

Sen. Barack Obama (D-Ill.) on Tuesday in the presidential election defeated Sen. John McCain (R-Ariz.), CNN.com reports. As of Wednesday morning, Obama has 338 electoral votes and McCain has 163 with results in Indiana, Missouri and North Carolina still undetermined. Obama has received 62 million votes, or 52% of the popular vote, compared with 55 million votes, or 47%, for McCain (CNN.com, 11/5).

According to nationwide exit polls conducted by Edison Media Research and Mitofsky International, 63% of voters said the economy was the most important election issue, followed by 10% who cited the war in Iraq and 9% each who cited health care and terrorism (CNN.com, 11/5). About two-thirds of voters said that they had concerns about their ability to afford health care, exit polls found (Davis, Wall Street Journal, 11/5). A majority of voters who said that they had concerns about their ability to afford health care supported Obama, according to exit polls (Calmes/Thee, New York Times, 11/5).

Obama Priorities
According to the Wall Street Journal, with increased Democratic majorities in the Senate and House, Obama likely will "start fast, with a large economic stimulus package, legislation to fund embryonic stem cell research and an expansion" of SCHIP funded with an increase in the federal tobacco tax (Weisman/Meckler, Wall Street Journal, 11/5).

The Washington Post reports that Obama faces "hard choices" in "interpreting his mandate" and "transforming his campaign promises on taxes, health care, energy and education into a set of legislative priorities for his first two years in office" (Balz, Washington Post, 11/5).

Obama likely will prioritize his health care proposal, although he might "try to take smaller bites" rather than seek to pass a comprehensive plan, the Los Angeles Times reports. According to the Times, health care is a "prime candidate" to be "downsized or delayed." Former Sen. Tom Daschle (D-S.D.), an Obama adviser, said last summer that the passage of health care reform legislation might be easier "if we take it a piece at a time." House Democratic Caucus Chair Rahm Emanuel (Ill.), also an Obama adviser, said that, although health care remains an important priority, he'd be satisfied to pass a "down payment" on Obama's proposal in his first term (McManus, Los Angeles Times, 11/5).

Possible Problems
"History says that presidents typically get one big promise fulfilled during their honeymoon periods, and since Obama is expected to push an economic relief package, it's unlikely that health care revisions would move down a parallel track that fast," as "he's likely to find that comprehensive change is too costly, too complicated and too dependent on a delicate consensus," McClatchy/Miami Herald reports (Lightman, McClatchy/Miami Herald, 11/5).

According to Bloomberg, analysts maintain that fiscal and "political realities," such as the recently enacted $700 billion bailout of Wall Street firms, also might "foil Obama's ambitions" on health care (Marcus, Bloomberg, 11/5). The Obama health care proposal would cost an estimated $1.6 trillion over 10 years, according to the Tax Policy Center (Drinkard, AP/Houston Chronicle, 11/4).

Editorials, Opinion Pieces
Summaries of two editorials and two opinion pieces that addressed health care issues in the presidential election appear below.

• New York Times: Obama during his campaign "offered a government that does not try to solve every problem but will do those things beyond the power of individual citizens," such as seek to "ensure that the sick have access to health care," a Times editorial states. According to the editorial, among the many "urgent problems" that Obama must address, tens of millions of U.S. residents lack health insurance, "including some of the country's most vulnerable citizens -- children of the working poor." In addition, many residents "can barely pay for their insurance or are in danger of losing it along with their jobs," the editorial states, adding, "They must be protected" (New York Times, 11/5).
  
  
• Orlando Sentinel: Obama "needs to set the right tone for his presidency by calling on the best-qualified experts, regardless of party," to address health care and other issues, a Sentinel editorial states. According to the editorial, "Obama has an expensive but promising plan to expand health coverage by strengthening the employer-based system," but "he would be wise to consult with people on all sides of the issue to avoid a rerun of President Clinton's disastrous effort to reform health care." The editorial adds, "There are other steps Mr. Obama could promote that are likely to find broad support in both parties: encouraging healthier lifestyles and better preventive care, computerizing more health records and providing consumers more information about doctors and hospitals." In addition, Obama "should also insist on using the federal government's bargaining power when buying drugs for Medicare," the editorial states. He "also needs to get started with lawmakers from both parties on a plan to slow spending growth in Medicare" and other programs "that are gradually but relentlessly crowding out other federal spending," according to the editorial (Orlando Sentinel, 11/5).
  
  
• Richard Cowart, Tennessean: "High on the list of priority targets" of the next Congress "will be the Medicare prescription drug benefit and Medicare Advantage plans," Cowart, a former president of the American Health Lawyers Association and current chair of the health law department at Baker, Donelson, Bearman, Caldwell & Berkowitz, writes in a Tennessean opinion piece. According to Cowart, the "Medicare prescription drug benefit was adopted in 2006 with the support of both parties and the president" but included a provision opposed by Democrats that prohibited the "federal government from utilizing its purchasing power to negotiate directly with pharmaceutical companies over drug prices." He writes, "Expect this prohibition to be revisited in the new Congress." SCHIP, "stem cell research and health information technology" also appear to "be low-lying fruit" for the next Congress, and also "on the list of important subjects will be addressing the physician payment issue," according to Cowart. However, expect "universal coverage to be a big stretch," Cowart writes (Cowart, Tennessean, 11/5).
  
  
• Ruth Marcus, Washington Post: Obama early in his first term must "produce some evidence that he can produce the change that he promised," some of which "can be accomplished by grabbing the low-hanging fruit," such as "reversing President Bush's order prohibiting federal funding of embryonic stem cell research" and "signing the Bush-vetoed expansion" of SCHIP, Post columnist Marcus writes. "There will be a lot of clamoring for marshmallows," but "Obama's ability to resist, and to dispense available goodies in an orderly fashion, will be key to the success of his presidency," Marcus concludes (Marcus, Washington Post, 11/5).