With unemployment soaring, the need grows daily for guaranteed health care. But that may not happen in the coming year because of the desperate need to revive the economy and put people to work.

It is true that President-elect Barack Obama is assembling a team well equipped for the difficult political and policy battle over health care reform. It will take more than political smarts, however, to keep health care a top priority in the administration and steer it through a Congress buffeted by so many pressing issues and special interests.

His designated secretary of health and human services, former Sen. Tom Daschle, knows the politics and understands policy. He is, after all, the author of the book “Critical: What Can Be Done About the Health Care Crisis.”

Obama has named a top expert on health care as head of the Office of Management and Budget, the agency that shapes the president’s budget and tries to make sure the huge federal bureaucracy follows his priorities. He is Peter R. Orszag, most recently director of the Congressional Budget Office.

But before his appointment, Orszag warned that the recession may overwhelm or at least delay health care reform. Writing in his informative and readable Budget Office blog on Oct. 13, he said: “Many observers have noted that addressing the problems in financial markets and the risks to the economy may displace health care reform on the policy agenda—and that may well be the case for some period of time. (As a small example, I know that over the past few months I have been spending less time on health care because the turmoil in financial markets and associated issues have consumed much more of our time and attention at CBO.)”

Since the fall, the recession has worsened, the downward slide continuing despite Obama’s election and the Bush administration’s scattershot effort to stop it.

Last week’s news that 533,000 American jobs were lost in November was accompanied by predictions that the recession will continue through much of next year. The November figure brought the job loss since September to almost 1.3 million. “There are no quick or easy fixes to this crisis, which has been many years in the making, and it’s likely to get worse before it gets better,” Obama said Saturday.

Obama also announced that he will offer a program to create at least 2.5 million jobs. Workers would replace old heating systems and take other steps to make federal buildings around the nation energy-efficient. An army of construction workers would build and repair roads and bridges and modernize old school buildings. The many thousands of laid-off information technology workers, installers and other technicians dumped by communications companies would create networks linking libraries, schools and hospitals to the Internet and bringing high-speed Web service to areas now without it.

I saw the difficulties in implementing the plan last Friday when I visited Los Angeles City Hall and talked to Deputy Mayor Jaime de la Vega and Richard Katz, transportation advisers to Mayor Antonio Villaraigosa. The two men, examples of the local officials who would actually execute such programs, told me that plans are ready for many of these kinds of projects around Southern California. But Congress must approve the projects without pork-barreling. Then plans must wind their way through city halls, county buildings and state capitals. Contracts must be proposed in accordance with many rules, environmental impact reports must be approved, workers hired. And all of this done in the face of entrenched state and local bureaucrats whose first reaction to any new proposal is “Just say no.”

Obviously aware of this tendency, Obama warned officials to “use it or lose it.” That means the work will have to be put on a fast track with bureaucratic practices put aside. But even with everyone cooperating, the sheer magnitude of the task threatens to drain all the energy from health care reform.

That can’t be allowed to happen. Think of the 1.3 million who have lost their jobs since September. And that number doesn’t include the discouraged who have given up on job hunting.

Some who had health insurance at work are eligible for COBRA benefits for 18 months, if their employer hasn’t gone out of business or filed for Chapter 11. If they’re lucky, the newly unemployed, with COBRA, pay the full cost of coverage plus 2 percent for administrative costs. And this is after they have lost their income. Many of these unemployed must also make house payments or pay rent, feed and clothe the kids, keep the electricity on and the car running and take care of all the other necessities. When their COBRA policies expire, they’re left to the cruel reality of the private insurance marketplace.

The number of uncovered and minimally covered people will increase. Their ranks will include those who were refused insurance because of pre-existing conditions and the many who cannot afford individual policies. In addition, there are the poor being deprived of care because of state and federal cutbacks in Medicaid and State Children’s Health Insurance.

Obama’s plan would make sure everyone was eligible for a private or a public plan, with various provisions to encourage or force employers to chip in. It is, in effect, Medicare for all.

Democratic Sen. Max Baucus of Montana, chairman of the Senate Finance Committee, has a plan that resembles Obama’s. That’s a huge plus for health care reform, since his committee must approve the plan. In the House, Democrat Henry Waxman, the new chairman of the Energy and Commerce Committee, is a strong medical care reform supporter.

The fight to pass such legislation will take all their combined policy smarts and political clout. Lobbyists will try to shape or kill proposals. Health professionals, health service companies, pharmaceutical concerns and other health-related enterprises were major contributors to House Energy Committee and Commerce Committee members. Health and insurance companies were big donors to members of the Senate Finance Committee, according to the Center for Responsive Politics. Obama will also need Republican support.

Despite all this, the Obama team must enact universal health insurance and do it in 2009. The need for everyone to have access to health care is too urgent to be delayed.

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