MELISSA BLOCK, host:

From NPR News, this is All Things Considered. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel. Nearly seven in 10 voters last Tuesday said they worry about the cost of health care - that, according to exit polls. And that's one of the problems President-elect Obama will inherit. Health-care costs continue to rise much faster than other costs, and 46 million Americans have no health insurance at all.

BLOCK: Presidents since Franklin Roosevelt have launched major efforts to overhaul the health-care system, and all of them have failed. As Barack Obama begins his transition to the presidency, we are reporting on the challenges he faces in our series "Memo to the President." NPR's Julie Rovner has our story on health care.

JULIE ROVNER: According to most exit polls, voters' concerns about the economy dwarfed all other issues. But Bob Blendon of the Harvard School of Public Health says voters who cited health care as their top issue flocked to now President-elect Obama in huge proportions. And that means health care is an issue he can't afford to put on the backburner.

Dr. BOB BLENDON (Professor of Health Policy and Political Analysis, Harvard School of Public Health): Sixty percent of his voters expect that if he became president, something big would be done about this problem. That is the really big number here. It is something his voters expect him to do something big about.

ROVNER: On the other hand, while the public is relatively united in that it wants something done, voters have very different ideas about what that something should be. Sheryl Peterson(ph) of Garvin, Minnesota, has a pretty good idea of what she wants from health-insurance reform.

Ms. SHERYL PETERSON: I guess I want it to be more affordable than it is now. I buy my own health insurance, and it's enormous, you know. And it just covers the basics. It doesn't cover much of anything.

ROVNER: Others, like Joe Ford(ph) of Sioux Falls, South Dakota, know what they don't want.

Mr. JOE FORD: They probably shouldn't mandate health care, I guess. I don't think there should be nationwide health care. They should just do it, kind of, how it is now. Improve it in some ways, but not mandate it.

ROVNER: So, obstacle one is a public that's divided between wanting more and less government involvement in health care. Obstacle two is the difficulty of fighting the status quo in a health system that's made a lot of people a lot of money. Tennessee Democratic Congressman Jim Cooper knows all about that. He's a veteran of the last unsuccessful effort to reshape the nation's health-care system in the 1990s.

Representative JIM COOPER (Democrat, Tennessee): I think the new president has to make health care a top priority because if you make it any less than that, they simply won't have the political capital to bust through the $2 trillion of vested interests that are there. I've never had anyone come by my office saying, Congressman, I'm wasting taxpayer money, and stop me from doing this.

ROVNER: Luckily for President-elect Obama, a lot of bipartisan groundwork is already being laid in Congress on health care, even by members who didn't suffer through the previous debacle. Rhode Island Democratic Senator Sheldon Whitehouse says he'd like to see Congress focus on fixing the nuts and bolts of the way health care is actually delivered, things like computerizing medical records and changing the way doctors and hospitals are paid. He says not only do changes like that enjoy bipartisan support, they are the kind of things that will need a long lead time to provide a payoff. That will coincide nicely with the time 78 million baby boomers will start to really put financial stress on the Medicare program.

Senator SHELDON WHITEHOUSE (Democrat, Rhode Island): The kind of reforms that can make the system more efficient, provide better care, save money and humanize the system will take, my guess, 10 to 15 years to really implement and claim the savings. And my view is that that wolf is going to be at our door about 10 to 15 years from now. So everything tells me that the start date for getting this done, if we're going to do it the humane way, is right now.

ROVNER: But then there's the biggest obstacle of all: how to pay for health reform. With the economy still in the tank, independent health policy analyst Jeff Goldsmith says even if there was consensus on how to fix health care, it would still be awfully hard for the next Congress and the new Obama administration to do much to improve the health-care system.

Mr. JEFF GOLDSMITH (Independent Health Policy Analyst): It's really a tremendous challenge for anybody that wants to increase coverage to do it in the kind of economic and fiscal climate we're in right now. I mean, the time to enfranchise people and to promise help with purchasing health insurance is at the top of an economic cycle. That's absolutely not where we are now.

ROVNER: Still, the public will be expecting some action on health care. The challenge is going to be to figure out what form that will take. Julie Rovner, NPR News, Washington.

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