The controversial crusade to reform US health care, which is at the heart of president Obama's credibility, moves to Congress today.  Providing a new more equitable health system in which all Americans will be covered is one of the president's most important campaign promises.

However, the more he does to try and convince Americans of the need to reform the system, the more his support seems to dwindle.

 By Reinout van Wagtendonk

President Obama promised that a law would be passed guaranteeing medical insurance for every citizen by the end of the year. The health care system is the most controversial issue his administration faces, with front-page coverage in nearly every newspaper and television reports on the pros and cons of the reforms.
 
This has not escaped the notice of Crown Prince Willem-Alexander. On Tuesday, Willem-Alexander and Princess Máxima were received on the aircraft carrier Intrepid by New York Mayor Michael Bloomberg and US Secretary of State Hillary Clinton for the celebrations surrounding the 400th anniversary of the Hudson expedition, which led to the founding of New York. Of course the reception on an aircraft carrier entailed a good deal of stair-climbing, which gave the Dutch crown prince an excuse to make an allusion to health care:

 'This morning exercise is good for health care,' he said.

 The loudest laugh in response to the joke came from Hillary Clinton. In 1993 she was responsible for drafting proposals for the (newly inaugurated) Bill Clinton to make the American health-care system more efficient and to make medical insurance available to everyone. It turned into a political fiasco. President Obama is all too aware of the painful history surrounding the proposals. As president, he hopes to avoid falling into the same pitfall of presenting a detailed plan to Congress and attempting to push it through. He will instead meet with all parties concerned, including politicians and the health care sector – insurance companies, doctors, patients – and negotiate with them until an agreement is reached that has broad support.

 
I see reform where we bring stability and security to folks who have insurance today. Where you never again have to worry about going without coverage. If you lose your job, when you change your job, when you get sick....
 

Notorious

Obama made the above statement several days ago in Ohio in preparation for tonight’s address to Congress. He emphasises stability and security for Americans who now have health coverage, but could lose it if they become unemployed or seriously ill. US insurance companies are notorious for dumping clients as quickly as possible when they become seriously ill

 
The fact that Obama is addressing people who are already insured is new. Previously he would speak about the moral commitment of ensuring that everyone had health insurance, especially the more than 45 million uninsured. He also used the argument that health costs are so high that they threaten economic recovery and welfare. However, opinion polls show that he is losing when it comes to these arguments. This summer the conservative opposition succeeded in giving people the impression that Obama favours a Socialist type of health system, which many Americans oppose a priori.
 

'I don't want this country turning into Russia, turning into a socialised country.'
 
Faltering prestige

Obama must gain the approval of the majority of US citizens who are already insured. Opinion polls show that he is losing support among this sector of the population. Giving a speech to both Houses of Congress - in a manner similar to a State of the Union address - is seen as heavy artillery for a president.

 It is too early to say that now is an ‘all or nothing’ moment. However, Bill Clinton attempted to save his reform plans in 1993 with the same weapon. It was a great loss, which led to a dramatic loss in his prestige.