President Obama faces a pile of troubles with the top four being Health Care, Afghanistan, Climate Change, and the Economy. A misstep in handling any of these would in all likelihood end the political honeymoon he and the Democrat controlled Congress have enjoyed since their resounding success in last year’s election. And the Dems are concerned. In an almost unprecedented interference in local politics, President Obama has directly appealed to Governor Paterson of New York to not run for reexlection next year, even though Paterson could arguably be considered the second highest ranking African-American office holder. The Dems fear that Paterson will lose big time and take down some of their Congressmen in the process.

I have written on all four major problems over these many months and will now summarize and make recommendations for each one in my next few blogs.

The battle for major health care reform has left dead bodies all over the field. The spit and baling wire bill emerging from the Senate has detractors within the Democratic Party itself, as well as the expected opposition from Republicans. My Senator, Bill Nelson, a Democrat is battling to add an amendment that would answer the complaints of his constituents, including me, but would at the same time smartly reduce the savings in Medicare that Obama expects to pay for most of his new plan. If Nelson succeeds, the president will have no option but to raise taxes to pay for his plan.

I believe the mistake made was to focus on insurance, rather than the cost of health care. Obama began by seeking to end runaway costs in health care, a point on which all will agree. However, rather than attack the costs directly, he sought to control them by controlling the insurers who pay the bills. This indirect route is difficult and complex and threatens to simply make the matter more complicated, rather than lower costs.

I have suggested that the government extend Medicaid to those who are not currently insured. Medicaid now covers some 50 million Americans. Of the 45 million Americans who do not now have health insurance, about 4 million already qualify for Medicaid, so the first thing to do would be to sign them up. About 11 million uninsured are illegal immigrants and Obama has already said the new plan would not cover them. That leaves about 30 million more Americans to add to Medicaid rolls. For the current year Medicaid will spend $400 billion to provide coverage for the 50 million of which the Feds pay a little over half and the states the rest. Assuming the costs for the added 34 million would be the same, extending Medicaid to them would cost the Feds another $135 billion. Part of this could be covered by charging higher income recipients, i.e. incomes above the poverty level, fees for being in Medicaid. Since Medicaid is dispensed mainly through HMOs, the fees could be kept low enough to make it an attractive option.

Those who do not wish to join a low cost Medicaid HMO could continue to cover their health care needs through the various health plans now in operation. What would probably develop would be two basic options, a low cost government provided HMO, or a higher cost private insurance plan.

Whatever the administration does, it has to work quickly to get some real results, or health care will come back to haunt the Dems in next year’s election.