As far back as the fall, skeptics were warning that Barack Obama would have to abandon his hope of overhauling American health care. There was no money to fund such a transformation, they said, and no time to pursue it, given the other crises. But Obama never agreed, vowing to make health care a top priority. He's now done exactly that.

The budget outline that Obama just delivered to Congress calls for setting aside $634 billion over ten years in order to subsidize insurance coverage for people struggling to get it on their own. No less important, Obama sketched out the basic principles by which a universal health insurance system must eventually operate--promising things like choice of doctor, protection against financial catastrophe, lower cost growth, and improved patient safety. Obama even set a timetable for his plan: "[L]et there be no doubt," he said. "Health care reform cannot wait, it must not wait, and it will not wait another year."

Whether you measure in terms of dollars or scope, Obama's health care gambit is the most sweeping domestic policy proposal a sitting president has put forth since 1993, when Bill Clinton introduced his own vision of health reform. But the comparison to Clinton's plan is also a reminder of the many things Obama hasn't done or said just yet. Like Obama, Clinton introduced his vision for health care reform during a joint address to Congress. But Clinton did it during a speech devoted to the subject; Obama tucked his message into a budget speech, giving it just a fraction of the time. Clinton gave a detailed framework of his proposal, prefacing the delivery of a 1,300-page bill--a rather more specific blueprint than Obama's reform principles memo, which runs not even a full five pages. And Clinton put forward funding mechanisms that would pay for his entire plan, down to the last dollar. Obama promises that "universality" is his goal, without specifying whether that means making sure everybody has insurance or simply making sure everybody can afford it. In this instance Clinton did no such parsing: If Congress did not deliver him a bill that covered every single American, he vowed, he would veto it--waving a pen in the air in a famously dramatic flair.

Alas, the dramatics would come back to haunt Clinton. His effort to pass a plan failed, dragging down the Democratic congressional majority with it. Nobody knows this better than Obama and his advisers--more than a few of whom were around for that debacle and who, at every turn, have sought to avoid the political mistakes that befell that ill-fated effort. The failure to provide many programmatic details and to fund the entire cost of universal coverage is a bit unnerving, yes. But there are good reasons to think this reflects sound strategic calculation rather than substantive timidity.

Let's start with the holes in Obama's plan. It says nothing about what type of insurance should be available, only that everybody should have a choice of quality plans. Nor does his outline of principles specify that employers must contribute to the cost of insurance, either by providing employees with coverage or paying into a fund that will defray the costs of subsidies and an expanded Medicaid program.

Why not specify these things now, to prod the debate? As tempting as a "hundred days" strategy for health care might have seemed, its prospects for success would have been limited; remember, this is a Congress that took an extra month debating a recovery bill Obama originally wanted on his desk right after his inauguration. This more tentative approach, meanwhile, offers distinct advantages. It deprives opponents of easy targets: The public insurance option, for example, is anathema to many special interests, so why endorse it explicitly--and turn at least some of those groups outwardly hostile- -any sooner than necessary? Going slow also gives Obama more opportunities to educate the public--to get the voters comfortable with the basic tenets of his agenda.

None of which is to say that advocates for reform should shy away from voicing concerns--or agitating for more. Obama's refusal to draw lines in the sand may be politically necessary--but it also leaves open the option of abandoning this crusade if it gets tough politically. As the stimulus debate showed, Congress cannot be counted upon to exceed Obama's ambition; and Obama's own ambitions, though considerable, are not always adequate to the occasion. By clamoring loudly and stubbornly for universal health coverage to be enacted now rather than in two or four or ten years, activists for health care reform can broaden the boundaries of political debate. That will ultimately make universal coverage far more likely. By pushing Obama to live up to his own rhetoric, these people will be doing him--and the entire country--a great favor.

By The Editors