There is a great deal at stake in the upcoming battle over health care reform, in some respects more than we might think. Reforming our cumbersome and costly health care system and finding a way to ensure that all Americans have adequate health care has been a major goal of progressives for decades. If a good health care bill gets passed millions of Americans will see almost immediate and tangible improvements in their lives. The US will no longer stand out among advanced industrial countries for its failure to meet this basic need.

This, however, is only one reason why health care reform is so important. The outcome of the struggle for health care may not only determine future health care policy, but the success of the Obama presidency more generally. It will either breathe life into the movement that elected Obama in 2008 or be a devastating and discouraging blow to that movement.

Obama's presidency, after the first five months, is at an important moment. The initial adrenaline and excitement, while still present in some quarters, has begun to wear off in others. There are some concrete accomplishments, most notably the passage of the stimulus bill, the closing of Guantanamo and the passage of the Lilly Ledbetter Act, to which supporters of Obama can point. There is also, however, an undercurrent of frustration in progressive circles regarding President Obama that is increasingly difficult to ignore. Obama's confounding failure to aggressively fight for gay rights and to push back against the finance industry remains puzzling, while some of his foreign policy decisions reflect the complexity and difficulty of the challenges facing any president. All of this has raised the political need for a decisive progressive victory.

Health care is the natural place for this to occur. A victory on health care would reinvigorate the progressive movement that elected Obama, and secure the president's place as one of America's great presidents. Failure on health care would have an equally negative effect on President Obama as well as the progressive movement.

Obama's campaign, and indeed his presidency, has been premised on the notion of change. Critics have argued that the word "change" has never been defined sufficiently by Obama either as candidate or president, thus making it something of an empty slogan. Obama's supporters, on the other hand, have always understood what was meant by this promise of change. It refers not just to changing the policies away from those of the failed Bush administration, but also changing the way we do government and politics, not just in Washington, but in the country more broadly.

This is why a defeat on health care would have such a big impact. The forces lining up against health care reform including the insurance companies, the AMA, right-wing ideologues and other conservative interest groups are an almost perfect symbolic collection of the past against which Obama's message of change has been positioned. If the president, and all of us who support health care reform, triumph over these forces of reaction it will be a critical victory for the future over the past. If, however, due to the lobbying, ad campaigns and scare tactics, of the opposition, health care reform fails, it will be very hard to argue that there has been any meaningful change, of any kind, at the core of politics in America. A defeat of health care will be a strong argument that nothing has changed and we are back to the nasty partisan and inefficient politics which has characterized our system for at least the last two decades. It should be remembered that the defeat of health care in 1993 was the beginning of the end for any progressive hopes that had been placed in the Clinton presidency.

Obama's campaign involved many people in politics for the first time. Some were young people experiencing their first presidential election, others were older people who had been angry and disillusioned with politics in the US. It is not at all difficult to imagine some of these people who were brought into politics by the excitement and hope for change generated by the Obama campaign and the early days of his presidency, walking away from politics again if the health care reform battle ends in defeat.

Passage of meaningful health care reform will be the most important piece of domestic legislation in a generation and the most important piece of progressive legislation in two generations. It will all but guarantee Obama reelection and generate more supporters for progressive change. If, however, opponents of health care reform prevail, they will have scored the first major victory for conservative forces since before 2006. It will then be possible to argue that the energy has run out of the progressive Obama movement and that conservatives are coming back.

Lincoln Mitchell