Listening to President Obama speak this morning, I was struck by the tone of his inaugural address, more somber and subdued than the rhetorical tour de force many had expected. In fact, his speech was in keeping with the serious tone he adopted in Chicago, the evening he won the election. His over-arching theme was individual and collective responsibility, "the price and promise of citizenship," as he put it. And he emphasized both the need to make tough choices and to resist the impulse to serve narrow interests. This has implications for healthcare, an issue he numbered among the great challenges facing the United States, along with two wars and the economic crisis. For the central problems in our healthcare system—47 million uninsured, inconsistent quality, runaway spending—reflect failures of responsibility and lack of political will to make hard choices. As much as any issue, foreign or domestic, coming to grips with healthcare will test Obama's leadership and whether he can break with the past or merely reframe old problems in a new administration. Ultimately his success in governing may depend on his ability to inspire the levels of idealism that served him so well in his campaign for the presidency.
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