With the return of Sen. Red Kennedy to the Hill today, we are reminded that healthcare reform will be not only a prominent issue, but also it could be the biggest challenge that President Obama will face. Here are some of the pitfalls, and possibilities for healthcare reform.

“I am very hopeful that this will be a prime item on the agenda. Barack has indicated that this will be a prime issue, and I believe that it will be. There are some major issues, obviously with the economy, and also environmental issues, but the president elect has indicated that this is going to be a priority and I certainly hope it will. We’ve got a good team. They have been working over the period of the late summer into the fall, and they’ve been doing a lot of good work, and I think we’ve got a good start on it,” Kennedy said.

The big news is that Sen. Kennedy said that Obama has stated that he wants to sign a healthcare reform bill by early next year. If this is the case, then Congress will need to have a bill ready by summer at the latest. The minefield of healthcare reform derailed the Clinton presidency early in his first term, so the question Obama faces is how can deliver on his promise of healthcare reform, while breaking the congressional gridlock on this issue.

The biggest change working in Obama’s favor is that the national attitude on healthcare since the Clinton administration. Americans are still greatly divided on how to improve the system, but almost everyone agrees that the system doesn’t work as well as it should. On the campaign trail, Obama made an interesting choice. Instead of advocating for a single payer universal system, he correctly, at least in my view, assessed the problem as being one of access not care.

The Obama plan doesn’t want to touch the system of medical care in our country. It wants to get more people into the system so that they can get care. The fact that Obama isn’t pitching government run healthcare, should melt away some of the conservative opposition. The issue of a mandate is going to be the stumbling block in any bill. Republicans are opposed to a mandate, and Democrats are divided on the issue. Obama opposes a mandate. However, I don’t see those who favor a mandate blocking a bill that doesn’t contain one. The problems will come if congressional Democrats try to ram through legislation that contains a mandate.

I still believe that we are going to see a series of smaller bills passed before we get to the big reform. Prescription drug costs, SCHIP expansion, and a bill allow consumers to buy their medications in Canada will all likely pass. I think that a healthcare reform bill could pass muster will Republicans and conservative Democrats if it sticks to the market model and offers some tax cuts. President Clinton’s healthcare reform failed because he overreached. Obama is an astute observer of history, so I doubt that he will repeat the mistakes of the 1990s.