The most critical issue in America’s recent general elections was health care. Time and again, Barack Obama pointed to the 46 million Americans who have no health insurance and promised that if elected he would get them covered. I think that promise was the main reason he is now President.

But he may not be able to keep his promise. In the convoluted American system of government, elections do not end discussion of campaign issues; they merely begin a new debate. To keep his promise of health care reform, President Obama must win agreement from both houses of Congress. The support he needs is assured in the House, where Democrats have an overwhelming majority. Even if health care reform meets resistance from Blue Dog Democrats (who usually try to block any legislation opposed by the special interests that fund their election campaigns), the President is likely to get what he wants from the House.

It’s in the Senate that the battle will be won or lost. And it really is a battle. But because health care reform is so popular among the electorate, it is being attacked by guile and subterfuge rather than by open resistance.

You may find it difficult to figure out what’s happening. The debate has produced unfamiliar code words calculated to deceive the uninitiated, phrases like “single-payer,” for example. According to the National Library of Medicine, a single-payer system is:

An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.

I am not sure what “single-payer” means in ongoing health care discussions. But I think what “single-payer” means to most people is the option to buy health insurance from the government – as well as from private providers.

From what he said on MSNBC-TV last night, Dr. Howard Dean, the former governor of Vermont (who introduced publicly funded health care in his state), thinks of “single-payer” as a system that would let anyone of any age join Medicare if they do not want to – or are unable to – buy private health insurance. (As you may already know, Medicare is now available only to those of us who are over 65 years old.)

As a workable compromise, I can find nothing wrong with that idea. With its accompanying prescription plan, Medicare seems quite reasonable. It took a lot of shopping around, but I have found a prescription plan that works very well for me. So I cannot fathom why Sen. Max Baucus, the chairman of the Senate Finance Committee (which is now considering bills that would introduce health care reform), insists that single-payer health care is “off the table.” (You will recall that 13 people were arrested recently for disrupting the committee’s hearings because of Sen. Baucus’s refusal to discuss a “single-payer” system.)

Of course, Baucus may be motivated by personal reasons. According to the Consumer Watchdog group, Baucus has received more campaign contributions from health insurance and pharmaceutical corporations than any other Democratic member of the House or Senate – $183,750 from health insurance companies and $229,020 from drug companies in the last two election cycles.

Baucus is not the only boll weevil in the heath care cotton patch. With public opinion solidly behind reform, the health care industry realizes politicians must do something. So their surrogates are plotting and scheming to water down any final legislation to the point where it would be useless. For example, their proposals include a “trigger” mechanism that would make government-funded health insurance available only after private insurers failed to provide satisfactory coverage. Naturally, the way the “trigger” provision is worded, it would be virtually impossible for anyone to take advantage of it.

Meanwhile, outside of Congress, a well-funded crusade is under way to change public opinion. For example, a group calling itself “Conservatives for Patients’ Rights” is airing a 30-minute TV infomercial titled “The End of Patients’ Rights: The Human Consequences of Government Run Health Care.” The program, which features anticipated “horror stories” from health care reform, is disguised to look like a “60 Minutes” report.  Masterminding the crusade is CRC Public Relations, which was responsible for those infamous “Swift Boat” attacks against John Kerry. As you might expect, the “facts” presented in the infomercial are bogus.

In view of the vast amount of money available for the crusade against health care reform, public pressure on Congress is vital. I don’t think the American public will be fooled by infomercials this time, but I think those sly politicians might be able to subvert the legislative process. The only hope American taxpayers have of winning this battle is “eternal vigilance” and constant pressure on those slippery politicians in Washington.