This commentary originally appeared at Spot-On.com on June 12, 2008.

Clinton has quit, Obama has three times McCain's resources, and the country is fed up with the Republicans' war, corruption and toadying to corporations. Democrats have won three "safe" Republican house seats in recent months. It's their election to lose, and assuming that the fences between rivals really are mended, it might be a landslide.

I've written previously that I don't think Obama is serious about pursuing health care reform. But this week in at a Health Care Town Hall held immediately after he clinched the nomination, he repeated that by the end of his first term, there would be universal healthcare.

    In an Obama administration, we'll lower premiums by up to $2,500 for a typical family per year. And we'll do it by ....covering every single American and making sure that they can take their health care with them if they lose their job.....We'll do it by the end of my first term as President of the United States......

Coming from someone who had relatively little to say about health care until goaded into it by former rivals John Edwards and Hillary Clinton this counts as a turning up of the rhetoric. So let's imagine that there is a solid Democratic majority in the House and Senate with a strong Democratic President.

What type of health care reform might actually pass into law?

Obama's proposed plan is complicated so the plan's trip through Congress will be tortuous. And some details are still not aligned. Although Obama says most employers would have to provide insurance, he doesn't mandate that individuals to buy insurance. But then he says we'd get to universal coverage by having people buy insurance, rather than having the government provide it for free.

The Obama theory is that if insurance becomes cheaper, more people will buy it, and those that truly can't afford it will be subsidized. But that's not realistic. Ten percent of people account for more than 50 percent of health care costs and the current game in insurance is to avoid covering that 10 percent.

It looks fairly inevitable that the worst excesses of current insurance practices - avoiding people with chronic conditions - will be banned. But the next step, which is spreading that uneven cost of health care across wider populations, means healthy folks who are not paying their "fair share" will have to pay more. That's necessary if those paying the most - or in reality, currently unable to get insurance - get to pay less. And those who will have to pay more will likely outnumber those getting a better deal right now. So the Obama plan will look like a cost increase to many. This has largely been the experience in the new Massachusetts "universal insurance" plan.

Obama's way around this is to have the U.S. government subsidize some of the most expensive cases. That's the source of his $2,500 a family savings. He'll also allow people to buy into an equivalent of the Medicare system. Both of these safeguard proposals mean big increases in government subsidies that will require more taxes. But this is all likely to be proposed during a recession. The Federal budget is already heading for another record deficit. Add in the opposition from much of the health insurance industry to these reforms (as they will put some of its members out of business), and you can see how hard this will be to pass Congress.