Written by Larry Sobal, CEO, Appleton Cardiology Associates

The economy needs long-term care, domestic carmakers need life support and a whole host of chronic financial ills are plaguing American families.

So while President-elect Barack Obama's list of domestic fixes may require major surgery, perhaps no treatment will require a miracle cure as his vow to overhaul the health care system.

Coupled with Democratic control in both houses of Congress, Obama has raised expectations for comprehensive health system reform to their highest levels since the early 1990s when the Democrats last found themselves in a similar position. In order to be successful, there are three major questions to be answered. First, can the Democratic Party reach consensus on reform — not to mention finding any bipartisan support? Second, will there be money to pay for reform in light of other urgent economic needs? Lastly, will the public and employers support the plan?

Let's discuss the first challenge. A variety of Democratic leaders are already jockeying to position their health reform plan as the basis for change. This suggests that a Democratic Congress isn't going to simply rally behind whatever Obama wants.

It took all of a week after the election for the first proposal to emerge: Sen. Max Baucus's Plan For Health Reform. As chair of the Senate Finance Committee, Baucus oversees taxation and about half of all government spending. This puts him in a unique position to drive change.

Don't let a malignant brain tumor make you think Ted Kennedy has taken a back seat on health reform. He has announced plans to move ahead early next year with his own proposed bill for universal health care. Kennedy actually has a head start, as he began working on reform legislation many months ago and claims his personal legacy for America will be to lead the reform process.

Let's not rule out Tom Daschle. As Obama's appointed Secretary of Health and Human Services, he has recently outlined a plan. The former senate majority leader understands the parliamentary tricks and has the Washington experience to line up necessary votes.

We should expect others to emerge, such as Sen. Ron Wyden, whose Healthy Americans Act brings another Democratic plan to a crowded table. The key will be whether Obama is able to bring focus and clarity to a single plan, and garner some Republican support, or will the different Democratic approaches bog down in bureaucratic debate.

Now for the second challenge. The next Congress will inherit a $10 trillion debt, a Medicare system headed for bankruptcy in the next decade, a federal budget with at least a $400 billion deficit and a long list of other financial problem spots all crying for funding. All of the health reforms plans on the table have substantial costs. Initial projects peg Baucus' proposal at $100 billion in its first year alone. The key to this challenge may eventually lie in one theoretical question — does failing to fix our broken health system cost more than the cost of reform?

The last challenge, regarding public support, will be the most compelling debate of Obama's term. How committed we are to having no uninsured? Do we feel that government centralization is better or necessary? Can we accept more mandates? All of these will be fascinating discussions for our nation.

Historically, Americans have been conservative about their health care because people with coverage are extremely nervous about changing what they already have. Employers will be very nervous about a plan that might mandate them to provide more insurance in an era where they are struggling to survive.

Without a doubt, there is a lot of energy and momentum being built on the subject of health reform. Right now, it seems everyone is in favor of reform.

Eventually, all these challenges boil down to whether we are all ready to change, or is our definition of change one that only involves somebody else?