(After months of bitter argument, we are about to give health care reform last rites.The political configuration of the battle suggested that it was a hopeless effort. Since my batting average on prognosticating political events is so poor, I am compelled to repeat my column of July 2009, written before the heat of the battle.)

If you happen to be one of the 68,000 North Dakotans without medical coverage waiting for passage of federal health insurance, don’t hold your breath. The ambulance will not be coming.

While the chorus of support for health care reform has been loud and long by everyone in the biggest choir ever, the harmony of health reform is slowly diminishing in the face of political realities. The singers can’t hit the high notes; the music is discordant, and political will does not match the rhetoric.

The first major barrier is the American political system itself. It is a “status quo” system, meaning that nothing happens unless it is supported by a huge majority. Even then, the system of checks and balances, buttressed by the growing influence of interest groups, can stop, delay or eviscerate any issue.

There is no huge majority willing to overcome the resistance of the institutional barriers and interest groups to move health care across the goal line. The truth is that there is not even a simple majority on the side of health care reform. Around 80 per cent of Americans already have medical coverage and will not support any reform that impinges on their present medical arrangements or impacts their pocketbooks.

Another major obstacle is the cost – $1 trillion or more. Since the beneficiaries of the present expensive system will not be willing to pay for the health care of others, new money must be found. Right now, there is no new money only borrowed money.The only hope for politically-acceptable new money is a major gold strike in the Teddy Roosevelt Park.

There is big money available to oppose reform. The major players with the big dollars may be giving lip service to reform, but when decision time arrives they will be missing. In fact, they are already sponsoring expensive advertising campaigns to discredit health care reform before the plan has been developed.

The beneficiaries of the present system already have an army on the ground. The country’s largest insurers, pharmaceutical companies, hospitals and medical groups have hired around 350 former Congressional staff members to kill, stifle or undo the health care reform being designed by their former bosses.

Then there are the ideologues on the left and the right. On the right are folks who believe that township roads are a dangerous form of socialism. On the left are dreamers who think that the money barrel is bottomless. Both groups will oppose an incremental governmental solution.

Finally, the majority in Congress is not unified. In the old days, Democrats were made a minority party with the conservative southern Dixiecrats breaking away on key issues. Today, they have the “blue dogs” to fracture the vote.

Thus far, the health care crisis has not reached deep enough into society to produce the massive majority needed to overcome the barriers. In other words, there isn’t enough hurt among enough people. Perhaps that will occur in another decade or so. Until then, the 68,000 North Dakotans without coverage will have to be content with two aspirin as their primary treatment for everything from hangnails to terminal cancer.