Are you tired of health care reform yet? Fox News wants you to be. True the U.S. Senate Finance Committee has yet to get a bill out, combine it with a Health Committee bill, and send it to the Senate floor. If the bill gets that far it has to go to a conference committee with the House, which will already have blended its own three separate bills. Then a conference bill gets sent back to the House and Senate for debate, amendment, and, with hope, passage.

Sounds bleak for health-care reform? Wrong! The good news is we will likely get a major health bill signed into law. The bad news is it will be incomplete -- like Social Security was back in 1935. Welcome to the U.S. Constitution and our nation's history of major social-policy reform, accompanied now not only by years of customary legislative practice, but by increasingly negative politics, 24-hour entertainment-style media coverage, and what Brookings Institution economist Henry Aaron calls savvy lobbying by insurance companies, medical doctors, and Pharma.

If the United States was a parliamentary system, Obama and the Democrats -- swept into office with large majorities -- could have enacted health care reform in a few months. And a disciplined House majority, using rules that make it easier to pass bills, could pass a health bill today containing deep subsidies to help people purchase insurance, no pre-existing condition or lifetime payment limits, and a serious public option to compete with private insurance companies, paid for in large part by income surtaxes on those earning over $500,000 per year.

So the problem in achieving health-care reform is not "death panels," or creeping socialism, or declining public support for reform. A recent New York Times poll showed 65 percent approval for a public option like Medicare that would be offered to everyone. But the people won't get anything close to that now.

The problem facing health reform is the U.S. system, designed to check central government power.  Sometimes that is a good thing, but not in this case. Extensive federal checks and balances, along with the power that individual states possess means that major changes, even with significant majority support, are very hard to achieve. Lyndon Johnson's overseeing the passage of Medicare was the last great health care victory, and it was very hard for even a master tactician like LBJ to succeed, with bigger majorities than the Democrats now have.

OK, so he's not LBJ , but why can't Obama just push a health bill through with large Democratic majorities? The barrier isn't just our constitutional structure -- that interpretation is far too forgiving to the current underperforming crop of legislators. My next post, of three more on health care reform, takes us "Inside the Sausage Factory," where we will investigate the real barriers to reform in Congress.