In 1994, he was one of the masterminds of the infamous Harry and Louise ad campaign that helped kill the Clinton health care initiative. Now Chip Kahn is trying to prepare the ground for comprehensive national reform after the 2008 elections. No more baby steps and incremental reform. Kahn wants to cover everyone. Economically, he says, we have no choice.

Kahn, currently the president of the Federation of American Hospitals, has been around Washington long enough to know that big change doesn't come easily, and that no matter how inclusive the message from whoever occupies the White House next year, partisanship is not going to dissipate like the morning dew. Far from it, he told us the other day in a friendly if not always 100 percent encouraging conversation that included words like "bludgeoning" to describe the national legislative process.

But if the political parties are as deeply, or more deeply, divided than in the early 1990s, some of the interest groups that were once metaphorically clawing each other's eyes out about health have found common ground. That's powerful, Kahn said. And it's different.

"I've been involved in some pretty strange bedfellow alliances in my time. But this is one of the strangest," said Kahn, who has been a Republican heavy-weight player on Capitol Hill and a top trade official for both insurers and hospitals.

He was referring to the Divided We Fail coalition, which has brought together big business, small business, labor and the AARP. For many of the participating groups, comprehensive health reform and coverage for all Americans has become a simple matter of economic survival, Kahn said.

Fifteen years after President Clinton unveiled his health plan, "we are at the other end of a long cycle," Kahn said. The costs trends in health care are affecting the insured and the uninsured alike, business and labor, employer and worker, both through the bills they pay directly and the costs that are shifted. "Major parts of the American economy are saying enough already... Let's have action and organize our health care system so that coverage is universal." Some of these groups voiced similar sentiments in the early 1990s, but "they are coming together in ways they didn't before, and there seems to be a certain will to carry it through." Both big and small business groups are increasingly seeking comprehensive reform to end the inefficiency and the "hidden tolls and taxes" in the system.

No details are on the table yet, and it's the details, Kahn said, "that tend to scatter people asunder in healthcare reform." But for the moment, they are "willing to get together and shake the policy tree and get some reaction." Besides, the details are Congress's job. And the next president, whoever he or she may be, will have to provide leadership on health policy from the outset: political honeymoons don't last long nowadays, and the new president will also have an agenda crowded with the Iraq war, the housing crisis, and the economy.

"We're only at the beginning of this process," Kahn said, surveying the long road from happy coalitions to a White House bill signing ceremony. "Hope springs eternal."