USA Today’s Julie Appleby lines up the odds for and against health care reform in the new administration. In addition to the usual “we can’t afford to” versus “we can’t afford not to” arguments (President-elect Obama has declared himself in the "can’t afford not to" camp) she has a great outside-the-Beltway comment. Phyllis Smith, 60, an uninsured Obama backer from Texas who can’t afford her blood pressure and diabetes medicine wonders with the world being the giant mess it’s in, whether Obama can try to fix it all at once.

"With the condition this world is in right now, that man has his hands full," she told the newspaper. "Whether I get my high-blood-pressure medicine is not going to be high on his priority list. It will take time. … Until our Congress agrees to work together, there's not going to be a whole lot of hope."

Back here inside the Beltway, we do see some signs that Congress might be ready to work together, although it won’t all be smooth sailing. But we know that House leaders as well as the Senate is revving up for action in 2009.

Congress naturally is going to work ASAP on the big (and getting bigger) stimulus package, and that addresses some of the top health care priorities. Jackie Calmes in the New York Times reports that about a fifth of the Obama package (which could near $1 trillion over two years) could go toward health care. The biggest piece would be up to $100 billion to help the states meet the growing demands the slow economy will place on Medicaid--health care for the poor. There will also be funds to push more adoption of health information technology and medical records.

There will no doubt be many other suggestions circulating about how to stimulate the economy while addressing health care problems, like our shortage of primary care physicians and related access problems. The Wall Street Journal's Health Blog tells us that the American College of Physicians is asking for an 18-month 10 percent boost for Medicare payments for primary care. Many primary care practices are having some pretty hefty economic challenges of their own (See this recent LA Times article), and good primary care can be a wise investment as it can help keep people out of hospitals and emergency rooms. This is the first we've heard of this particular proposal, and we don't know all the specifics. But we do know that shoring up primary care—whether this way or another way, now or soon—is going to be an essential tool in creating a more sustainable, more responsive health care system for all.