Things are looking up for substantive reform of America's troubled health care system.

No one who knows the history of such efforts, from Harry Truman's administration through Bill Clinton's, needs to be reminded of the difficulties that inevitably confront any plan to overhaul one-seventh of the U.S. economy and bring quality medicine to millions of the uninsured.

But developments at both ends of Pennsylvania Avenue last week – and across the country – pointed up both the urgency of the problem and the prospects for significant action.

When Barack Obama's transition team let out word that former Senate Majority Leader Tom Daschle would be his choice to run the Department of Health and Human Services, and quarterback his work on health reform, it signaled that Obama is serious about his campaign promise to make that issue a first-term priority.

Daschle would not leave a lucrative job at a law firm to twiddle his thumbs. Only with a clear understanding that the new president will put his own political capital at risk in this cause would the South Dakotan sign up for the job.

Daschle can be of great help to Obama in achieving the goal. He has made his own in-depth study of health care issues and brings a genuine passion to the subject. And he knows the Senate, where past efforts have foundered.

But there are positive signs within the Senate as well. Max Baucus of Montana, the chairman of the Finance Committee, one of the two main centers of Senate action, moved first by releasing a detailed outline of his preferred piece of legislation. Sen. Edward M. Kennedy of Massachusetts, the chairman of the other committee of jurisdiction – Health, Education, Labor and Pensions – quickly asserted his right to be at the center of action. He organized three task forces within his committee and reached out to Baucus to suggest that their staffs start exchanging ideas as well.

One issue that could have clouded House prospects was resolved when the Democratic caucus voted to make Henry Waxman of California the chairman of the Energy and Commerce Committee, replacing John Dingell of Michigan. Both are skilled legislators; Waxman is closer to Speaker Nancy Pelosi.

A fast start is important because it takes untold hours to work through all the complex issues involved in comprehensive health care. When Bill Clinton delayed in getting Hillary Clinton's legislative proposal up to Capitol Hill until the end of 1993, his first year in office, he made it much easier for opponents to throw up roadblocks.

The architects of the Clintons' defeat were Newt Gingrich and Bob Dole, then the leaders of GOP forces in Congress. Gingrich has now become an advocate for systemic change in the way health care is financed and delivered. His approach differs from Obama's, but it starts from the same premise: The current system is too wasteful and unproductive to be sustained.

And Dole told me in an interview last week that today's circumstances make a repetition of those scorched-earth Republican tactics inappropriate.

Dole and Daschle have both worked for the firm of Alston and Bird for the last few years, and it would not surprise me if Dole finds ways to be helpful to Daschle and Obama in the coming fight.

Some have argued that Obama will be forced to delay his promised effort at health care reform, either because of the urgency of the economic problems facing the country or because there will be no money in the budget to pay for such an enterprise.

But every indication is that he will not wait. Indeed, he could well argue that the current plight of the Big Three automakers stems, in part, from the burden Ford, General Motors and Chrysler are carrying for the failures of our employer-based health care system.

One of their basic competitive disadvantages stems from the fact that Japanese and other foreign carmakers are operating in countries where the government and society as a whole pay the costs of health care – not individual companies.

No question, it will still be a tough fight. But you can see the possibility of success.