President Barack Obama has won the approval for his health care reform plan, the first item on his agenda. It really is a little more than Medicare and a little less than an effective and universal health coverage for the entire population. Perhaps it would all have been easier had it been taken on as a philanthropic act in the fashion of Bill and Melinda Gates, which is what it looks like. It is clear that this is not the end of the road for the president. It is but the first of many steps, laying the foundation toward the fulfillment of his program to change the United States, which could be the boldest political move since the barbarians stood up to Rome, and could make Gorbachev look like a mere country town reformer.

The trouble is, it is not enough to be convinced, as one part of the establishment would appear to be, that the United States needs to change. The opposition encountered in those who deny this idea needs to be overcome. More than political orientations and common sense, it is power interests that are at stake here. It is not unlikely that the United States may be changed, but it is difficult to see it happening from the bottom up. Being born in Hawaii of a black father seems to be more a liability than an asset.

Obama is a child of the system just as Lincoln, Roosevelt, JFK and all the others were. Over 234 years, 43 presidents have worked without contradicting or failing the interests of their kind toward becoming what they are now: an empire. Despite having carried out some more or less radical reforms, none of them ever turned away from the system nor attempted to go against the basic institutions of the nation.

Personally, I do not have any doubt that the United States will change, not because its elites are advanced, but because they are not suicidal, and Obama is their tool for the task. While his being black carries the image of change, this is not the most important factor in the issue: The same would be true if he were green. What really matters is that he qualified for a task that John McCain and Sarah Palin could not have carried through.

The need for change, not so much in their political system as in their lifestyle, their attitude towards strategic natural resources, their social priorities, particularly regarding employment, health and education, their immigration policies and also their international image, is a fact. The doubts spring from the shape taken by a process whose forms, pace and timing are a mystery. In this scenario, Obama is more the tool than the ideologist, more Rocinante than Don Quixote.

Health care reform, like any other similar move at the level of the entire system and of the entire nation in the United States, must overcome a strong opposition not only from the conservative sector committed to the status quo and averse to change, but also from economically disadvantaged elements; without forgetting those who, without fully understanding all that is going on, fear the interference of the state in social life. We need only remind ourselves how the Supreme Court of the United States repealed practically every reform of the New Deal, which one day rescued the country from disaster.

With no basis in political or social statements, the first challenges this project faces are of a philosophical nature. Opponents hide behind pure liberalism and argue that the state does not have the right to impose a health insurance on the citizens, even to their own benefit. They may even claim to appeal to the Constitution in protest.

The reason for this prerogative is that the only way to contest a law in the U.S is to call out its anti-constitutional character, which does not apply in this case since the Constitution overlooks socials matters, while the words health and education do not appear in the text nor in the first ten Amendments that establish the rights of Americans.

Unfortunately for him, Obama did not start his reform plan from the angle that would suit the rich, but from the one that favors the poor. Immigration reform, which seems to be the next challenge on the agenda, will be all the more difficult now with the conservatives seeking revenge, and also because it concerns the most neglected group in American society today: poor Hispanics.

The vicious and brutish way in which the Right united like an "entente cordiale" in the face of a proposition whose goal is to help 30 million Americans who currently lack any form of medical coverage can only foretell what will happen when the rights of millions of Mexicans, Central Americans and other Hispanics who have been residing in this country for years as illegal immigrants are brought into question.

A good look at the landscape after the battle does not show President Obama to have too many reasons to feel optimistic. No sooner has he taken his first step, in an act more philanthropic than revolutionary, than he has to face the overwhelming ire of a part of the establishment for whom the poor are not their "fellow man." In his own words, it was an exhausting process. It remains to be seen if he has enough strength and determination left in him to carry on forward, and if this will turn out to be the first or the last of his reforms. Let's hope he does move on forward and finds the support he needs in order to do so. To find out if he does, we can only give him time.