Barack Obama's ambitious plan to provide every American with health insurance, the first attempt since Hillary Clinton's effort as First Lady ended in disaster 15 years ago, officially began yesterday on Capitol Hill.

Tom Daschle, the former Democratic Senate leader and the man tasked by Mr Obama to spearhead the push for health care reform, appeared before the US Senate as the first confirmation hearings for Mr Obama's incoming Cabinet began.

Mr Daschle, nominated to become health secretary, is expected to easily win confirmation. But his task in getting hugely expensive health care legislation through Congress, even as Mr Obama tries to win quick passage of a separate $775 billion economic rescue plan, will prove far more difficult. The health care plan will cost at least $60 billion a year if it is passed.

More than 46 million Americans are without health insurance. According to the Commonwealth Fund, a Washington-based charity aimed at improving health care for individuals, the US ranks last among 19 industrialised nations in health care efficiency and quality.

When Bill Clinton came to office in 1993, he made the issue a priority, but committed several tactical blunders that condemned his plan to ignominious defeat - mistakes that Mr Daschle has closely studied.

Mr Clinton first put his wife in charge of the project. She kept the drafting of the legislation inside the White House - cutting out Congress - and by the time her massive 1,342-page bill arrived on Capitol Hill in November 1993, it was already doomed.

Mr Daschle intends to get Congress closely involved from the outset and wants to get a Bill presented within three months of Mr Obama taking office. Yet aides to the Democratic committee chairman who will be responsible for passage of the Bill are already calling such quick timing highly unlikely and warn that health care reform could be pushed beyond the summer recess. By then, it risks being subsumed by other priorities.

Mr Obama wants to create a government-funded public health insurance plan that will compete with private insurers. Yet the proposal is fiercely opposed by most Republicans, many employers and the very powerful health insurance sector.

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