I admit it: I had fun watching right-wingers go wild as health reform finally became law.

But you say does it represent change? The change is that we are fighting an insurance industry that has killed health reform for generations. They're spending tens of millions of dollars right now to defeat this bill and we're on the doorstep of winning a great victory for the American people.

One of the jewels in the crown of Labour's time in office was the rescue of the National Health Service. As the Commonwealth Fund the London School of Economics and the Nuffield Foundation have all shown health reforms as well as additional investment were essential to improved outcomes especially for poorer patients.

With a host of proposals on the table and a President examining new ideas for health reform we have an obligation to give real reform our best shot.

I agree with just about everyone in the reform debate when they say 'If you like what you have you should be able to keep it.' But the truth is that none of the health reform bills making their way through Congress actually delivers on that promise.

It's correct that I wanted health reform to do more to create choices and promote competition.

It is hard to miss the irony in the fact that the very same week that Republicans were publicly heralding Congressman Paul Ryan's plan to inject market forces into the American health care system they were crafting a budget deal to strip them from the health reform law.

Without Free Choice Vouchers there is little in the health reform law that discourages employers from increasingly passing the burden of health care costs onto their employees.

True health care reform cannot happen in Washington. It has to happen in our kitchens in our homes in our communities. All health care is personal.

Obama is capable - as evidenced by his first-term success with health care reform. But mandate-building requires humility a trait not easily associated with him.