The New England Journal of Medicine (a favorite of mine, albeit biased because I did a rotation there in med school) just came out with an article putting it very succinctly and eloquently the reasons why health care reform has not been succesful and possible strategies to have it happen. In summary, he points out the reasons why health care reform efforts have failed in the past - there are lots of parties who prefer the status quo, reform is difficult, bureaucracy always gets in the way, and reformers have yet to support a single approach.
He quoted Machiavelli (whose political philosophy of realism differs from my own, but who has a lot to contribute to political thinking nonetheless) in summarizing, "There is nothing more difficult to manage, more dubious to accomplish, nor more doubtful of success . . . than to initiate a new order of things. The reformer has enemies in all those who profit from the old order and only lukewarm defenders in all those who would profit from the new order."
I just found it a very nice article on why health care reform is so difficult, yet how it is not impossible.