AMERICANS will get their national health insurance plan whether they like it or not. That was the prevailing opinion in Washington on the eve of Thanksgiving.Whether this prediction holds water after the turkey has vanished from their tables should become clearer over the weekend. Republican activists and stirred-up independent opponents of Big Government have promised scores of tea parties to scare the daylight out of their senators and congressmen and -women back in their districts for the holiday.That’s American politics up close and personal. Every gimmick is in play, including pieces of American history like the Dec. 16, 1773, Boston Tea Party. Ostensibly an act of resistance against taxation without representation, the American colonials boarded three British ships tied up in Boston and dumped their cargo of tea.The tea parties awaiting President Barack Obama’s health care reform are not in the same historical league. But if they are widespread and intimidating enough, their political impact could derail Mr. Obama’s signet project — as well as his chances for a second term in the White House.Health care is the heart of the “Yes, we can” change he pledged to bring to Washington and if he flops, he will be politically crippled — or worse.I don’t think I am overstating the significance of the health care struggle. A rickety economy is already hurting Mr. Obama more than he lets on. He spent trillions of dollars on Wall Street bailouts and trillions more on economic stimulus that refuses to translate into American jobs.Repeated setbacks abroad, as in Beijing last week when Chinese leaders lectured him on the foolishness of overspending, must be cutting him down to size in the eyes of foreign governments and publics. And Iran thumbing its nose at Mr. Obama’s threats of sanctions, unless Tehran abandons its quest for nuclear weapons, is rubbing salt into his wounds.Put public opinion polls telling him that more Americans reject national health care than support it against this grim backdrop, and the depth of Mr. Obama’s troubles becomes obvious to friend and foe alike.But, as I said, he will pull it out because he must. An American president’s power to grant or to withhold political favours is enormous and there should be no doubt he will use it.Canadians know the up and the downside of national health insurance. They don’t have to worry about medical bills, but must wait their turn for anything short of dire emergency.Most Americans don’t have to wait. They are well insured and get top services without delay. The less fortunate and the 20-odd million uninsured live in fear of financial ruin and depend on emergency room care.The national health care legislation now wending its way through Congress is supposed to end this scandal.Who could argue with such a sensible solution? On the face of it, only heartless curmudgeons, blind politicians and those who profit from the misery of others fit the frame.The biggest problem is the enormous cost — and that scares the voters. Can the United States afford national health insurance? Mr. Obama and most Democrats in Congress say “yes.” Americans “cannot afford not to have it,” says Mr. Obama as he assures the country that his plan would save money over time and reduce the national deficit.Experience with Medicare — benefits that Americans who paid social security taxes for 10 years get at age 65 — says something else. When President Lyndon Johnson sent his Medicare legislation to Congress in 1965, projections for the next 25 years said the plan would cost $12 billion by 1990 — $9 billion for hospital payments and $3 billion for doctors’ services. The actual 1990 tab was $110 billion.These figures can be found in government accounts.For all the political noise and numbers buzzing in Washington, the nut question is: How much? And I don’t have to spell out the spin from both sides.Mr. Obama will buy the votes he must have to salvage his eroding power and offer a chance of re-election. The bidding has already started — at $300 million for a vote — when Senator Mary Landrieu, a Democrat from Louisiana, withheld her support on make-or-break procedural votes until she got the money for her state.Unless the tea parties fizzle and the Republicans turn out to be paper elephants, Americans will join Canada and the rest of the modern world where national health care is a given. It will cost them trillions of dollars more than Mr. Obama says it will, but who’s counting?rless processes and simplification is administrative savings and “green government.”