President Barack Obama has fulfilled at least one campaign promise. He’s brought change to Washington.

His fervent belief that an activist government can solve most problems offers a sharp difference in trajectory from the Bush administration.

What Obama hasn’t done is transform the capital by ushering in a post-partisan atmosphere. Most legislation so far—like the stimulus package—has been approved largely along party lines.

The best opportunity for bipartisanship is in health care reform. Republicans and Democrats are certainly saying all the right things about working together as this massive undertaking gets under way.

That’s a contrast from 1994, when the Clinton administration’s health plan was opposed almost immediately by Republicans, the business lobby and eventually many Democrats.

Now both parties and many interest groups assert that health care is second only to economic recovery on the “to do” list. Obama allocated a $634 billion down payment on health care reform in his $3.6 trillion budget.

Lon O’Neil, president and CEO of the Society for Human Resource Management, says that up to $1 trillion could be saved if reform is done correctly, providing a huge boost to the economy.

“The fundamental, core issue is health care reform,” O’Neil said at a SHRM reception at the Newseum in Washington on March 9.

O’Neil comes by his health care passion honestly. He joined SHRM last year after serving as senior vice president and chief human resources officer at Kaiser Permanente, a $40 billion not-for-profit health care organization.

His perspective on health care sounds as if it’s been informed by dealing with real life problems employees face.

“Many Americans are frightened to death they will lose their health care,” O’Neil said. He went on to say something that demonstrates how much the political context for reform has changed. “It is a civil right to have access to health care,” O’Neil said.

I can’t remember anyone from an organization that often represents management uttering that phrase in 1994.

There’s also a sense of urgency this year that wasn’t present in the previous major health care reform debate, in part because of inexorable increases in costs. There’s a new president, a new Congress and no election in sight until 2010.

“If [health care] isn’t done this year, it won’t be done in the next four years,” Sen. Charles Grassley, R-Iowa and ranking member of the Senate Finance Committee, told reporters at a breakfast Thursday, March 19, sponsored by the Kaiser Family Foundation.

The chairman of the committee, Sen. Max Baucus, D-Montana, wants to get a comprehensive health care reform bill onto the Senate floor this summer and has outlined a framework to get things started.

Democratic and Republican leaders of three Senate committees with jurisdiction over health care—finance, health and budget—are meeting regularly to develop a bill. They’re also talking to groups with a stake in reform. So far, participants are reporting a healthy dialogue.

But political divisions could arise over several aspects of health care reform.

For instance, tension could develop over a so-called “public option” for health insurance in which a government-run plan would compete with private insurance to offer coverage. Grassley and other Republicans worry that such a system would “crowd out” the private sector, put company plans at risk and lead to a single-payer system.

“I don’t see a compromise in that area,” Grassley said. “But nothing is uncompromiseable except abortion.” He stressed that “everything is on the table.”

Another sensitive area involves taxing employee health benefits, an issue that my Workforce Management colleague Jeremy Smerd has covered.

“This is an 800-pound gorilla in the room,” Grassley said. “It’s something we’re going to have to move on cautiously. It’s not going to happen unless there’s a great big consensus to get it done.”

There’s also the tricky question of whether companies should have to provide a minimum health care benefit and how it would mesh with existing plans.

“I ask all of the employers with whom I meet to work through those details,” Baucus said in a March 11 speech to the National Business Group on Health. “Help us to develop a pay-or-play structure that works. My vision for reform is one of shared responsibility.”

The only way for Baucus’ vision to come true is for Democrats, Republicans, insurers and the business community to share the inevitable political burden of health care reform.