President-elect Barack Obama has demonstrated that health care reform is one area of change that his administration will attack promptly.

Three factors argue against it (but Mr. Obama seems intent on working past them). The first is that the field is a rat's nest of entrenched interests, making money from the way things are and resisting changes that might hurt this profitable arrangement.

The second is the disastrous experience of the previous Democratic president, Bill Clinton. He threw what he thought was his first team -- his wife, Hillary Rodham Clinton -- into reform early in his first term. She and he emerged from the effort bloodied and unsuccessful. Some fault the way the Clintons went at it. Others recognize that America's health care is controlled by an interlocking set of institutions -- hospitals, doctors, insurers -- that prefer the status quo.

The third is that Mr. Obama will have other pressing priorities when he (finally) takes office Jan. 20 -- repairing the economy, getting his Cabinet nominees confirmed and fixing foreign policy starting with Iraq and Afghanistan.

To take on health care reform in that context will require courage and confidence. Mr. Obama nonetheless has signaled his intention to tackle it. He has nominated Tom Daschle as his secretary of health and human services and head of the new White House Office of Health Reform. Mr. Daschle is the former senator from South Dakota who was majority leader and, more recently, a close adviser to Mr. Obama during the campaign. Most important of all, he knows the Congress very well from 26 years in the House and the Senate.

His only problem is one he will encounter in the confirmation process. For years his wife has been a prominent and powerful Washington lobbyist. Mr. Obama had promised the American public a respite from such entanglements, and Mr. Daschle should be asked for assurance that his wife will not profit from his role in the health reform effort.

There is no question but that American health care needs work -- to increase access, to improve quality and to make it affordable. Hats off to Mr. Obama for his willingness to pick up that bristling porcupine.