It's a struggle for the 45 million Americans without health insurance. When serious illness occurs, they often have to hope to get care before they can hope for a cure - and hope can be in short supply.

Better believe, then, that people without insurance are hoping President-elect Barack Obama delivers on his campaign pledge to push ahead with reforms designed to achieve "affordable, accessible health care for every single American."

So far, Obama is making all the right moves. Most important, he appears to be sticking to his first-year timetable - economic crisis or not.

Indeed, businesses in a tough economy are hampered that much more by health-care costs. So as the president-elect said the other week, reform is "not something we can put off because we are in an emergency. This is part of the emergency."

Obama's choice of former South Dakota Sen. Tom Daschle to lead the charge for reform as secretary of Health and Human Services is a further indication the new administration plans to move boldly.

The goal will be to expand coverage while also pulling the reins on health costs.

In his book

Critical

, Daschle maps out a workable strategy to make progress toward both goals. The former Democratic Senate majority leader also is well-versed in the ways of Congress, where Obama's reform will rise or fall.

Weeks before the inauguration, the Obama-Biden transition team is sponsoring hundreds of kaffeeklatsches over Christmas and New Year's. Smart move. By sampling public input on health reform in town hall and living room discussions, the incoming administration should be able to incorporate ideas from the grassroots - and blunt top-down criticism that helped sidetrack Clinton-era reform efforts.

As Obama aides embark on what amounts to a listening tour, they will no doubt hear troubling stories like those that The Inquirer has published in recent months. The series by reporter Michael Vitez - "Falling Through: Casualties of the Health Insurance Crisis" - provides a rare and compelling look at the struggles of people from this region who lack health insurance.

While it seeks to heal, the nation's patchwork health-care system also causes its share of suffering. Consider the people Vitez met:

A South Jersey salesman worked hard for 30 years, only to see illness lead to a job loss that triggered a downward financial spiral.

After receiving care that wasn't covered by insurance, a college student faces $15,000 in doctor bills; an uninsured barber, $20,000; an upstate cancer patient, $27,000.

Even though she was lucky enough to have insurance, a Lawnside leukemia patient maxed out her coverage because of the staggering cost of treatment.

These stories (

) put a human face on what should be a push for universal coverage. At the same time, reformers must tame costs that exceed the rest of the industrialized world's, and improve quality, since key U.S. health outcomes don't measure up.

An Obama strategy to expand government coverage by creating a Medicare-like option that typically uninsured younger workers could afford would make sense. To control costs, Daschle's concept of Federal Reserve-style oversight is promising. Any plan, of course, should require everyone to buy insurance, as long as subsidies are made available to those who cannot afford it. For their part, private insurers already have advanced the effort by pledging not to turn away customers because of chronic health conditions.

The details are tricky, sure. But a can-do spirit and sense of urgency from a president-elect who wants "change" are the best things America's uninsured have going for them.