A young President Barack Obama with his grandparents. —Photo by Ho New/Reuters

Barack Obama wants to reform the nation’s health care system. That’s good news. The better news is his intimate knowledge of the reasons that reform is so necessary. Perhaps no president has taken office with such personal exposure to the critical aspects of American health care—especially the challenges we face in restructuring a fractured system and bringing costs and services into balance with needs.

Lessons from home, namely the experiences of his mother and grandmother, will come into sharp focus as Obama proposes his first federal budget. His administration and Congress must wrestle with the conflicting dynamics of a soaring national debt, lagging revenue and a $2 trillion annual health care bill that still leaves 45 million Americans uninsured and consumes one-quarter of the federalbudget—even as U.S. infant mortality rates are higher, and longevity lower, than in the rest of the industrial world.

“My mother died very suddenly and very young,” Obama told the AARP Bulletin last fall. [Read the complete interview at bulletin.aarp.org.] Ann Dunham died in 1995 at age 52 after working as a consultant for the U.S. Agency for International Development, the Ford Foundation and Women’s World Banking. She taught her son an important lesson about access to health care. “She’d go from contract to contract and would be able to buy health insurance [only] when she got a new contract,” Obama said. “When she got sick, she had just signed up for a new job, a new contract, and she had a lot of arguments of whether this was a preexisting condition of which she had no knowledge whatsoever.” Later he added, “As someone who watched my mother argue with insurance companies while she lay in bed dying of cancer, I will make sure those companies stop discriminating against those who are sick and who need care the most.”

From his grandmother, Madelyn Dunham, who continued living in the same Honolulu apartment where he had been raised, Obama learned important social and economics lessons about long-term care. “What I’ve learned from watching my grandmother is that with some modest help she’s able to remain independent,” he told the Bulletin shortly before she died. “And that costs the system much less than if she’d gone into a long-term care facility. The problem we have is that so much of our system is built around institutional care that we end up spending more money than we need to and probably with worse outcomes in a lot of cases.

“These are not abstractions for me,” he said frequently during the campaign. Nor are they abstractions for millions of Americans. As AARP’s leaders write in a letter to the White House [see page 10], this is an important moment for the nation. With the approaching retirement of 78 million boomers, reining in health care costs and strengthening the core safety net are crucial to stabilizing the nation’s finances and establishing an upgraded and rational system of health care. Starting points are the leadership of the president and the firsthand lessons he learned from his mother and grandmother. His first book was titled Dreams From My Father. His next must be “Lessons Learned.”