Before dismissing any prospects of health-care reform this year, consider this: Who would have thought two years ago that a black man would be elected president, or that a Republican would win Ted Kennedy’s U.S. Senate seat?

The odds are against it, but progress is still possible. President Barack Obama has until Wednesday’s State of the Union address to set a direction and revive momentum. He can’t give up. Reforming the health care system is too important to the U.S. economy.

The challenge is to win over middle America. It isn’t just the poor who desperately need health care reform, it’s middle income people who see their share of premiums and co-pays escalating, who can be lopped from insurance rolls if they get sick and who have no affordable option if they leave or lose their jobs.

Their interests have fallen by the wayside in Congress.

Small business remains the backbone of this nation and affordable health care has been their No. 1 issue for a decade, according to the National Federation of Independent Business. Major industries have similar concerns.

The rising cost of health care is preventing thousands of businesses from hiring employees or giving them raises that would further stimulate the economy.

The only way the United States can compete in the global economy in years to come is by finding a way to slow the nation’s skyrocketing health care costs.

Surely both Democrats and Republicans can see that. The president has been ineffective at making the case. He has one more chance.

But since last week’s Massachusetts election, Obama’s choices have become extremely limited, and each has obvious pitfalls.

The best of the bad choices is for the House to hold its nose and pass the Senate version of the health care reform bill, then fix as much of it as possible in reconciliation. That would require only a majority vote. Democrats should do this because offering coverage to 30 million uninsured Americans and putting the nation on a path to reduce medical costs is a solid step in the right direction, even if it falls far short of original goals.Some argue that Obama should float a scaled-back version of reform that could generate bipartisan support.

But it’s hard to extract popular ideas from related, unpopular ones.

Take the insurance company practice of denying coverage to people with pre-existing conditions. Congress could outlaw it, but companies would respond by raising premiums. Congress could alleviate that problem by requiring everyone to purchase insurance, but that only works if the government subsidizes those who can’t afford it.

And the only way to pay for subsidies is by cutting popular Medicare or by raising taxes somehow.

The health-care reform bill the Senate passed on Christmas Eve offers the best chance to provide near-universal coverage to Americans. It remains a historic opportunity that must not be missed.

• McClatchy-Tribune News Service