If the CDC predictions about a swine flu pandemic are not to be ignored - up to 40 percent of Americans infected and several hundred thousand deaths - than the Obama administration has had the country's first national health care crisis dumped in its lap.

The CDC has said this past week that this is not a drill. They are predicting a swine flu breakout this fall and winter in much larger numbers than seasonal flu. So far, swine flu's blow has been glancing, killing about 500 Americans. But the victims proportionately are higher among young adults, a troublesome trend. One group, pregnant women, has accounted for 6 percent of swine flu deaths in this country, through as a group they represent about 1 percent of the population.

All indications are Obama and Health and Human Services Secretary Kathleen Sebelius are gearing up to do battle with this unpredictable virus. They've pledged to spend about $8.5 billion on prevention programs, the bulk to be spent on buying and distributing vaccines to all 50 states for free.

While a healthy supply is needed if the most at-risk Americans are to be vaccinated, the concern - not unlike many questions about this administration - is whether the solution can reach the American people in time to have an effect.

Too often, Obama has presented solutions, such as the $819 billion economic stimulus package, that have had a lukewarm effect on a cold economy - in short, not doing enough trickling down to Main Street.

This is an administration that has had trouble making a difference where it wants (i.e. the economy) and making an impact where it doesn't (inflaming race relations after Obama's ill-worded remarks about the arrest of Harvard Professor Henry Gates by the Cambridge Police Department).

This time, with a potentially potent public health threat lurking, it is crucial that Obama's message make it out of the Washington beltway. A successful vaccine will do no good if it sits on laboratory shelves.

That will mean Obama's people connecting with lower levels of government: from state offices of emergency services, to county public health agencies and school districts. Frankly, we haven't seen evidence of these kinds of connections from the still young White House, at least not in our region. And not from the milquetoast California delegation in Congress.

If a swine flu vaccine is to roll out in say, October or November, then hospitals, clinics, doctors and HMOs must be part of the roll out team - the same stakeholders that Obama promised would be part of health care reform.

We need to see boots on the ground.

So, yes, in a sense, this will be more of a "test" for the president's ability to affect immediate health care reform than the various health care reform bills bouncing from committee to committee on Capitol Hill. Because people will need the vaccine as a first line defense against contracting and ultimately, spreading this flu virus.

Again, if this works well, this will be a boost to Obama and the Democrats, showing that big government - in cooperation with lower levels and the private sector - can move quickly to solve problems. If not, this has the potential of being what Hurricane Katrina was to his predecessor, George W. Bush.

And we aren't ready to say "good job, Katie" just yet.