Decades from now, when our healthcare system is being run by a government call center in Sweden, where they really know how to do the “Socialized medicine” thing, we’ll look back and wonder why the likes of Hillary, and then Barack, couldn’t get the job done.

To be sure, today’s constipated, regulation-ridden, Medicare-Medicaid besotted healthcare marketplace is less “free market” than conservatives might suggest, but the American inclination towards market signals and incentives has never gone away.

When Hillary plotted a government takeover of heath care, while meeting in a secret tunnel underneath husband Bill’s White House, the vast right-wing conspiracy swatted her like a confused bug and the Great Unwashed expressed their suspicion of plots against the family doctor.

Obama squandered his Messiah-like election victory by dismissing incremental healthcare tweaks and insisting on a grandiose semi-takeover that reeked of “I know what’s best for you.”

Why couldn’t either of the two cleverest politicians around come up with a health care “fix” or “reform” that would generate widespread support? They were both dismissive of that American itch for the marketplace; that American affection for competition and personal freedom; the American suspicion of government intervention that goes too far and comes too fast.

Mitt Romney, sneaking in from the right, rather than the left, had better luck in Massachusetts with the “everyone has to have health insurance” initiative, although the result seems to have been an explosion of demand, with little cost-control in place to sustain public and industry support.

Even with 97 percent of the state’s population insured, there has been no appreciable drop in utilization of hospital emergency rooms for primary care.

In a state where, at least in theory, almost everyone now has insurance – and in a state with sufficient per-capita and family wealth as to never be mistaken for Arkansas – that loyalty to or affection for the charms of the emergency room might offer a lesson for the nation.

Whether it be Mass. General or the Tiny Little Community Hospital on the Village Green, hospitals have created a level of trust and demand that comes with being a “brand.”

It doesn’t take a savvy consumer to recognize that hospital emergency rooms are a noisy, messy, confusing, inefficient delivery system by which to have your mystery rash slathered with cortisone magic cream. And it’s not as if the hospitals have doubled their emergency room ad budgets.

Little Bits

Part of the dirty little secret, of course, is that traditional healthcare providers are reluctant to welcome the poor and unsophisticated into their well-polished waiting rooms, whether or not the patients come clutching a new and improved insurance card, let alone the dreaded Medicare discount nightmare.

The Massachusetts Medical Society reports that only half the commonwealth’s primary-care docs are accepting new patients – unlike the hospital emergency room, where the door is always open, if not overly welcoming.

This is where Obama and the warring Democrats and Republicans should focus. An incremental, but important and understandable challenge: How do you get the teeming masses out of the hospital driveway, to make room for the ambulances?

In fact, Washington already knows the answer – and Massachusetts does as well. Community Health Centers might not win over too many upper-middle-class snobs looking for high-end coddling, but the health center approach is competent, social service-like in its business model – and much preferable to competing with the drug addicts and kidney stone crazies in the emergency rooms.

With a better, business-oriented marketing and advertising campaign; and recognition from the likes of Obama that incremental, positive progress deserves to be promoted from the pulpit, Community Health Centers can offer up positive healthcare change, without the political angst.

None of this is mysterious or magical. In Worcester, Great Brook Valley Health Center just spiffed up its marketing with a name change to the Edward M. Kennedy Community Health Center – and it snared a $6.4 million federal grant to blow up two-store-front clinics and open a larger facility in Framingham.

This kind of progress is going on across the country, but it needs a marketing blitz and a political attitude that welcomes “competition” from the health centers, which can offer up government-subsidized medical care that doesn’t reek of desperation.