It is not just in health care that United States President Barack Obama is facing challenges. In education, a fundamental shift is afoot.
Jay Altman, a New Orleans charter school leader who has worked in England, comments: "Obama is taking on real education reform. These are the biggest changes in my generation. He is proposing performance-related pay, and closing down failing schools. It is a willingness to take on entrenched institutional interests in favour of what will produce the best outcomes for kids."
For "entrenched interests", you could probably read teaching unions. They are likely to oppose much of what emerges from Race to the Top, the administration's $4.35bn (pound;2.69bn) federal programme to kick-start school reform across America. But the teaching unions were among Obama's biggest backers in his election campaign, and he risks upsetting them.
This willingness to offend natural allies, and continue and deepen a path of reform that was actually started under George W Bush, is one reason US schools could be on the cusp of such big change.
The second is money. In the US, the federal government isn't just responding to the economic crisis by bailing out banks: it is also pouring billions of extra dollars into education. A one-off extra federal fund of $48.6bn (pound;29.8bn) is being dished out to help state governments pay for education. But, to get their hands on their entitlement, states have to agree to four basic principles of reform that are the basis of the Obama agenda for schools.
States have had to sign up to the idea of:
- using robust assessment to ensure pupils reach the standards required by universities and workplaces;
- recruiting, developing, rewarding and retaining effective teachers and school principals;
- building data systems to measure pupils' "success" and inform teachers how they can improve;
- turning round the lowest-performing schools.
The same principles are the basis for Race to the Top - a competition between state governments to come up with the best reform ideas to make the principles a reality - with the "winners" sharing a sizeable chunk of the $4.35bn available under the programme.
The scheme addresses a key problem for any American president - how do you get your way on education when it is school districts and states that hold the real levers of power? You could attempt to create a more centralised structure, but that would be a risky enterprise in a country where so many are suspicious of federal government.
Instead, the Obama administration has provided a powerful incentive for states and school districts - who can compete for another smaller fund - to come up with their own solutions.
"We want to be tight on ends and loose on means," says Brad Jupp, who heads the administration's drive to improve teacher quality. "We are not going to change the present civic structure. We have the system we have, and what we need to do is make it work."
It is not just the federal government that is challenging the American status quo. Last summer, the New Teacher Project, a non-profit organisation aimed at improving the quality of teachers for poor and minority pupils, published an influential document called The Widget Effect.
Its basic point is that it is the individual teacher rather than the school who is key to improving education, a view shared by increasing numbers of academics, think-tanks and politicians in the UK.
In the US, where many state-school teachers enjoy security of tenure and are often left largely to their own devices, this presents a problem, the paper argues. It says the evaluation of teachers by the school districts that employ them is a paper exercise that almost invariably concludes they are good, regardless of the reality.
This "decades-old fallacy" means teachers cease to be understood as individual professionals, but as interchangeable parts or "widgets", the report says. The "denial of individual strengths and weaknesses" is "deeply disrespectful to teachers" and "gambles with the lives of students".
As Mr Jupp admitted, from the time a teacher reaches tenure until they retire "we go silent".
The Obama team aims to build on George W Bush's No Child Left Behind Act, which aimed to hold all state schools accountable by insisting that they give all their pupils state-adminstered tests.
Margaret Spellings, who was education secretary under Bush, commends the Obama administration for taking forward the reform "to the great dismay of lots of their union friends".
She is particularly pleased that there is a continuing emphasis on the use of data, of which there is felt to be a dearth in America. Ms Spellings rounds on critics who oppose this: "Are these people suggesting we don't measure, that we go back to the good old days of not finding out, not caring enough to ask how our kids are doing?"
The suggestion that data can be unfair, because it compares schools in very different circumstances, is also bullishly dismissed: "Frankly, both here and in your country, my opinion is that that is pretty over- stated."
But, although President Obama wants change in the schools system, his administration is not going to take on local democracy over it. It will encourage charter schools, which have risen up as an alternative to district schools, but Brad Jupp is cautious. "We don't support charter schools," he says, "we support effective charter schools."
But they will never be more than a minority, he suggests. "Ultimately, we have over a hundred thousand schools to which we need to pay attention," he declares.
THE GATES OF POWER
Charities are playing an increasingly influential role in US education. The $35bn (pound;21.5bn) Bill and Melinda Gates Foundation is pouring billions into the schools system - money that brings a lot of power, even dictating the size of schools. It has allocated more than $250m (pound;153.3m) in subsidies that act as incentives to create smaller schools.
This means larger schools losing out, such as Pritzker College Prep, a successful charter school in Chicago. Pablo Sierra, its principal, says he will lose $750,000 (pound;460,024) of his school's $4.5m (pound;2.8m) annual budget if it goes one pupil over 600.
"Gates is so far-reaching," he added. "Every blighted urban (school) district is affected by Gates, because the foundation has targeted these districts as areas that need help, and rightfully so. And in their wisdom they have decided they need small schools. So in New York, they take schools that were made for 2,000 kids and chop them up into four."
But on balance, Mr Sierra thinks the existence of the Gates Foundation is a good thing because it encourages innovation.