In his State of the Union Address, President Obama had little to say about health care reform.  Without a doubt, he recognizes that the window of opportunity to elevate and secure health care in the US has now passed.  As we enter the election/demagoguery season, there is virtually no possibility that Republicans will cooperate on anything that remotely might be perceived as a success for the adminstration, regardless of merit.   With its archaic and abused 60 vote filibuster rule, it seems inevitable that the only thing to expect from the Senate is perpetual gridlock.