I hear talk of the end of the American empire often, but I see issues like healthcare and education as superfluous in the face of a few underlying trends that provide the basis for another American century.
Healthcare reform is something we already have the levers to execute through government policy, and I believe it will happen during the next financial crisis along with entitlement reform.
On the other hand, there are certain trends that there are no obvious ways to reverse, namely demographic decline, geographic dominance, and technological innovation.
When you consider the decline of America in the face of China, for example, consider that China faces a far more serious demographic issue, and as Russia teaches us, it is almost impossible to grow economically during such a period. America's birth rate, however, is 1.8 births per woman with immigration putting the country into a healthy range.
Geographically, American is set up between the Atlantic, Pacific, and Arctic. If global warming does hit the arctic hard, we will have access to the arctic ocean via Alaska, whereas China and other regional super powers will not. In terms of energy, raw resources, and land America is also looking at self sufficiency for the next century to come.
Technologically, America draws on the best universities in the world, with cities that have external economies of scale so large that they will be hard to displace (ie SV, NYC, Boston). Not to mention we have an engrained culture that affirms those who experiment and forgives those who fail. In the technological sense I think America will succeed also.
Instead of looking at this as the end of America, I think people need to recognize that we face extraordinary problems, which we can overcome. In my own opinion, I think the highest order offence against the American people is American business co-opting the government, and as soon as we work this out, we will have a better ability to overcome issues of healthcare, education, etc.