On Nancy-Ann DeParles' houlders rests the Obama administration's top domestic policy goal: to cover millions of uninsured Americans, improve care nationwide and control skyrocketing medical bills that are devouring personal, corporate, and government budgets. When former senator Thomas A. Daschle withdrew from consideration for the post because of tax troubles, White House Chief of Staff Rahm Emanuel persuaded Deparle to leave the lucrative private sector and return to government. Her first gambit in the health battle illustrates the challenges DeParle faces.