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A road map to healthcare reform

If we heed lessons of the past, we can achieve universal coverage.

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3. Make Congress own it. Mr. Clinton's other big political mistake was to craft his 1,342-page bill within the White House and executive agencies, rather than move quickly to spearhead congressional action. That left members of Congress free to grandstand and stall, and made Clinton's plan a huge bulls-eye for his conservative critics. Mr. Obama should not make the same mistake. He should supply the vision; Democrats in Congress should write the legislation.

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4. Keep it simple. Finally, that vision should be simple and unthreatening. Clinton's plan had too many moving parts and too many red flags: regional purchasing cooperatives spread across the country, efforts to encourage people to enroll in tightly managed HMOs, caps on private premiums if they grew too fast. Obama resisted this temptation during the campaign, and he should resist it now.

The reforms that Obama called for during the campaign had three key elements: (1) lowering the cost of health insurance for workers who have it, so employers continue to provide good job-based benefits, (2) creating a new national insurance pool that allows those without such benefits to buy coverage as good as that received by members of Congress, and (3) the creation of a new public plan modeled after Medicare that would be offered within this pool to provide a secure guarantee of coverage for those who now lack it and to drive down costs while improving quality. Those are still the right elements, and Obama should push for them quickly.

The great unanswered question is whether a public disillusioned about politics can be brought to kindle some faith in their leaders and their government. Nearly two-thirds of Americans say they believe in government action to universalize health insurance, even if it means an increase in taxes. And most (85 percent in a Pew Research Center poll last month) say they want reform to be a "top" or "important" priority. Similar sentiments helped bring healthcare to the top of the agenda in the early 1990s, and reformers are on the verge of having their moment in the sun again. If they heed the lessons of the past, they have a real opportunity to finally seize the moment.

Jacob S. Hacker is codirector of the Center for Health, Economic, and Family Security at the University of California, Berkeley, and a fellow at the New America Foundation. He recently edited "Health at Risk: America's Ailing Health System – and How to Heal It."