Tonight, during his prime time address to the nation, President Barack Obama said, “let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.”

I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.

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Obama’s urgency is well placed. Skyrocketing health care costs are threatening the country’s economic stability and Congress cannot help American families or address the economic woes “in a lasting, meaningful way without health care reform.”

Indeed, his budget will include a “historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American.” While the budget lays out his principles for reform, Obama left the details of the plan to Congress.

Thankfully, that body has already started working on reform. In November, Sen. Max Baucus (D-MT), the powerful chairman of the Senate Finance Committee, released his own principles for health reform and has held numerous meetings on restructuring the system.

Under the direction of Sen. Ted Kennedy (D-MA), “many of the leading figures in the nation’s long-running health care debate have been meeting secretly in a Senate hearing room” and “appear to be inching towards” a consensus on what a reform bill could look like.

The stakeholders agree on several principles: reform should preserve the current employer-based system, allow Americans to purchase affordable and comprehensive coverage through a health insurance exchange, control costs by reforming reimbursement practices, invest in coordinated care, preventive care and health information technology, all the while improving care quality.

But the devil will certainly lie in the details. How will we finance reform? Will insurance companies accept new regulations of price and coverage and a new public plan that will compete with private insurers? Will the pharmaceutical industry allow for the reimportation of safe drugs? Will ideological conservatives accept a government mandate to purchase coverage? And will business groups support a plan if it mandates employers to provide coverage?

Many questions still linger, but the American public and key lawmakers are pushing for imminent health reform. During Monday’s fiscal responsibility conference, for instance, Sen. Chris Dodd, a member of the Banking Committee, said that he wants the Senate to pass a comprehensive health reform bill by Memorial Day.

Today, during an appearance on MSNBC’s Hardball, former Gov. Howard Dean (D-VT) said that a public insurance option is essential to any health reform effort:

If Barack Obama’s bill gets changed to exclude the public entities, it is not health insurance reform…it rises and falls on whether the public is allowed to choose Medicare if they’re under 65 or not. If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again.

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Progressives argue that regulated competition between a public and private health insurance plans would lower health care costs and improve quality. In other words, allowing patients the choice of a private plan or a public plan would re-invigorate real market competition. Private and public plans would have to deliver the highest quality at the lowest possible cost to attract patients.

This is certainly a familiar argument, but Dean is going one step further. He’s suggesting that a public option is a key progressive value, on par with universality and affordability of coverage. President Obama is expected to lay out his health care principles during tonight’s address. We’ll have to see if the President agrees with the Governor.

As President Barack Obama prepares to outline his vision for comprehensive health care reform in tonight’s national address, several new polls suggest that the Americans strongly support the Obama’s intention to turn the page to reforming the health care system:

- Besides the economy, health care is the domestic policy area Americans want Obama and Congress to concentrate on most. [NYT/CBS News Poll, (2/18-2/22)]:

- 72 percent favor “a program that would increase the federal government’s influence over the country’s health care system in an attempt to lower costs and provide health care coverage to more Americans. [CNN/Opinion Research Corp Poll, (2/18-2/19)]

– 66 percent of Americans that it is “the responsibility of the federal government” to “make sure all Americans have health care.” [Fox News/Opinion Dynamics, (2/17-2/18)]

But the problem is not in convincing the American people that we need reform; they’ve heard that message in 1993 and they agreed with it then. The real goal for Obama is to mobilize the public support into action for change. It’s about getting all the troops behind a proposal that lowers costs and expands coverage.

During yesterday’s fiscal summit, Obama said that he intends to educate the public about the need for health care reform by hosting a summit on health care next week:

Everybody here understands a lot of the trade offs involved in health care and that there are no perfect solutions. But in the sound bite political culture we have got, it is hard to communicate that. We think that it’s very important to have some forums….that there’s a process that the public an listen to about what these trade offs are.

Indeed, Obama can use the presidential bully pulpit to lay out the case for reform and demonstrate that he’s really serious about reforming the system. Tonight and then again on Thursday, when the administration lays out its budget priorities, he’ll have that opportunity.

During today’s HELP committee hearing on the 25 million Americans who are underinsured, Sen. Michael Enzi (R-WY) laid out the conservative solution for providing coverage to individuals who are not adequately protected against catastrophic health care expenses:

We also know that when consumers bear some of the costs of their health care, total spending is reduced. It is common sense that we are more vigilant with our own money than if someone else is paying the bill, and this is especially true in health policy. Going all the way back to the Rand study in the 1970’s, we know that reasonable cost sharing reduces spending, without adversely impacting the quality of care. Anyone needing further proof of this need look no further than our recent experience with health savings accounts. HSAs require consumers to pay for more routine services, and as a result, HSAs have seen premium increases that have been dramatically lower than other types of insurance.

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We need a private health insurance market that can deliver choices of high quality products to all types of people – not a one size fits all federally determined solution.

It’s this ideology that underlines the conservative health vision: allow Americans to buy insurance on their own and you’ll reduce health care spending. It is based on the theory that increased financial exposure will encourage patients to act like consumers, comparing quality and costs and negotiating lower prices. It also, according to the rhetoric, gives people greater control over their health care.

But Enzi is wrong in assuming that purchasing health insurance is the same as buying any other consumer good. If one car is too expensive, a consumer can chose a cheaper model or rely on public transit for transportation. But health is about life and death and high-deductible plans only discourage consumers from seeking any care, even when it is high quality or critical.

According to a survey from the Employee Benefit Research Institute, while people in such plans were more cost conscious, they were twice as likely to report delaying or avoiding care and about three times as likely to report paying a large fraction of their income on health costs as those in comprehensive insurance.

Ironically, Enzi’s solution to dealing with Americans who don’t have enough insurance is to encourage them to use even less care.