I agree with the President on the basics:

"Health care reform is no longer just a moral imperative, it's a fiscal imperative."

"When it comes to health care, the status quo is unsustainable and unacceptable. So reform is not a luxury. It's a necessity...."

So far so good.

Where we part company. Why I cannot support his current plan.

The President often engages in sloppy thinking and lazy rhetoric in pursuit of his political goals. Perhaps he does this because he holds his audience in low esteem. Perhaps he does this because he can. Perhaps there are other more compelling explanations.

No matter, the President loves the straw man, and he loves the false choice.

Quoting the President:

"We also know that there are those who will try and scuttle this opportunity no matter what - who will use the same scare tactics and fear-mongering that's worked in the past. They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors."

I hate it when those guys show up. They are always up to no good. Their goal is always the same: work against the public weal for the special interests. Seriously, and forgive me for the repetition, this president engages in this brand of straw man sophistry way too much. This is a continuing disappointment for me. He should abandon this low road of public discourse.

Does he have a point?

True, conservatives worry that this massive government intervention into health care is the first step to socialized medicine (better known under the euphemistic umbrella of a "single-payer system").

Is this just another example of the paranoid strain of American politics? Are conservatives merely blurring the real issue with scare tactics concerning an unlikely eventuality?

Here is one very personal reason I think not: EVERY thoughtful liberal I have ever met has eventually admitted to me that European-style or Canadian-style national health care is exactly what they wanted--if not now, eventually.

Why? In general, my liberal friends tend to see government-guaranteed universal health care as the "smart" and humane solution. In fact, I hear plenty of discontent that the President is not asking for the "whole enchilada" right now. The grousing is often tempered by the consolation that this half-measure is merely what is politically possible at this moment. But, rest assured, they tell one another, we're gonna get there eventually. This is no secret. National Health Care has been a staple for Democratic Party platforms and public policy since FDR.

The President, who fancies himself an honest man steeped in nuance, ought to deal with this question more frankly. But don't blame conservatives for viewing this latest installment of a long running national drama in the context of a much larger philosophical-political discussion.

President False Choice.

"So the notion that somehow we can just keep on doing what we're doing, and that's OK, that's just not true. We have a long-standing critical problem in our health care system that is pulling down our economy. It's burdening families. It's burdening businesses. And it is the primary driver of our federal deficits. All right?

"So -- so if we start from the premise that the status quo is unacceptable, then that means we're going to have to bring about some serious changes."

Translation: either you are FOR my plan or you are against reforming health care. My way or the highway.

Sound familiar?

Either you are for my $787 billion stimulus bill or you are for doing nothing to combat this recession.

These are false choices. There are other options.

True enough, we are in a health care crisis--and it is a crisis of sustainability. True enough, the health care debate has shifted beneath our feet.

Why? The Party is Over.

One day, we will look back wistfully on this moment and recall our privileged status regarding health care in America. Although we have NOT spent a lot of time appreciating the wonder of the current system, the vast majority of us have been privy to the best-trained physicians, the most advanced medical technologies, and the most comprehensive network of doctors and facilities ever assembled in the annals of medical history.

Those days are necessarily coming to a close. WHY?

Not because of the humanitarian impulse. For decades, we have been very close to totally deaf to the sad refrain of "forty-something million uninsured" fellow citizens. Why so unresponsive?

Two Reasons: the claim is mostly a distorted and transparent political manipulation; and, more importantly, the vast majority of us were thriving under the status quo. We are not a blindly utilitarian society, but when the great bulk of the citizenry are prospering under a given regime, they are loath to sacrifice their advantage for a disadvantaged minority. In that regard, nothing has changed. Collective compassion will not be the impetus for the massive change in the offing.

What is different this time?

The UNSUSTAINABLE rising costs.

Ironically, we are victims of our own success. The wonders of medical research and development and production have outdistanced our financial resources. Most of us assume we are inherently deserving of the very best and most-advanced medical care. Ironically, conservatives even more than liberals seem to have swallowed this sense of entitlement when it comes to health care. Unlike products in our consumer culture where we make choices commensurate with our ability to pay, most of us assume that we are due the very best health care available regardless the cost.

In this way, the one-payer system is completely disingenuous. As a society, we CANNOT afford to pay for health care through government agency anymore than we can afford our current system of health care as an employee benefit. It is just not credible to believe that we are going to provide coverage to fifty million extra people and pay less money through the magic of bureaucratic streamlining. Something has to give. The obvious solution is cost control, which means rationing care, which means the Golden Age of carte blanche health care is concluding--no matter which road we take.

How we get there remains undetermined, but the ultimate destination is certain.

We can no longer enjoy unlimited health care regardless of our ability to pay. Socialized medicine is one way to combat this economic problem. In fact, socialized medicine is probably a less painful way to inaugurate the era of limits than doing nothing. Socialized medicine means a lot of changes that we will not view as positive--but this may be unavoidable. However, it would be nice if Democrats would be straight with us about the real problems and their actual proposed solution.

Having said that, I still cannot support this framework at this time. The planned Obama-Pelosi cram-down is an impending disaster; it is bad politics for them and for us. It is a drastic and irrevocable step. We would be better off defeating this attempt at social revolution and waiting for a moment when there is more political equity and, therefore, more honesty and more bipartisan buy-in. Also, the crisis may not be at a point in which the sense of urgency is such that partisans are actually willing to come together for the common good. This is one of those cases in which both parties need to come to terms and go forward with a compromise solution. There are better ideas out there. We need to wait for an atmosphere more conducive to positive change.