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A road map to healthcare reform

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1. Use the budget. There is but one high-speed train that leaves the Capitol Hill station each year: the budget. The budget cannot be filibustered by an obstructionist Senate minority of 41. It is how George W. Bush obtained his massive tax cuts for the rich in 2001 and 2003. And it is how the foundation for reform must be laid in 2009. Not everything can be done in the budget, of course, but the key features of reform – new subsidies to help lower- and middle-income Americans obtain coverage, and changes in existing tax policies and health programs – can and should.

2. Move it or lose it. The history of major presidential initiatives shows that Obama cannot afford to wait until 2010, as some suggest, to achieve healthcare reform. To take advantage of his "honeymoon"-heightened influence and the public desire for change that emerged during the campaign, he should undertake the heavy lifting this year – the sooner, the better. President Clinton delayed releasing health legislation until late 1993, almost a year after entering office. His plan went down in flames for many reasons, but it didn't help that members of Congress had stopped worrying about the 1991 recession and started worrying about the 1994 midterm elections.

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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