President Obama was right last week to publicly reengage in the legislative process to outline his health care priorities, including renewing his call for a public health insurance option for uninsured Americans and those who cannot otherwise afford coverage.

In recent weeks, the President had beaten a disturbing drum of retreat from health care reform: his senior advisors and emails from the President's political operation all started talking about health insurance reform.  Interestingly, the components of the Republican response - assuring that insurers can't deny coverage for pre-existing conditions, allowing individuals and small businesses to pool for insurance, providing assistance to those who cannot access a doctor and allowing insurers to provide incentives for preventative care - amounts to roughly the same thing: insurance reform.

Reforming within the narrow confines of the current health insurance system is not a bad idea and it can deliver some results.  In the 1990s, led by another outspoken advocate of health care reform, one state did just that.  Prior to Howard Dean's reforms of the health insurance system last decade, insurance companies in Vermont offered cheap health insurance - as long as people were and remained healthy.  But as soon as a person got sick, her premiums would skyrocket or, worse, she would lose coverage all together.  And, if a person had a preexisting condition, affordable coverage wasn't anywhere to be found.

With more and more people struggling in a health insurance system that kicked folks when they were already down, the Vermont legislature passed and then-Governor Dean signed insurance reforms that did many of the things Republicans on the national stage are now calling for - insurance companies can't deny coverage or kick people off plans if they get sick, etc.  Now, there are cheaper insurance plans in other states, but those cheap plans are only masking the same problems that Vermont's limited health insurance reforms in the 90s sought to resolve: cheaper coverage for some (usually the young and the healthy) masks ridiculously expensive or no coverage for others (the sick and the elderly).

Another state is now confronting the realities that underpin what Vermont learned from health insurance reform: You can shift the bill from one group to another, but those costs of care - expensive tests, expensive equipment, expensive drugs - continue to lurk, no matter where you try to hide them in the system.  This decade, with the support of another prominent ex-governor on the other side of the aisle, Massachusetts has aggressively pursued the next step in reform - working toward universal coverage.

Massachusetts created a health insurance exchange through which residents can purchase insurance, an idea President Obama wants to take national.  Now, three years after reforms passed the legislature, the state is gearing up to tackle the cost question.  Among the ideas Massachusetts is considering is a new model for reimbursing doctors and hospitals for care.  Currently, doctors and hospitals get paid per service - encouraging more and more care and discouraging holistic and preventative care.  Coupled with other changes in the ways we deliver care - things like electronic medical records - paying doctors and hospitals to get and keep people well could go a long way toward reducing inefficiencies and bringing down costs.  And with the price tag for health care in this country at $2.2 trillion in 2007 and climbing fast, our generation needs long-term costs of care to be part of the equation.

Interestingly, Massachusetts has a well-known model to which it can turn as it considers building a fee system based on keeping people well rather than paying per procedure.  Medicare - that government-run program - generally pays based on the diagnosis, not per procedure or by the length of a hospital stay.

Which brings me back to a public option and why I believe the President was right to stop backtracking on a public plan.  Americans should be able to choose the coverage that works best for their families, their health and their pocketbooks.  If a public plan can deliver better and cheaper care for families, then Americans should have that choice for their coverage.  If private insurance companies can get creative and innovate, then Americans should have the choice of keeping their business in or taking their business to the private sector.

But one thing is clear: No American should go without coverage and no one should be bankrupted by care.  The stakes here are higher than insurance or costs or government plans.  The stakes are higher than all the buzzwords and slogans that either side can muster.  Because the fact remains that roughly every 25 minutes, a son or daughter, a mother or father, a brother or sister, a friend or relative dies for no other reason than that, in the richest country in the world, he or she didn't have health coverage.  It was time for the President to get back in the game and it's time for this country to do better.