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The release of today's federal budget was accompanied by 8 principles that President Obama laid out for the Congress as it takes up health care reform.  The president clearly learned from Governor Schwarzenegger's failed health care overhaul in California. Whereas the Gov started with the premise of mandatory health insurance purchases, Obama begins from the bedrock of affordability and access to care.

While vague, the principles below can be fulfilled only by one long term solution -- a viable public health system option for every American like Medicare that reduces costs, creates efficiencies and provides broad coverage.  Mandatory purchases of private insurance policies, and the enormous taxpayer subsidies to the insurance industry necessary to make them available to enough people, are not on Obama's list, even though they were the non-negotiable starting point of Schwarzenegger's plan. The lack of affordability for individuals and government was what tanked The Terminator's proposal, and so the necessity of affordability for government and individuals is the starting point of President Obama's.

The campaign promises of Obama's plan at whitehouse.gov -- "Make Health Insurance Work For People and Businesses -- Not Just Insurance Companies and Drug Companies" -- include "Establish a National Health Insurance Exchange with a range of private
insurance options as well as a new public plan based on benefits
available to members of Congress that will allow individuals and small
businesses to buy affordable health coverage."

As our recent polling shows 65% of Americans support expanding Medicare to be this new public plan, and 60% support the idea even when told they would have to pay for it through payroll deductions. By contrast only 16% of Americans are supportive of mandatory purchases of private insurance when told they will have to pay if their employer doesn't and they do not qualify for subsidies.

If the president forces Congress to stick to the mandates of public opinion, Obamacare will succeed where Schwarzenegger's plan failed.

Here are the Obama principles:

• Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

• Make Health Coverage Affordable. The plan must reduce high administrative costs, unnecessary tests and services, waste, and other inefficiencies that consume money with no added health benefits.

• Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. They should have the option of keeping their employer-based health plan.

• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking— as well as guarantee access to proven preventive treatments.

• Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of
medical interventions to improve the quality of care delivered.

• Maintain Long-Term Fiscal Sustainability.
The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.