Obama's promise [that people satified with what hey have now wouldn't be forced to change] sent the reform effort off the rails. It meant that efforts to expand coverage marched ahead, but efforts to fundamentally reform the system got watered down.

Instead of true reform we got a series of bills that essentially cement the present system in place. The proposals do not fundamentally challenge the fee-for-service system. They don't make Americans more accountable for their own health care spending. They don't reduce costs. They just add more people into the mess we've got.

But the president's in political hot water already. He got there trying to dodge the hard issues. He might as well be there because he's fighting for something real.

There are many people telling him to go incremental. They're telling him to just enlarge the current system a bit and pay for it by pounding down a few Medicare fees. But did Barack Obama really get elected so he could pass the Status Quo Sanctification and Extension Act?

This is not the time to get incremental. It's the time to get fundamental.