In last night’s State of the Union address, Obama only touched on health care reform briefly. He made it clear he wants something done, but left Democrats scratching their heads about what the path forward should be. Some thoughts:

Now let’s be clear – I did not choose to tackle this issue to get some legislative victory under my belt. And by now it should be fairly obvious that I didn’t take on health care because it was good politics.

I took on health care because of the stories I’ve heard from Americans with pre-existing conditions whose lives depend on getting coverage; patients who’ve been denied coverage; and families – even those with insurance – who are just one illness away from financial ruin.

The fact that Obama mentioned pre-existing conditions is an indication that he may still push for a comprehensive bill, and has not already decided to go for something much more scaled down.

After nearly a century of trying, we are closer than ever to bringing more security to the lives of so many Americans. The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care. And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make our kids healthier.

Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.

Still, this is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, this process left most Americans wondering what’s in it for them.

This is not just a problem of Obama failing to sell health care reform. It is true that Obama could have done more to try to market reform, but an inherent problem with the Senate bill is that it is full of unpopular ideas–ideas Obama personally campaigned against.

People don’t want a tax on their benefits or a mandate forcing them to buy private insurance. Many people do want to keep the coverage they currently have, and will not be able to do that under the Senate bill because the excise tax is designed to force your employer to change your policy. Obama should know these ideas are politically toxic because he won by running against both of them.

Obama spent all year fighting to protect ideas he claimed to be against on the campaign trail, yet he did nothing to advance, and often tried to stop, very popular ideas he campaigned on like the public option, drug re-importation, and direct Medicare drug price negotiations. Obama’s many flip-flops on health care played an important role in people’s cynicism about reform. Blaming Congress and communication strategies may feel good, but it ignores a big part of the problem.

But I also know this problem is not going away. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.

As temperatures cool, I want everyone to take another look at the plan we’ve proposed.

The fact that he said, “the plan we’ve proposed” could be a sign that Obama would support the House passing the Senate bill, with or without a reconciliation sidecar.

There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.

Obama’s “let me know” line does leave open the door to a completely new bill. It could be a new bipartisan bill, or even a new pure reconciliation bill.

To Obama’s suggestion for better ideas, I think the proper response is to quote Peterr “I’ll give it to you in two words, Mr. President: Public. Option.”

I would also like to submit a three word answer: “Medicare for all,” and a one word answer, Pete Stark’s: “Americare”

This is the most painfully frustrating part of this entire health care reform effort. Obama not only refuses to point out that progressives have better ideas about health care reform, but he pretends that these progressive ideas don’t even exist at all. This is bad policy and bad politics.

If Obama did not reflexively lurch right every time Republicans came up with some new crazy lie about reform, people would be less inclined to believe the lies. The logic goes, if Democrats drop end-of-life counseling quickly because Republicans called it “death panels,” then they probably really were death panels. Why else would Democrats drop the idea so quickly?

Finally, if Obama had made a point of showing how much further to the left the vast majority of Democrats wanted health care reform to be, it would have made it easier for him to explain to the American people that the Senate bill is very much a right-of-center reform package. By never acknowledging that a large percent of the country was far to the left of Obama on this issue, he let the Republicans define his plan as extreme. Hint for Obama: if you pretend everyone to your left does not exist, then, by default, you can never be seen as a “centrist” like you crave.