Barack Obama opened the March 5 White House forum on healthcare on a promising note, describing action on the issue as a moral and fiscal imperative. “Our inability to reform healthcare in the past is just one example of how special interests have had their way, and the public interest has fallen by the wayside,” he cautioned. “And I know people are afraid we’ll draw the same old lines in the sand and give in to the same entrenched interests and arrive back at the same stalemate we’ve been stuck in for decades.”

Ironically, Obama delivered this message to a room of “stakeholders,” many of whom represent those “same entrenched interests.” House Republican Joe Barton was there to brag about blocking reforms in the 1990s. Big Pharma CEOs were accorded prime speaking slots. So was the president of America’s Health Insurance Plans, the trade group that battered reform proposals in the ’90s with those noxious “Harry and Louise” ads. (See also Christopher Hayes on prominent opponent Rick Scott, on page 4.)

Meanwhile, the doctor who heads Physicians for a National Health Program–which would replace the for-profit model with the single-payer, publicly run program Obama has said he’d prefer if he were “designing a system from scratch”–was let in only after intense lobbying and was kept far from the microphones.

When it comes to healthcare, we’d be delighted if Obama decided to start from scratch. This magazine has long supported the development of a single-payer plan, the most efficient and equitable repair for a system that leaves close to 50 million Americans uninsured and at least 40 million underinsured, and that costs far more to maintain than those of countries with national healthcare programs. But the president is not going to go there–at least not yet. Determined to avoid the mistakes of the Clinton era, Obama is bending over backward to make initial discussions transparent and inclusive, if also vague. The White House wants Congress to take the lead on drafting a plan–as it did with the stimulus package, which started strong in the House, took a hit in the Senate and was approved with a push from Obama. This gambit makes tactical sense. No matter what the president proposes, healthcare reform won’t go anywhere without a Congressional buy-in, as the Clintons learned the hard way.

There have already been good moves on the Hill. House Appropriations Committee chair David Obey tipped his hand in January when he proposed to subsidize healthcare for older workers until they become eligible for Medicare. This complements a smart strategy long championed by Congressman Pete Stark, chair of the health subcommittee of the powerful Ways and Means Committee, to build on Medicare’s success as the “preferred approach to universal coverage.” And Senator Edward Kennedy, still a dominant player in the debate despite his own ailing health, is talking up a plan under which “all citizens would have the option of remaining in their employer-based plans or joining Medicare–a program which has earned the trust of the American people.”

Any proposal will face a fight. Congressional reformers should not compromise at the outset or allow opponents to frame the debate. Despite what the fearmongers say, a government-run option along the lines of Kennedy’s plan would be cost-efficient, effective and far superior to the profit-driven mess we’re in. Obama campaigned on universal coverage and has budgeted $634 billion to get reforms going. Congressional allies should match that with a proposal that puts Americans’ health needs ahead of private interests.