The Republicans can do a Nixon-goes-to-China by offering a better version of universal coverage. There is, after all, substantial concern about the Democrats' reliance on universal coverage through a government-controlled system like Medicare. Some distrust government's ability to make good on its promises. Medicare currently owes $36 trillion in services to those who paid for its use when they hit 65. Have you seen a spare $36 trillion hanging around? (For perspective, that amount is equivalent to about three years of US GDP.)

Another concern is that government will control costs by rationing health care to the sick. The government-controlled UK health care system, for example, has the lowest uptake of cancer drugs among the five biggest European economies and correspondingly low cancer survival rates. Concerns about rationing are not demagoguery. How else can a government control costs? Many experts dismiss as wishful thinking the Democrats' claims of achieving efficiency by implementing dazzling information technology and other technocratic tools. And because the truly sick constitute only 20 percent of health-care users, but account for 80 percent of health-care costs, they may as well wear a bull's eye on their backs: they are a politically vulnerable target for cost control through rationing.

Transforming the government into a monopolistic buyer of health care will also affect the supply of doctors. All too many doctors, saddled with massive educational debts, refuse to see Medicaid patients because they are pay so little. But if government were the only payer, some prospective physicians, facing the prospect of incomes totally controlled by the government, would reluctantly enter other professions.

Finally, a government-controlled system would likely impair the medically and economically important genomic sector. US venture capitalists have provided billions for research that may provide cures or even preventions for genetically linked diseases. Kiss that money -- and the important personalized medicine industry it could create -- goodbye under a system of government-controlled universal coverage. Venture capitalists will find it too risky to invest in markets where one payer controls prices.

The Republicans could instead offer a consumer-controlled universal coverage system, like that in Switzerland, in which the people, not the government, control how much they spend on health. There are no government health insurance programs. Instead, the Swiss choose from about 85 private heath insurers. Rather than being stuffed into the degrading Medicaid program, the Swiss poor shop for health insurance like everyone else, using funds transferred to them by the government. The sick are not discriminated against either -- they pay the same prices as everyone else in their demographic category. Like the US, Switzerland is a confederation of states that, as in the US, oversee the insurance system. Enforcement by the tax authorities has produced 99 percent enrollment.