Mr. President:

Momentum for universal health care is slowing dramatically on Capitol Hill. Moderates are worried, Republicans are digging in, and the medical-industrial complex is firing up its lobbying and propaganda machine.

But, as you know, the worst news came days ago when the Congressional Budget Office weighed in with awful projections about how much the leading healthcare plans would cost and how many Americans would still be left out in the cold. Yet these projections didn’t include the savings that a public option would generate by negotiating lower drug prices, doctor fees, and hospital costs, and forcing private insurers to be more competitive. Projecting the future costs of universal health care without including the public option is like predicting the number of people who will get sunburns this summer if nobody is allowed to buy sun lotion. Of course the costs of universal health care will be huge if the most important way of controlling them is left out of the calculation.

If you want to save universal health care, you must do several things, and soon:

1. Go to the nation. You must build public support by forcefully making the case for universal health care everywhere around the country. The latest Wall Street Journal/NBC poll shows that three out of four Americans want universal health care. But the vast majority don’t know what’s happening on the Hill, don’t know how much money the medical-industrial lobbies are spending to defeat it, and have no idea how much demagoguery they’re about to be exposed to. You must tell them. And don’t be reluctant to take on those vested interests directly. Name names. They’ve decided to fight you. You must fight them.

2. Be LBJ. So far, Lyndon Johnson has been the only president to defeat American Medical Association and the rest of the medical-industrial complex. He got Medicare and Medicaid enacted despite their cries of “socialized medicine” because he knocked heads on the Hill. He told Congress exactly what he wanted, cajoled and threatened those who resisted, and counted noses every hour until he had the votes he needed. When you’re not on the road, you need to be twisting congressional arms and drawing a line in the sand. Be tough.

3. Forget the Republicans. Forget bipartisanship. Universal health care can pass with 51 votes. You can get 51 votes if you give up on trying to persuade a handful of Republicans to cross over. George W. Eight year ago George W. Bush passed his huge tax cut, mostly for the wealthy, by wrapping it in an all-or-nothing reconciliation measure and daring Democrats to vote against it. You should do the same with health care.

4. Insist on a real public option. It’s the lynchpin of universal health care. Don’t accept Kent Conrad’s ersatz public option masquerading as a “healthcare cooperative.” Cooperatives won’t have the authority, scale, or leverage to negotiate low prices and keep private insurers honest.

5. Demand that taxes be raised on the wealthy to ensure that all Americans get affordable health care. At the rate healthcare costs are rising, not even a real public option will hold down costs enough to make health care affordable to most American families in years to come. So you’ll need to tax the wealthy. Don’t back down on your original proposal to limit their deductions. And support a cap on how much employee-provided health care can be provided tax free. (Yes, you opposed this during your campaign. But you have no choice but to reverse yourself on this.) These are the only two big pots of money.

6. Put everything else on hold. As important as they are, your other agenda items — financial reform, home mortgage mitigation, cap-and-trade legislation — pale in significance relative to universal health care. By pushing everything at once, you take the public’s mind off the biggest goal, diffuse your energies, blur your public message, and fuel the demagogues who say you’re trying to take over the private sector. You have to win this.

Your obedient servant, RBR