On this point, give a tip of the hat to the other Nelson, the unrelated Sen. Ben Nelson of Nebraska, who got the bill passed even as he struck a special—and a bit tacky—deal to protect his state. Stridently opposed to the health bill up until the 11th hour, Nelson finally traded his 60th and winning vote in return for a promise that the feds would pay for Nebraska's portion of Medicaid costs related to health reform in perpetuity. This did not sit well with other governors. Indeed, in his January State of the State address, California's Gov. Arnold Schwarzenegger went ballistic about reform that would dump huge costs on states already struggling to pay their bills. Once a supporter, he called health reform a "trough of bribes, deals, and loopholes" and challenged the state's congressional delegation "to fight for the same sweetheart deal Senator Nelson of Nebraska got for the Cornhusker State."
If the federal government were to make the Nebraska deal with every state, reform would add billions more to the federal deficit, and the president by his own promise would have to veto the bill. But if the "I'll vote for the law as long as I don't have to follow it" approach is what carries health reform to his desk, he should by his own conscience consider using his veto pen.
Clearly, fixing the Obamacare mess will take time, if it's possible at all. But one bipartisan effort that's worth tackling and is doable right away is targeted insurance regulation. Let's begin creating a health reform puzzle with this key piece: a system with no denials of access; no cherry-picking of the healthy over the sick; and, rather than one-size-fits-all coverage, an open market where people can search anywhere across the country to find the best policy at the best price for their own needs. Such change would cause insurers to compete to win the trust of, and lower the premiums for, their "covered lives" in order to keep their business. That would be real change.