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"The time has come, this year, in this new administration to modernize our health care system," President-elect Obama said at his December 11 press conference.

Democrats have been there, done that. Or rather, not done that. "I did try in 1993 and 1994, and I like to say that I have the scars to show for it," Hillary Rodham Clinton said at a Democratic presidential primary debate. "But I learned a lot about what we have to do." Like what?

Like, you can't do it with a closed process that produces a scary 1,400-page plan. You'll frighten "Harry and Louise," the characters featured in television ads sponsored by the health insurance industry that helped bring down the Clinton plan. Obama seems to understand that danger. "My goal is to make sure that we have everybody involved -- doctors, nurses, patient advocates, businesses, labor, everybody -- sitting around the table, Republicans and Democrats," Obama said. "This is going to be an open, transparent process."

Cost control first. Then universal coverage. That way you can reassure Harry and Louise that, in extending coverage to everybody, they won't lose anything.

Will Harry and Louise be there? Yes, said Tom Daschle, Obama's nominee for secretary of Health and Human Services and director of the White House Office of Health Reform. Daschle explained, "We will be coordinating thousands of health care discussions in homes all across the country through our website, change.gov, where ordinary Americans can share their ideas about what's broken and how to fix it."

In 1994, polls showed that most middle-class Americans were satisfied with their health care and health insurance. What were they worried about? Losing it. In one ad, Louise said, "We've been clear about the reform we want." Harry elaborated, "Private health insurance we can all have even if we've been sick, coverage we can keep even if we change or lose our jobs -- coverage we can afford."

Middle-class Americans wanted the federal government to guarantee health care, not take it over. What about the goal of universal coverage? The public supported it in the 1990s and continues to support it now. Hillary Clinton tried to make it an issue in her primary campaign. "This is a big issue between Senator Obama and me because he does not have a universal health care plan," she argued in a debate. Obama insists that his objective is the same as Clinton's -- universal coverage. But he refuses to start out by imposing a mandate, either on consumers or employers. That was a key lesson of the Clinton experience: To get to universal coverage, you cannot ask the middle class to give up what they have and like or to turn health insurance over to the government.

Obama begins from a different place. "Any plan that we have starts with the premise that rising costs are unsustainable," the president-elect said on December 11. "We can't simply insure everybody under the current program without bankrupting the government or bankrupting businesses or states."

Cost control first. Then universal coverage. That way you can reassure Harry and Louise that, in extending coverage to everybody, they won't lose anything.

The Clinton experience taught one other lesson: There needs to be a sense of crisis to get reform through Congress. That was the case in 1992 when the economy was in recession, middle-class workers were losing their jobs, and health care costs were rising rapidly. Democrat Harris Wofford had just won an upset victory in a special 1991 Senate election in Pennsylvania by asking, "If every criminal has a right to a lawyer, shouldn't every American citizen have a right to a doctor?"

By 1994, the recession had ended and the inflation in health care costs had subsided. The middle class was no longer in a panic over the issue. The moment was lost.

Now, of course, economic anxiety has risen to a new peak. The public's biggest worries are job losses, mortgage security, business failures, and the credit squeeze. And health care? At his press conference, Obama talked about small businesses having to lay off workers because of health care costs. And U.S. automakers struggling to compete with foreign companies because of those costs. The president-elect warned, "It's not something that we can sort of put off because we're in an emergency. This is part of the emergency."