Compared to his energy initiatives with visions of a nation going hydrogen in twenty years, the President’s health care proposals seemed tame. Indeed, the President offered no new initiatives on health care. Instead he proposed to continue supporting the buildup of the health care equivalent of the Web — a broadband-based system of sharing all sorts of information on health care — and making incremental changes in existing programs and tax regulations that will allow people to invest (tax free) in their own health and increase the range of health plans they can choose from. There was no defense of his health care proposals as there was for other aspects of his agenda.

That was a shame. The President could have framed the health care debate in powerful terms and reached out to those core voters who would benefit most from being able to choose their own health plans. There are 35 million Americans who either run small businesses or are self-employed Americans and who pay the highest price for health insurance. Democrats offer these people Medicaid. The President offers them freedom and more.

Health savings accounts are a middle class tax cut and means for providing continuous health care coverage for millions of Americans who want to change jobs, start a new life, work from home, care for a loved one, etc. The President is proposing to deduct expenditures on insurance and out-of-pocket expenses as long as they purchase at least insurance against medical catastrophes. This would give individuals the same tax breaks that big corporations now have when buying health care, which by the way is the Democrat approach to making health care affordable. Many other small improvements can be made to HSAs. One in particular the President should have mentioned and recommended is allowing families to meet the individual deductible requirement for HSAs ($1,000) instead of the family contribution of $2,000.

Second, the President could have framed the choice debate in starker terms: the private sector is quicker to adopt and use the best technologies to extend life and reduce costs. Those who oppose tax-free accounts are opposing not only freedom but better health. He could have talked about the woman, on Medicaid because her multiple sclerosis forced her to stop working, who was denied access to a drug prescribed by her doctor that ironically would have allowed her to return to work. The reason? Medicaid focused only on the price of the drug, not the value of its benefit to the woman. He could have compared that to the private health plans that are using a combination of medical information technology and new drugs to reduce total health spending. He could have talked about the increased investment individuals with HSAs are making in wellness and preventive care. Just as the American economy grows when people are allowed to keep their own money through tax cuts, so too will the health of the nation improve when people are free to seek out the care that is right for them.

That’s about a paragraph and two minutes more on health care than the President spent last night. But going on the offensive on health care — while not the defining issue in 2006 — could have helped solidify support for Republicans in key areas and given the President a head start on an issue he cares deeply about. It’s still not to late but there is little time to waste.