PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as a Congressional press secretary in Washington, D.C., an Oregon state government manager in Salem and Portland, press secretary for Oregon’s last Republican governor (Vic Atiyeh), and a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

In the aftermath of an often-angry mid-term election, it’s hard to know what’s next for health care policy directions, even though many election prognosticators suggested that results turned on health care issues.

Over the last few days, I have engaged in interesting, not to mention friendly, discussions with a friend of mine who favors a single payer system. I don’t because, if nothing else, I believe such a system would bankrupt the country, or, at least, bankrupt other important federal responsibilities.

Does that mean nothing can be done? No.

There is much that can be done, but one of my notions, in the aftermath of the election, is that not much is likely happen in Congress where leadership will be split between Democrats in the House and Republicans in the Senate.

Plus, we’ll be stuck for at least two more years with a buffoon in the White House.

I wish reasonable minds in Congress – yes, there are some – could get together to craft an approach from the middle. Not Obamacare, which garnered only Democrat votes when it passed several years ago. Not the Republican alternative because there wasn’t an idea other than overturning ObamaCare.

Given all this, when I suggested to my friend that federal inaction would leave room for state initiatives, he was skeptical. Here is what he wrote in an e-mail to me:

“You and I know this cannot be solved at the state level. It has to be imposed by Congress to have the leverage and mandates required for a successful scheme. Universality is not just a desired feature, it is an absolute must to work. Wish it could be resolved locally but I think that is a fool’s mission.”

Point made.

But, still, I hold out hope that legislators in a state like Oregon could develop something useful. The state has a tradition of finding middle ground on various health care issues, though the main leader, former governor John Kitzhaber, is no longer in the game, at least from the standpoint of holding a public office.

As an aside, there have been reports that Kitzhaber is trying to get back into the health care policy game, not by holding public office, but by making health care speeches, though usually not in Oregon. My view is that, if he were to insert himself more directly into the Oregon debate, he would turn off many who believe, at best, that his time has passed.

If true, that leaves room for other leaders to emerge.

With the Democrats in super-majority control of both the Oregon House and the Oregon Senate, it is not clear that leaders will define health care as a major issue. One wag suggested this will be true because the Ds will be more interested in passing new, higher taxes than crafting policy in such areas as health care.

I say, who knows?

But, while this may be plowing some old ground, I add that I have thought about the health care debate in the past and wanted – both then and now – to have ideas to drown the accusation that centrists like me have nothing to propose. So, here goes.

1. It won’t be popular in some quarters, especially with some Republicans, but, first, a critical component of reform is to require all citizens to have health insurance, either by buying it if they can afford it, or by having it provided by government if they cannot.

Without everyone in the to-be-insured pool, any system will collapse, much as occurred with ObamaCare. The very rationale for insurance is that the largest pool possible should be covered in order to spread the risk.

Think of this way. All of us who drive cars are required to have automobile insurance. If we don’t, we pay a price. While the analogy could break down, the same policy should exist for health insurance.

2. Second, a catastrophic health insurance plan should be provided so that those who cannot afford regular insurance have an option for a lower-cost plan.

As the American Enterprise Institute has written: “Health insurance is also important for financial security. Any plan should make it possible for all people to get health insurance that provides coverage for basic prevention, like vaccines, and expensive medical care that exceeds, perhaps, $5,000 for individuals.

“Those Americans who don’t get health insurance through employers, or Medicare and Medicaid, should be eligible for a refundable tax credit that can be used to enroll in a health-insurance plan. The credit would be set at a level comparable to the tax benefits available to individuals with employer-sponsored insurance plans. The subsidy would be enough to make a basic level of catastrophic coverage easily affordable for all Americans.”

3. Third, any new middle-of-the-road health coverage approach should accommodate people with pre-existing health conditions.

I have mixed emotions about this because, inevitably, the price of insurance will go up with the added risk of covering pre-existing conditions. Yet, there is a reasonable social consensus that people should not be penalized financially for health problems largely outside of their control.

And, to put a point on it, controversy over pre-existing conditions roiled many recent election races for seats in Congress. Many Ds alleged that Rs were out to leave those with pre-existing conditions out in the cold. It wasn’t necessarily true, but with political advertising, truth is a feeble goal.

4. Fourth, any new plan should allow broad access to health-savings accounts (HSA). ObamaCare pushed millions of Americans into high-deductible insurance without giving them the opportunity to save and pay for care before insurance kicks in. There should be a one-time federal tax credit to encourage all Americans to open an HSA and begin using it to pay for routine medical bills. And HSAs, combined with high-deductible insurance, could be incorporated directly into the Medicare and Medicaid programs.

As millions of consumers begin using HSAs, the medical-care market will begin to transform and deliver services that are convenient and affordable for patients.

While I am not advocating this specifically as part of my proposal, I believe consideration also should be given to deregulating the market for medical services.

As I wrote above, HSAs will empower the demand side of the market, but suppliers need freedom from overly-aggressive regulation to provide packages of services better tailored to individual needs, not government mandates.

Hospitals and physicians should also be allowed to sell access to their networks of clinics, oncology services, and inpatient facilities as an option to be used in the event a patient is diagnosed with an expensive illness.

American health care is teetering because it relies too much on governmental mandates and funding, a problem that would be exacerbates by a single payer system along the lines of what socialist senator Bernie Sanders is advocating.

A functioning marketplace, with even-handed federal government oversight, can deliver high-quality care at lower cost.

Well, that’s my opening gambit. If my wife read this, as she often does, she would add another proposal…this: Every citizen who owes taxes should pay those taxes, which, like the expanded insurance pool option, would help to fund real health care reform. By “everyone,” she includes the current occupant of the Oval Office and, at the moment, knows whether he pays taxes or, at least, how much he pays.

So, I say let the health care debate begin – both in Salem and in Washington, D.C.