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.

On the occasion of a controversial decision by a judge in a Federal Circuit Court to declare the Affordable Health Care law unconstitutional, it is a good time to resurrect my ideas for middle-of-road health care reform.

Members of Congress are deciding what to do, either legislation to save pre-existing coverage or ask another court to overturn last week’s ruling.

I post this blog, at least in part, so a partner of mine in my old lobbying and public relations firm cannot justifiably accuse of me joining many Republicans, including those who applauded the circuitous reasoning of the federal judge, of having no ideas on health care except to say “no.”

On the contrary, I have health care reform ideas. I have these based on my 25 years as a lobbyist in Oregon where I handled major health care and health insurance issues for one of Oregon’s largest employers, Providence Health and Services.

I believe that a country such as ours, with all of its various political viewpoints, should be able to solve the health care public policy challenge. Doing so will require courage and a willingness, on occasion, to risk political repercussions.

A solution can emerge if, in contrast to the Obama Administration, the goal is to produce a program somewhere in the middle, not one adopted by only one side or the other.

As columnist Kimberley Strassel wrote in the Wall Street Journal, “Republicans already agree on the general contours of a free-market proposal—one based on tax credits, entitlement reform, freer insurance markets, portable policies and fewer mandates. The internal debates are over scope and details, not approach.”

And, for me, the dutiful analyst, the key problem for Republicans is that they don’t like what should be one of the cornerstones of reform – a mandate to buy health insurance. See below for more on this.

Senior Democrats crafted the Affordable Health Care Act – it came to be called ObamaCare — in backrooms, foregoing hearings, markups, even input from their own colleagues, much less Republicans. It was an exercise in secrecy and control.

The then and now-future Speaker of the House, Representative Nancy Pelosi, because famous for one of her quotes. “We have to pass the bill so that you can find out what is in it.”

In other words, pass the 2,000 page health care bill, even if you don’t read it. Pelosi and her Democrat friends did just that.

It’s time for something different, a middle-of-the-road plan that takes into account perspectives from reasonable folks on both sides of the aisle in Congress – and, yes, there are still a few reasonable folks at the Capitol who are interested in more than their next election. They want to govern.

Here are what could be called my “four legs of the health care stool.”

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.

If everyone is not 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. If a large pool is not insured, those who do have insurance will pay more as those without insurance inevitably run into health care needs.

Think of this way. All of us who drive cars are required to have automobile insurance. If we don’t, we pay a price. 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, even if government has to pay for at least part of the coverage.

As the American Enterprise Institute has written: “Health insurance is also important for financial security. The ObamaCare replacement (if there is one) 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, many political analysts agreed that, in the recent mid-term election, fears of losing pre-existing coverage if Republicans were in charge prompted many voters to case ballots for Democrats.

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.

American health care is teetering because it relies too much on government mandates and funding. A functioning marketplace can deliver high-quality care at lower cost.

Among other things, this means that Senator Bernie Sanders’ proposal for a single payer system will – and should – crater on its own demerits. It simply will not be possible for the federal government to pay the bill for Sanders’ system or one like it.

One other feature of middle ground health care reform should rely on the fact that America offers both Medicaid and Medicare coverage. That represents a solid grounding for further reform.

If Congress and the Trump Administration move to do something different than a government, top-down ObamaCare approach, the time right to develop a system that empowers consumers to take more responsibility for their own health care and that of their families.

A political approach from the middle is the only way to achieve acceptable reform that has the potential to surmount the inevitable naysayers – and do what America should be able to do, which is to reform health care.