Barack Obama needs to make good on his campaign pledge to reform health care. It is not enough to throw the issue off to former Senator Tom Daschle, Obama's choice to head the Department of Health and Human Services.

Daschle says he wants to hear from us, the American people, on this issue. So we should oblige him.

Obama and Daschle have a choice: Rely on a private insurance-based plan that does little to mitigate the escalating health care crisis, or solve the problem once and for all and adopt universal, single-payer health care.

Many in Congress, the media, conservative think tanks and some advocacy groups - led by the Service Employees International Union and its business allies - are stumping for piecemeal changes.

Such a path would perpetuate the crisis and deal a cruel blow to the hopes of Americans for real reform. Those in Congress and liberal policy organizations who are embracing caution or promoting more insurance, not more care, are playing a risky game. It could jeopardize the health security of tens of millions of Americans and, in the process, fatally erode public support for the Obama administration.

Hardly a day passes without fresh signs of the health-care implosion.

Just days after the election, the New York Times reported a sharp increase in cost-shifting in employer-paid health plans, with more employers pushing high deductible plans that typically cost workers thousands of dollars in out-of-pocket payments.

Similarly, the Wall Street Journal reported a huge spike in health care premiums for small businesses, which prompted many to raise deductibles or cut coverage.

The consequences are chillingly apparent. In October, the Washington Post cited a study that found one-fourth of Americans are skipping doctors' visits, and 10 percent could not take their child to the doctor because of cost.

That same month, USA Today reported that one in eight patients with advanced cancer turn down recommended treatment because of the bills.

America is falling embarrassingly behind.

A study by the Commonwealth Fund in November compared adults with chronic conditions, such as high blood pressure, diabetes, or heart disease, in seven major industrialized countries. A stunning 54 percent of the American respondents said they were likely to go without recommended care, compared to just 7 percent of chronically ill patients in the Netherlands. Over 40 percent of the Americans spent more than $1,000 on medical bills, compared to just 4 percent of British and 5 percent of French patients.

If we adopted a universal, single-payer system like these European countries, or if we simply expanded Medicare to all Americans, we would rectify this problem.

The need is urgent. Today 46 million Americans are without health care.

Millions more are at risk of losing it during this recession. And huge numbers of Americans with insurance can't afford the cost hikes.

At some point, our government must stop subsidizing these private companies and start investing in the American people.

The time to do so is now.

The best way to get it done is to guarantee all Americans health care in a single-payer system.

Tell Obama and Daschle to support improved Medicare for all.