Even President Obama’s most fervent supporters agree that Wednesday’s prme-time speech to Congress will be a do-or-die occasion for the president to revive his flailing health-care plan–and also his presidency.

So we hope he follows the advice of Robert Reich, the former Clinton labor secretary and current University of California-Berkeley professor who calls on Obama to demonstrate “courage” and adopt a public-opinion-be-damned stance on even the most unpopular of hs $1.5 trillion tangle of proposals. Reich’s advice to Obama: Ram it through!

Here’s Reich on what he thinks Obama ought to say in front of Congress and the television cameras::

Finally, I want a true public insurance option — not a “cooperative,” and not something that’s triggered if certain goals aren’t met. A public option is critical for lowering healthcare costs. Today, private insurers don’t face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 percent higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.

Mmm, hmm–go for it, Mr. President! Never mind that, according to an Aug. 18 NBC poll, 47 percent of Americans oppose having the government compete with private insurers, while only 43 percent support the idea. Never mind that in the same poll 48 percent of respondents said a public option “would reduce access to their choice of doctors, and would lower costs by limiting medical treatment options.”

Never mind the math, either. If it’s true that three insurance companies in any of 36 states account for 65 percent of the market, each of those three has less than 22 percent of the market, hardly a monopolistic disaster. And there would be lot more competition if states didn’t require coverage to include expensive mandated treatments that many people don’t want: mental health coverage, alcoholism counseling, extra days in the hospital after childbirth, and so forth.

And yes, Medicare does reimburse doctors a lot less than private insurers. Guess what that means? Doctors are either fleeing the Medicare system altogether because they can’t break even on it, or refusing to accept new Medicare patients, as this New York Times article from April 2009 reported. Here’s what the New York Times said:

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

Here’s what the Times advises:

“If you have just moved into town and are 64,” said Dr. Jeffrey P. Harris, an internist and the president of the American College of Physicians, “it is easier for you to see a doctor than if you had just moved into town and are 65.”

So please, Mr. President, follow Professor Reich’s advice and push for a health-care system that will virtually ensure that there are fewer doctors to treat the patients. Don’t listen to those fearful Americans who think that medical care in the U.S. will substantially deteriorate. Don’t mind the fact that when voters start thinking about the prospect of paying a lot more in taxes for a lot less in medicine, both you and many Democrats in Congress could well be out of office very soon.

Because you will have shown “courage.”