A. The plan offers nothing that hasn't been rejected already.

B. And it fails to address two major cost issues.

During his recent ABC appearance, Mr. Obama gave a glimpse of his cost-containment strategy. Responding to a question, he said, "We can let doctors know . . . maybe this isn't going to help," maybe the patient is "better off not having the surgery but taking the painkiller."

Unsaid was who would be the "we" who was going to "let doctors know." But what Mr. Obama did refer to, inadvertently, was what used to be called in the early and mid-'90s - when I was a managed-care executive - medical management using "clinical practice guidelines."

This meant an actuarial company would establish an extensive database of medical procedures that were the most effective and efficient. Then the list was used by HMOs to decide the treatments patients received.

This approach was soundly rejected. The public, politicians and providers derisively referred to it as "cookbook" medicine.

Obama has merely recycled it under a new name, "evidence-based practice."

The Brookings Institution, a liberal think-tank, recently published a paper about health-care reform that made several recommendations. One was, "Use comparative effectiveness results to support innovative coverage and payment policies . . . help support novel payment policies that will be more effective at rewarding evidence-based practice."

" 'Evidence-based medicine' is the au courant term," said Dr. Celeste Mruk, of Bala Cynwyd Medical Associates. Mruk is a clinical assistant professor of medicine at Penn, and well-versed in the finances of medical services.

She began her career in the '80s with an inner-city practice. Later, she was on the board of one of Pennsylvania's largest HMOs.

Another recycled provision of the Obama proposal is increasing the role of "primary-care physicians" (internists, family practitioners and pediatricians).

"This is not the first time this has been proposed," said Dr. Peter R. Kongstvedt, a highly regarded authority on the health-care industry. He said his own career as a primary-care doctor was the result of incentives.

The Obama plan includes another staple of the HMO field. As he mentioned during his speech to the American Medical Assn., in the current system, there are incentives to do more. What's needed, he said, is to reform "the way we compensate our providers - doctors and hospitals. We need to bundle payments so you aren't paid for every single treatment you offer a patient."

Rewarding doctors for doing less was one of the concepts of the HMO Act of 1973, which established "prepaid" medicine. In the early '90s in the Philadelphia area, insurers started paying for "episodes of care" or for "diagnostically related groups." This was widely criticized as discouraging treatment, since the providers get a single payment for treating a specific complaint, whether they see the patient one time or 10. It's one of the reasons HMOs and medical management are now nearly nonexistent.

Another item that President Obama alluded to yet didn't address directly was the cost of medical education. This system creates an enormous financial burden and discourages talented people from entering the field.

A reform plan hatched in 1989 by ardent advocates of socialized medicine acknowledged that the single-payer system they wanted did nothing to address medical- school costs. The total cost of a medical education in the U.S. is close to $200,000 on average, plus the accrued interest.

New primary-care physicians can't be expected to be able to repay this when compensation for their services is being reduced. They'll go into more lucrative specialties that add to the cost of health care, or will enter other occupations that provide less work for more pay.

Obama health-care reform promises to increase coverage, decrease costs and increase or maintain the quality of medicine we now have. No one else has been able to do this - and neither will he.

His solutions aren't new.

They've been tried and rejected - or attempted and failed. Impartial, knowledgeable observers know this. The only question they have is if Mr. Obama can succeed in selling the American public old wine in a new bottle. *

Michael Tremoglie is a writer who blogs at tremoglieteatime.blogspot.com. His novel, "A Sense of Duty," is available at Barnesandnoble.com.