Anyone out there who thinks it's only Democrats who are all fired up and ready to go to do health reform this year hasn't heard from Chuck Grassley.

"If it isn't done this year, it won't be done for the next four years," the Iowa lawmaker and top Republican on the Senate Finance Committee said on Thursday. "I think it needs to be done this year."

"I'm positive we can get health reform done," he added, dismissing any notion that Congress and the president couldn't work on pulling us out of the recession while also fixing health care. If U.S. lawmakers could pass major domestic legislation while fighting World War II—long before anyone coined the term "multitasking"—they can pass health care legislation while fighting whatever it is that historians will eventually label this recession. (Particularly since the only other big item Grassley foresees on Finance's agenda this Spring may be the tax portion of an energy bill, which he didn't expect would be controversial within the committee.)

Grassley talked about health reform for nearly a full hour to reporters at the Kaiser Family Foundation. (I had a schedule conflict this morning, but the webcast and podcast are here). And he certainly wasn't promising that overhauling a $2.2 trillion health care system that leaves 46 million people uninsured would be simple. Indeed, he said several times that it would still be quite easy for someone on either side to "upset the apple cart." But he did repeatedly say health reform was necessary, and that he was willing to make compromises to get it done, as long as the Democrats were open to compromise as well.

Moreover, he said he wasn't the only Republican thinking that way. Senate Republicans have been meeting every week with outside experts to learn more about health policy. "Honestly to this point I have not had one of the 41 (Senate Republicans) tell me we should not be doing health care reform."

Now to the sticking points. Grassley said he was concerned about preserving the "doctor-patient relationship," and that any move to limit the tax break for employer-sponsored insurance would have to have a "big consensus" or it wouldn't happen. He called on Democrats to use "regular order," and not try to use rules that would require 51 votes, not the 60 typically required on controversial legislation. And he said reform would have to be paid for—although he also said he believes that savings can be found by making health care delivery higher quality, more primary-care oriented, and more efficient..

But the issue Grassley concentrated on is, no surprise, the controversy over whether to have a public plan compete with private insurers. It has the potential to be a dealbreaker, he said bluntly. But if everyone negotiates in good faith, it isn't destined to be a dealbreaker.

Grassley's concern, shared by other conservatives, is "crowd-out." That's when people leave private insurance coverage to go into public plans. That, he argued, would deplete the private sector risk pool, making private insurance unaffordable. It would be a back-door to single payer. And for Republicans, that's not acceptable. He also tried to make the case that it's counter to President Obama's promise to let people keep the health care they have because what they have would no longer be available.

Grassley said he doesn't see a compromise on the public plan right now, but the process is only beginning. He's been in politics for a long time, and has learned that compromise can come even when it's not expected. About the only issue that's not "compromisable" he said, is abortion.

(New America's health policy program director, Len Nichols, recently co-authored a paper with Jon Bertko on a potential way of structuring a public plan that might avoid an impasse and lead to a middle ground. Full paper here, two-page summary here, blog post here.)