Today, nearly 50 million Americans lack health care coverage, the average American is often one serious illness away from financial ruin and every year nearly 20,000 Americans die because they don't have health insurance.

Yet last week, when President Barack Obama gave a nationally televised news conference to explain his health care policies, he focused on two narrow questions that are defining the health care debate in Washington: "What's in this for me?" and "How does my family stand to benefit from health insurance reform?"

For a president who speaks regularly of the national urgency in reforming America's health care system, these questions are hardly reflective of that critical effort. Instead, Obama must explain to Americans not what's in it for them but what's in it for all of us. In short, the president must demand of the American people that they be willing participants in realizing the change he believes the country needs. By framing the health care debate in the cold terminology of efficiency, cost containment and, above all, self-interest, the president is failing to make the moral case for reform and is constraining the ambition of his own domestic policy goals.

Take, for example, the current debate on how to foot the $1 trillion price tag for reform. Since polls show opposition to taxing employer-provided plans, that idea has been dropped; so, too, has the president's proposal to limit tax deductions on charitable contributions. A proposal to pay for health care reform by imposing a surtax on those making more than $250,000 a year is being furiously opposed by Republicans and Blue Dog Democrats.

While such a surtax may be an appropriate way to pay for health care reform today, it's a solution that places the burden for reform on a minority of the country -- it fails to ask all Americans to do their part -- and glosses over the changes that Americans will have to accept for health care reform to succeed.

When asked whether Americans will have to sacrifice for the sake of reform, the president replied, "They're going to have to give up paying for things that don't make them healthier." But while this may improve care, it represents a significant shift in the mind-set that defines the current patient-doctor relationship.

For uninsured Americans, health care reform represents a bonanza. For millions of other Americans (many of whom like their health care coverage), reform will mean more in the long term but potentially less in the short term: fewer tests, a demand for changed lifestyles and, as Obama suggests, a more "discriminating" approach to the health care system.

For doctors, reform could mean less take-home pay; for small businesses, new mandates; and for insurance companies, more government regulation and greater competition.

In short, all members of the health care ecosystem will have to change their behavior so that, in the end, the overall system will be more efficient and more effective. But such a change involves sacrifice. By placing the burden for reform on the wealthiest Americans -- and focusing on "what's in it" for Americans -- the president and his Democratic allies risk cultivating the notion that reforming the health care system can be done on the cheap with minimal sacrifice.

This is not unintentional. The president has sought to reassure Americans that nothing will change for them with reform. But if Obama's goal is far-reaching and not incremental change, then inevitably he is going to have to ask Americans to give something of themselves for the greater good. It's foolish to think that there can be serious policy changes that don't involve someone's ox getting gored, whether the issue is health care, climate change or any other policy shift that will have an effect on the way Americans live their lives. Obama clearly wants to be a change agent, but he's not pushing Americans to do their part.

For a politician who rose to prominence by using the force of his words to inspire and energize millions of Americans, such a call for sacrifice and citizenry responsibility has been strikingly absent from his rhetoric. During his campaign for the White House -- and even in his inaugural address -- Obama showed little inclination to merge patriotic devotion with civic responsibility, à la John F. Kennedy or even Lyndon B. Johnson. The result is a debate on health care focused on making the system more efficient rather than more fair.

In his election night victory speech, Obama said, "Let us summon a new spirit of patriotism, of responsibility, where each of us resolves to pitch in and work harder and look after not only ourselves but each other." The time has come for the president to demand of his fellow countrymen that they help make that pledge a reality.