Many of us first saw Barack Obama bounding onto the stage at the 2004 Democratic convention, weaving together that wonderful narrative about how we don't live in red states or blue states but that we all share the United States of America.

That riveting speech revealed Obama's preference to integrate people and their conflicting views into one storyline. He sidesteps divisive choices for the unified field.

That's what he largely tried to do in his recent Notre Dame speech, when he went into a potentially hostile audience and talked about how people of differing views on abortion nonetheless can find common purpose. To some extent, it's what he has tried to do on foreign policy. He started by talking about closing Gitmo, but he's keeping in his hip pocket some options President George W. Bush employed with enemy combatants.

The coming health care debate is tailor-made for Obama's instincts as an integrated thinker. He's trying to talk to people who are concerned about the lack of insurance for all, along with those concerned about the threat of rising costs. He knows some conservatives are nervous about reform, so he wisely argues that Medicare will continue to expand the federal debt until health costs are brought under control.

Yet this debate also runs counter to his integrationist thinking. It presents him with several binary decisions where "all of the above" won't be an option. It's either A or B.

Let's start with the most worrisome: How does he pay for the ideas he has about expanding health care?

He wants to limit philanthropic tax deductions for wealthier Americans and use those revenues to help finance universal coverage, but even congressional Democrats are shooting that one down. In fact, some are moving toward John McCain's reform idea, open to his campaign proposal to tax at least some workers' health benefits.

There are legitimate reasons to go at least partly down that route: Many companies deduct the costs of executives' lavish health plans, while small businesses that can't afford workers' insurance are denied that advantage. There's also significant money to be raised from ending even part of the tax break and using the revenues to fund a universal coverage plan.

Earlier, Obama indicated openness to the idea, but he didn't mention it last week in speaking to the American Medical Association. That may be because that reform has opponents on the left and right, which I saw in living color during one five-hour stretch last week.

One morning, a union-worker friend told me how his group is dead-set against seeing that tax exemption taken away. That afternoon, I listened in on a conference call as House Minority Leader John Boehner, R-Ohio, quickly dismissed the McCain idea of cutting the tax preference for businesses.

Yes, all payment options have downsides, so which will Obama fight for? Will he fight for his equally contentious idea about paying hospitals less money?

Without a rock-solid way to finance his agenda, he will explode the debt, which he says he doesn't want to do. So, which is more important: expanding universal coverage or controlling the growth in the federal debt?

The rap against Obama as a state senator was that he missed too many votes. Taking a pass, even if for legitimate reasons, allowed him to sidestep some yes/no choices.

Reforming our health care system doesn't afford him that luxury. While he's right that partisans like to force false choices, this is one time when he must make either/or calls. And if he chooses wrong on the payment side, the growing federal debt will make the current economic crisis look like a day at the beach.