With an OnMessage Inc. poll of 2,200 likely voters in hand, GOP strategists now believe they have the ammunition they need to engage President Barack Obama and Democratic Congressional leaders more effectively on the health care debate.

A memo written by veteran Republican consultant Alex Castellanos and now being circulated to GOP leaders around the country argues that while the discussion about health care often involves access to care, patient choice and quality of care, to most Americans “reducing health care costs is health care reform.”

“Our cause,” Castellanos writes, “must be about what is driving this debate as well. Our cause must also be bringing down health care costs.”

The memo paints the health care approach being advocated by Obama and Democratic Congressional leaders as an “old, top-down Washington-centered system” that “will empower Washington to restrict the cures and treatments your doctor can prescribe for you. ... Their Washington-centered system will end up costing trillions more, not less, and bankrupting the country.”

Repeatedly portraying the Democratic plan as “risky” and “an experiment,” the memo charges that “Obama’s plan will put government in charge of the doctors you can see and the types of treatment you can receive.” It promises higher taxes, more bureaucracy and less patient control, all at the same time that it “will further bankrupt the country with trillions more in deficit spending.”

In response, the Castellanos memo urges Republicans to offer what it calls “bottom-up, common sense fixes,” including:

• “Requiring/incentivizing doctors and hospitals to post pricing and outcomes” on the Internet;

• Incentivizing insurance companies to compete with each other with “simple one page contracts/summaries,” as well as “one page reimbursement forms;”

• Protecting doctors from “frivolous, expensive lawsuits;”

• Portability of health insurance;

• Prohibiting insurance companies from denying coverage because of pre-existing conditions;

• Cutting the Washington bureaucracy to produce “big health care savings;”

• Changing the law “so any American can buy the lowest cost insurance available nationwide, not just in their states — whether from insurance companies, businesses, church groups, college alumni associations or groups like AARP.

The memo also includes a call for a “new language” for Republicans, arguing for a “patient-centered health care movement” and against a “Washington-centered plan,” a “top-down system” and “monopolies.”

But if some of the words and phrases in the memo are new, the overall thrust isn’t. Anyone who watched the fight over the Clinton health care plan in the early 1990s will remember that critics complained about the creation of a new Washington bureaucracy, higher costs and government decisions that would tie the hands of doctors and determine who could receive what treatments.

Fundamentally, Republicans believe that while the Obama White House has been politically astute in promising that people happy with their current health care plan can keep it and that any new program won’t add to the deficit or require a major tax increase, the Obama plan will result in nothing less than government takeover of health care.

And Republicans think that time is on their side, which is why the Castellanos memo insists it is crucial for Republicans to slow down what it calls “the Obama experiment with our health.”

“Even voters who support a ‘public plan’ think Obama and Congress are moving too fast, with reckless speed, risking a huge part of our economy and our health care, when they don’t know what reform would really bring,” the memo says. “If we slow this sausage-making process down, we can defeat it, and advance real reform that will actually help.”

The memo comes at a time when Congressional Democratic leaders are giving conflicting signs about what kind of legislative package they could eventually support.

Senate Majority Leader Harry Reid (D-Nev.) has praised Baucus’ efforts to strike a bipartisan deal, even signaling that he might support a plan that does not include a government-run insurance option. House Blue Dogs also continue to be uncomfortable with aspects of the House leadership’s approach.

Meanwhile, House committee chairmen are emphasizing that they haven’t bought into any deal that may be worked out in the Senate, and liberal grass-roots groups are already warning that a final bill that doesn’t include a public insurance option is unacceptable.

After months of media coverage of bank and automobile company bailouts, of stimulus spending and of growing deficits, says one Republican operative, voters seem less inclined to trust anyone — including a personally popular president, even on health care.

If Republicans can successfully convince Americans that they have a significant health care reform agenda that addresses exploding costs and protects both the quality of care and patient rights, yet doesn’t add to the deficit, require higher taxes or turn over control to government bureaucrats, they will only add to Democrats’ problems in producing a bill that can pass both chambers of Congress.

Stuart Rothenberg is editor of the Rothenberg Political Report.