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Do the Right Thing

A message to House Democrats: This is your moment of truth. You can do the right thing and pass the Senate health care bill. Or you can look for an easy way out, make excuses and fail the test of history.

Tuesday’s Republican victory in the Massachusetts special election means that Democrats can’t send a modified health care bill back to the Senate. That’s a shame because the bill that would have emerged from House-Senate negotiations would have been better than the bill the Senate has already passed. But the Senate bill is much, much better than nothing. And all that has to happen to make it law is for the House to pass the same bill, and send it to President Obama’s desk.

Right now, Nancy Pelosi, the speaker of the House, says that she doesn’t have the votes to pass the Senate bill. But there is no good alternative.

Some are urging Democrats to scale back their proposals in the hope of gaining Republican support. But anyone who thinks that would work must have spent the past year living on another planet.

The fact is that the Senate bill is a centrist document, which moderate Republicans should find entirely acceptable. In fact, it’s very similar to the plan Mitt Romney introduced in Massachusetts just a few years ago. Yet it has faced lock-step opposition from the G.O.P., which is determined to prevent Democrats from achieving any successes. Why would this change now that Republicans think they’re on a roll?

Alternatively, some call for breaking the health care plan into pieces so that the Senate can vote the popular pieces into law. But anyone who thinks that would work hasn’t paid attention to the actual policy issues.

Think of health care reform as being like a three-legged stool. You would, rightly, ridicule anyone who proposed saving money by leaving off one or two of the legs. Well, those who propose doing only the popular pieces of health care reform deserve the same kind of ridicule. Reform won’t work unless all the essential pieces are in place.

Suppose, for example, that Congress took the advice of those who want to ban insurance discrimination on the basis of medical history, and stopped there. What would happen next? The answer, as any health care economist will tell you, is that if Congress didn’t simultaneously require that healthy people buy insurance, there would be a “death spiral”: healthier Americans would choose not to buy insurance, leading to high premiums for those who remain, driving out more people, and so on.

And if Congress tried to avoid the death spiral by requiring that healthy Americans buy insurance, it would have to offer financial aid to lower-income families to make that insurance affordable — aid at least as generous as that in the Senate bill. There just isn’t any way to do reform on a smaller scale.

So reaching out to Republicans won’t work, and neither will trying to pass only the crowd-pleasing pieces of reform. What about the suggestion that Democrats use reconciliation — the Senate procedure for finalizing budget legislation, which bypasses the filibuster — to enact health reform?

That’s a real option, which may become necessary (and could be used to improve the Senate bill after the fact). But reconciliation, which is basically limited to matters of taxing and spending, probably can’t be used to enact many important aspects of reform. In fact, it’s not even clear if it could be used to ban discrimination based on medical history.

Finally, some Democrats want to just give up on the whole thing.

That would be an act of utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care — remember, both houses of Congress have already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual.

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I am going to write to Paul Krugman.
Well  Paul, stop and smell the coffee for a change!  It is not about A health care reform bill, it is about what is on the table.  We the people are fed up Paul, and we do not want what is on the table.  It is time to start over and get to a real bipartisan bill that has cross-border competition and reduces cost and perhaps also addresses tort reform, once again addressing cost.

If the House passes the Senate bill, it would make progress in one direction that would be impossible to undo. How many amendments would it take to get to the correct solution Paul?