THE question is as tough and divisive as it is vital: Would enacting the Democratic version of health-care reform now be better for the country than doing nothing?
I vote yes, with reservations. So I support President Obama's strategy for moving the legislation through Congress over the irreconcilable opposition of the Republican minority, with reservations.
Ends before means: America's health-care system is broken. It needs to be remade, not tinkered with at the margins. It costs too much, works too inefficiently, and fails too often to deliver high-quality care.
It leaves too many people without access to care, until they have to visit the emergency room. It includes too many economic incentives for medical providers to treat illness rather than prevent it.
All of these problems are getting bigger by the day, as are the costs of fixing them. Demands to restart the reform debate "from scratch," after a year of impassioned national discussion, are cynical votes for the indefensible status quo.
We desperately need comprehensive reform, as an issue of national solvency as well as personal security. There won't be a better opportunity to achieve it in the foreseeable future.
I'm persuaded that the plan the President is promoting would deliver that reform - not perfectly, but well enough. It would give millions of Americans the opportunity to get good-quality insurance coverage they can afford.
Mr. Obama makes a plausible, if not bulletproof, case that the plan will pay for itself through taxes and cost savings, and would help bring down the federal deficit, at least in the long run.
The Republican approach, by contrast, would continue to allow insurers to cater to the well and ignore the sick. For all the complaints about high costs, it would do less to contain them than its advocates claim.
I respect those who argue that Washington should focus on creating jobs as its chief domestic issue during this deep and persistent recession, and should wait until the economy recovers to make big changes to the health care system. But I'd suggest that reform now would help employers by easing the burden medical providers impose when they shift to business the cost of care for people who lack health insurance.
In the way of Washington, the plan would impose its taxes and other costs immediately, while its benefits could take years to realize fully. But it would finally start to control the runaway costs not only of medical services but also of both private insurance and government programs such as Medicare.
Even though these ends are good, the means to accomplish them count too. Mr. Obama says he wants a prompt, up-or-down vote on the legislation. That's code for doing whatever you have to do to overcome Republican parliamentary maneuvers and push the bill through. Republicans suggest this strategy would be the policy equivalent of going nuclear - that it would permanently, irreparably damage relations between the parties in Congress.
This wouldn't be an issue if the President had greater influence over lawmakers of his own party. He hasn't been able to persuade House Democrats to send him the flawed but workable health care bill the Senate passed late last year. House liberals object to the Senate bill's removal of the "public option" for insurance coverage. Anti-abortion Democrats think the Senate bill doesn't do enough to limit insurers' coverage of abortions.
So the President wants to send the original bill, which passed with a 60-vote supermajority, back to the Senate with some useful proposals for changes - several of them Republican ideas. But because he knows he no longer can call on 60 votes in the Senate, he wants to use a procedure called reconciliation to enact the bill with a simple majority and avert an inevitable GOP filibuster.
Republicans say the proposed use of reconciliation would be both a destructive partisan power play and improper, since the procedure is limited to budget issues. Democrats say Republicans had no problem with reconciliation when they used the procedure several times to pass tax cuts sought by President George W. Bush.
Anyway, Democrats say, they wouldn't have to resort to reconciliation if Republicans didn't use the filibuster to enforce the tyranny of the minority. Republicans say Democrats used the same tactic when they were in the minority. And on and on. You can play "he hit me first" all day and not accomplish anything.
Opponents of reform say polls show that Americans don't want it. But when you ask them about the principles of reform embodied in the legislation, they endorse the basics overwhelmingly. What they appear to oppose most are the gridlock and posturing and acidic rhetoric that have poisoned the congressional debate.
Passage of a health-care bill this year not only would be important on its own merits, but also would show Americans that Washington still can get something done. It would be better if the effort were bipartisan. But if it can't be, do it anyway.
David Kushma is editor of The Blade.
Contact him at: firstname.lastname@example.org