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Published: Friday, 10/16/2009

Leadership deficit

WHEN President Obama made his speech on health-care reform before a joint session of Congress last month, he made one bold statement that led even some of his supporters to suspect that he might be dreaming. He promised that he would sign no legislation that added a dime to the federal deficit.

With the enormous cost of reform, it seemed a worthy goal but too far-fetched to be true. As the nonpartisan Congressional Budget Office had already marked one reform bill down as a budget buster, Mr. Obama seemed to have painted himself into a corner. As it turns out, he was not giving further ammunition to the "you lie" crowd.

What he said he would do can be done. Who says so? The Congressional Budget Office last week came back with an analysis of the bill drafted by the Senate Finance Committee. The bill, which would raise the portion of Americans insured from 83 percent today to 94 percent over 10 years, would actually pare the federal deficit by $81 billion over a decade, in part by addressing the long-term growth in health spending.

Some 29 million people would be added to health insurance rolls at a cost of $829 billion. But, according to the analysis, some 25 million people would be left uncovered by 2019, about a third of them illegal immigrants.

You might think that news would give cheer to the Republicans, who have been obsessing over illegal immigrants and the budget deficit. Unfortunately, most are still sitting on their hands and pouting. As much as they jumped on the bad news of the last CBO report, they are dismissive of this one's good news, arguing that it will all be badly undone behind closed doors.

Then, as if on cue, the health insurance industry released a report that appeared timed - a day before the Senate committee's vote on the bill - to spread fear about reform's consequences. The report claims the legislation would add $1,700 to the cost of family coverage in 2013, when most of the changes have gone into effect.

Reform advocates such as AARP rejected the claim, and at least one health economist said the study had several holes. It did not gauge the impact of subsidies that would help low and middle-income people buy coverage and it did not allow for savings from the reduction in use of health services that would stem from the proposed tax on high-value, executive insurance plans.

So much for the insurance industry's desire to collaborate on a solution.

Indeed, there is much in the legislation still to be worked out, but lawmakers need to focus on the budget office's conclusion - that what Congress (at least the Democrats) is contemplating can be done responsibly.

It's a shame that none of this moves the Republicans to help. Sen. Charles E. Grassley of Iowa, the senior Republican on the finance committee, personifies the problem. "The bill spends nearly $1 trillion and still leaves 25 million without health insurance. That's not much bang for the buck."

While apparently content to let the perfect be the enemy of the good, Senator Grassley shows his contempt for those 29 million more people who will be insured. The bang in their lives is likely to be huge.

But it seems as if only congressional Republicans are committed to being obtuse. The old warriors of the party understand what is at stake. Bob Dole said he regrets that he didn't support Hillary Clinton's earlier plan. More surprising, former Senate Majority Leader Bill Frist of Tennessee, a physician, supports the effort. "I would end up voting for it," he said. "As a leader, I would take heat for it. That's what leadership is all about."

Indeed, it is, but you see none of it from the Republicans in Congress or from an industry hungry for profits, even when the news is good.

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