The health reform quandary

Congressional Democrats are on the threshold of answering an important question: Is a sweeping health care reform effort worth the risk of losing power?

President Barack Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid each have talked about, and hinted around, the possibility of simply ramming a reform bill through with the ayes of Democrats only. But they have yet to do so, for two likely reasons. One is that they don't have the votes. House members who voted for the original House bill don't necessarily like the Senate version. The other reason is that the American people don't want it. That is a reality about which every member of Congress is aware.

Obama is said to be ready to unveil his own, smaller version of reform later this week, perhaps on Wednesday. The bill supposedly will incorporate some of the items of possible compromise that emerged from last week's health care summit. That was an attempt to get Republicans to buy into this reform effort. Obama's bill likely will be a way to pressure them into coming aboard, which would give Democrats some political cover.

But the chances of this happening appear slim, and so some Democrats are talking about going it alone and calling for a simple majority vote in the Senate, not the usual 60 percent majority needed to overcome any filibuster threat. This would be done through a tactic known as reconciliation, which is supposed to be used only for items that meet certain budget criteria. Because health care reform already passed the Senate with 60 votes, this is entirely fair, Democrats say. But that argument conveniently ignores the fact that, since that vote, the people of Massachusetts elected a Republican to the Senate largely because of popular opposition to health care reform.

Polls consistently show a majority of Americans oppose expansive federal reforms. A new Gallup poll shows 52 percent of Americans oppose using reconciliation, with only 39 percent in favor. If Democrats use this procedure, Republicans are sure to pound them mercilessly on it all during the election season. If Democrats abandon the reform efforts, Obama will have been handed a huge defeat on his most important issue, and the party still is likely to lose many seats in November.

It's a difficult and complicated situation, but it's one that was created by pursuing a wrong and unpopular strategy from the start.

Many Americans agree the health care system is out of control. The answer, however, isn't a huge federal one-size-fits-all effort. It involves a combination of insurance and tort reforms, new transparency rules and incentives to encourage states to find solutions that enroll the uninsured while taking care of their own unique needs.

Changing course right now may be politically difficult, but it also might be the only way for the ruling party to save face on this issue while giving Americans what they truly want.