The nation was in the throes of the Great Depression when Congress debated the creation of Social Security. Progressives were infuriated that it didn't go far enough, while opponents decried it as socialism under the "lash of the dictator," as one Republican congressman of the era put it.

President Franklin D. Roosevelt got the compromise he wanted in 1935 despite widespread Republican opposition, but it was only the beginning. Over the years, it was updated and improved. Disability and survivors benefits were added, and gradually it evolved into the popular and successful (albeit financially challenged) poverty-reducing program it is today.

The incremental nature of the legislative process is something to keep in mind as Congress returns this week to rejoin the battle over health care reform. The procedural vote in the Senate on Nov. 22 demonstrated what many already knew: The Democratic coalition is a fragile thing.

To muster 60 votes in the Senate will likely require even further compromises. If the public option survives, it will be watered down like a discount cocktail at a low-rent nightclub. There are too many senators like Connecticut independent Joseph Lieberman who would willingly allow the whole thing to collapse out of self-interest or perhaps misplaced pride, and so the dilution will continue.

Small wonder that public enthusiasm for the bill has waned. Between the hysterics of the Republicans (whose views on government insurance programs seem trapped in 1930s amber) and the concessions made by the left to address internal dissent - particularly the House restrictions on access to abortion - it's a wonder that hospital emergency rooms aren't crammed with those made queasy by merely witnessing the process.

But it would be a mistake to see the health care reform movement as either being reduced to the proverbial beef-less burger or somehow on the brink of it. What has survived to this point in both House and Senate versions of the bill - and is likely to ultimately emerge from deliberations - is the essential core.

At its heart are three goals: providing access to quality health care for millions of Americans who lack health insurance today, reducing the growth in the cost of health care, and accomplishing both of without significantly adding to the federal deficit.

These are the priorities President Barack Obama set forth at the start of this process - and reiterated in September. Too many Americans are put at risk, both medically and financially, by the status quo for the country not to act boldly.

Is the measure strong enough? Not really. There is not enough reform and too much compromise to be terribly satisfied with it. But average Americans can still find much to like, from the limits on out-of-pocket costs to the guarantee of coverage for individuals with pre-existing conditions.

That's often lost in the heated (and too often nonsensical) debate over whether offering a public option - a government-run insurance plan that might attract a relatively small percentage of those who buy coverage through a state or national exchange.

Working families are suffering because they can't afford health insurance and live one medical emergency away from financial ruin. Businesses are struggling to cope with their share of the burden. Our current system is expensive and ineffective: We are not the world leader in health care that we should be.

With few exceptions, Republicans have all but deserted the public on this issue, and so it's up to Democrats and their delicate coalition to soldier on. Between the House and Senate versions of the bill lies an opportunity to make the sort of groundbreaking progress that comes perhaps once every 75 years.

Readers respond

Are we not already paying for those with no insurance through increased premiums and higher pricing at the source? I am not sure why we need to throw more money into health care.

On the contrary, we need innovative approaches for doctors to reduce their student loans, malpractice and administrative cost burdens while providing a cost structure that allows a comfortable living for providers that does not bankrupt the patient.


Passing a bill this massive and invasive is crazy. Remember the promises of Medicare (1966)? That it was just a safety net that would cost $3 billion, and only $12 billion by 1990 (even adjusted for inflation)? At the end of the day, the only way to cut costs is to cut care.


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