The path from the summit

It was a foregone conclusion that Thursday's health care summit would turn out to be a set piece of stagecraft in which all sides would make nice while continuing to advocate the same positions that have produced partisan gridlock over health care reform. It was, in short, a waste of time. The only benefit is that the course ahead for Democrats should now be crystal clear: agree on the bill the Senate has already passed, or modify it and send it to the president by the time-tested process of budget reconciliation.

That's the process Republicans employed 16 of the 22 times that Congress has used reconciliation since 1980 to pass major bills by a simple majority and avoid a Senate filibuster. If reconciliation was good enough for Republicans to use to pass the Reagan tax cuts and George W. Bush's deficit-financed tax cuts in 2001 and 2003, it's good enough for Democrats to use to pass vital health care reform.

Republicans have no room to gripe about the quid pro quo. The Bush/GOP tax cuts put the country $4 trillion in the hole for tax cuts that went mainly to the country's super-wealthy. The proposed health reform would cost less than $1 trillion over 10 years, and that sum would be offset by savings in the costs from changing the status-quo system that is now spiraling out of control.

It should now be evident to every observer, moreover, that the oft-repeated Republican mantra of dismantling a year's worth of work on reform and starting over with the GOP's proposed "step-by-step" approach is merely a semantic stall coined by enemies of reform and cozy allies of the current and highly lucrative health insurance industry.

As every independent health care expert has noted, reform rests on a three-legged stool: making comprehensive insurance available to all; requiring everyone to buy into the system; and subsidizing the cost for middle and lower income earners (the vast majority of working American families) to make it affordable. All legs must be put on the stool at one time; take one away, and the stool doesn't stand up.

That's why Republicans' "step-by-step" rhetoric is an empty sham and won't work: the major pieces have to come together simultaneously to make reform work. A comprehensive health insurance system cannot provide coverage at affordable, level community rates unless everyone participates in paying for the system. We can't leave out 50 million Americans (the current number of uninsured) -- and millions more if current trends continue -- and provide affordable, level rates.

In addition, we also build in efficiency standards and change the fee-for-service system that encourages the over-use of the most costly tests simply to fatten fees.

This is not rocket science, though Republicans, kowtowing to their insurance industry campaign funders, would like to make it seem more complex than that.

Indeed, every other advanced industrial nation in the world provides universal care using a similarly inclusive model, and their total health care costs are 50-to-60 percent less than America's, as a percentage of their nations' gross domestic. They spend 8-to-11 percent of GDP on health care, vs. America's excessive costs, now 17.5 percent of GDP, and rising fast.

They have secure, affordable, comprehensive, universal health care and better health indices across the board than Americans, and none of our dysfunctional insecurities of medical bankruptcy, unaffordable care, or lack of comprehensive insurance. They can change jobs or become self-employed entrepreneurs without fear of losing insurance coverage or facing the fright of living with so-called pre-existing conditions that no insurer will cover.

Americans deserve similar, affordable health insurance and secure health care, even if insurance companies have to quit giving scores of executives in each of the giant insurance companies salaries of more than $1 million annually, plus more lucrative stock options.

The challenge for Democrats now is to move forward with an improved proposals that, through reconciliation, can include a public option to compete with for-profit insurers. Americans deserve nothing less.

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