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The endgame

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President Obama didn’t use the “R-word,” but he effectively called on Democrats on Wednesday to use the reconciliation process to pass a comprehensive healthcare reform bill that Republicans vehemently oppose. That kind of majoritarian power play is not how we prefer to see important legislation enacted, but we don’t like the alternative either. The GOP seems wedded to an approach to healthcare reform that simply will not work, and might even make matters worse for millions of Americans. Although Obama’s proposal has flaws, it gets the basic pieces right. And the problems in the healthcare system have become so severe, we can’t afford to put off fixing them.

Opponents of the pending healthcare bills grumble that nothing so sweeping has ever been enacted through the reconciliation process, which would allow the legislation to be passed with simple majority votes. That’s crucial because Democrats couldn’t overcome a GOP filibuster in the Senate. But it’s not as if the reforms were being muscled through in the dead of night. Five House and Senate committees held lengthy hearings and markups last year, and the two chambers passed competing bills through conventional means. Reconciliation would be used only to bridge the gap.

The House and Senate proposals reflect the consensus among physicians, hospitals, insurers and other sectors of the healthcare industry that the system needs to be overhauled, not tweaked. There is broad agreement that government has to change the warped incentives in the system that reward providers for treating sick people instead of keeping their customers well, and to promote prevention, quality and efficiency. These goals cannot be achieved unless coverage is extended to as many of the uninsured as possible -- not to mention that covering the uninsured is the right thing to do.

At last week’s healthcare reform summit, Republicans insisted on pursuing half-measures that ignore the incentives that drive up costs. Their proposals also would encourage insurers to cherry-pick customers rather than spreading risks more broadly. Meanwhile, Democrats have moved steadily toward the center, abandoning the “public option,” trimming insurance subsidies for the working poor and reducing proposed taxes on employers and the wealthy.

These concessions haven’t satisfied GOP leaders, who continue to reduce the pending bills to caricatures rather than offer effective alternatives. Lately they’ve shifted the debate from substance to process, holding up as sacrosanct arcane procedural rules that aren’t even embodied in statutes, let alone the Constitution. We don’t accept the argument that an intransigent minority should be able to force a take-it-or-leave-it choice on the majority. If Republicans won’t consider a comprehensive bill, Democrats should pass one without them.

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