The window narrows for health reform

Health care reform wasn’t on Tuesday’s ballot, but it might as well have been.

The decisive Republican victories in the New Jersey and Virginia governors races have spooked at least some congressional Democrats recently elected from red districts. That may mean that the window for action on health care reform is beginning to close – and that the window may already be too narrow for the most controversial measures to squeeze through.

Yet House Speaker Nancy Pelosi and fellow congressional leaders continue to obsess about the single most controversial provision: the “public option,” a new government-run insurance plan that would compete with private insurers.

The public option seems to have an infinite capacity to inspire arguments. Lately, the arguments have focused on abortion, with pro-life forces bent on preserving Congress’ longstanding ban on federal abortion funding, pro-choice forces bent on removing all restrictions on abortion funding, and a seemingly reasonable compromise plan under cross-fire from both camps.

This is not just an argument between Democrats and Republicans; the real fight is within the House Democratic caucus. Roughly 40 Democrats won’t support a bill that looks like it expands abortion funding. If most of them aren’t on board, Pelosi can’t get a bill through.

That’s only the House. The Senate’s got its own set of issues with the shape and details of the public option. Another complication: Independent Sen. Joe Lieberman this week announced that he would join a Republican filibuster if the health care bill didn’t meet his specifications.

In the meantime, an election year looms. The prospects for anything like comprehensive health care reform are going to fade fast once vulnerable Democratic lawmakers from conservative districts start fixating on the threat of a GOP resurgence next fall.

This would be a very good time to stop focusing on the trees and start looking at the forest. Even President Obama has called the public option a small part of the plan.

A recent review by the Congressional Budget Office bears this out: It found that roughly 2 percent of Americans under 65 might wind up covered by the public option, as proposed. The CBO concluded the plan wouldn’t run private insurers out of business, as conservatives fear; it might even cost more than private plans.

That’s good reason not to fight the public option as though it were a resurrection of Stalinism. But it’s also good reason not to risk the entire package for the sake of an insurance scheme that may make little difference in the end.

Real health care reform must include three elements: 1) making coverage available to all Americans, including those with pre-existing conditions; 2) preserving the quality of care, and 3) not breaking the bank in the bargain.

A package that gets reasonably close to all three would be far better than what this country has today. A package that offers the public option, yet sadly didn’t get through Congress, wouldn’t be any improvement at all.