Time to conclude health care debate

President Obama is correct. It is time for an up or down vote on health care reform. He has challenged Democrats in the House and Senate to bridge the differences in their two bills, pass those changes through the reconciliation process, and vote.

After a year of debate, conclude the matter, one way or the other. Critics say the focus should be on jobs and the economy. Setting a course forward on health care is central to long-term economic strength. Ever higher premiums are burdening businesses and individuals. About 45 million Americans have no health insurance coverage. And the nation cannot rein in federal deficits if rising health costs remain unbridled.

Whether there is the political will in Washington to do what the rest of the Western world figured out generations ago - how to provide access to health care for all citizens - is very much in question. Republicans have opted for the status quo. They talk of starting over, of incremental changes. This is the proverbial Band-Aid on the gaping wound, the perception rather than the reality of action.

The GOP sees itself in a no-lose situation. If Democrats approve a health care bill, Republicans will hammer them in the coming election for approving a big government program. If the Democrats fail to act, the Republicans will have handed an embarrassing legislative defeat to the president and the majority. And so the minority chooses the safety of political non-action and self-interest. It may be miscalculating.

So it is up to the Democratic majority to muster the unity and political courage to act. Can the House and Senate push past differences over whether to include a public option, coverage restrictions for abortions, and methods of taxation, to reach a compromise? Will fear of election consequences persuade some from acting boldly? This may be the first-term president's biggest political test.

If the Democrats fail, they will have squandered much political capital with nothing to show for it. However, if the president has a bill-signing ceremony in a few weeks, the politics may turn in favor of the Democrats. If Republicans want to campaign on trying to repeal health care reform, to strip away the promise that millions will finally have coverage, that should be a debate Democrats welcome.

Are Congressional Budget Office projections, showing the House and Senate bills reducing future deficits, overly optimistic? The answer is almost certainly, yes. Achieving the projected Medicare savings will be difficult, perhaps impossible. The degree to which technology, preventive care and reducing redundancy can bend the spending curve is likely overestimated.

But the cost of doing nothing is almost certainly higher if the uninsured continue to turn to emergency rooms for routine care, if millions of illnesses go undetected until they reach a chronic and costly stage and if premiums continue to spike to pay for it all.

Republicans had their chance when in power to tackle the problem. They did nothing. Democrats offer a plan that will continue to utilize the private sector for insurance coverage. It mandates that all people get insurance, or pay a penalty for failing to do so, but which also offers subsidies to make it affordable. To pay for it, it taxes those entities that benefit from universal coverage, the pharmaceutical industry, medical device manufacturers, for-profit health insurance providers.

Is it perfect? No. But it is better than ignoring the problem, which the country has done for too long.