So as the final language moves forward their leaders are focusing on two elements they hope can kill in practice what they can't kill legislatively -- the public option and comparative effectiveness.
The public option would allow people to buy into a government-run health plan if they are unhappy with private market options. Critics call Republican logic tortured -- the public option will be irresistible and government can't do anything right?
But logic has little relevance in politics. This is about messaging, a broad effort to link the bank bailouts, the GM mess, health care, and energy legislation into a message that President Obama is taking over the economy, on which they can run in 2010.
The second line of attack is a Senate GOP leadership plan to forbid use of Comparative Effectiveness (CE) research, in effect blinding the government from using industry-funded research on what works.
The idea is that CE would "ration care." As though industry were not already using CE to ration care for the insured, and millions were not being rationed out of care altogether.
Many otherwise-intelligent people, like economist and columnist Robert Samuelson, are buying these arguments. They ignore the best practices meant to cut the cost of care, insist that cutting funding means cutting service, then argue covering everyone is impossible.
Maybe. But Australia manages to do it. So do Canada, England, and every other technologically-advanced country on the planet.
Critics exist for every health care system, but no system spends as much with results as bad as ours. We pay more for care than people anywhere, yet our life expectancy is on a par with that of Cuba.
So something will pass. Whether it's useful is still up for debate.