Unwilling to push for the strong medicine needed to fix America's health care system, a battle-weary Senate and administration appear poised to settle for health reform lite. That would be a major mistake.

The Senate and possibly the White House are unfortunately veering away from support of a public insurance option, which would make coverage more universal and drive down health care costs.

They are looking instead at setting up a system of regional, consumer-run insurance cooperatives.

But research is not encouraging about the ability of cooperatives to dramatically improve access to health insurance and put a lid on rising costs — the primary goals of reform.

The Commonwealth Fund, a leading researcher on health care issues, published a 2002 report on co-ops that had been created to help individuals and small businesses purchase insurance. Researchers found numerous failed ventures, and concluded the model did not result in lower premiums or significantly reduce the number of the uninsured.

Plans for establishing cooperatives are vague so far. But presumably each would need to recruit a board of directors, raise capital, set up administrative structures, develop information technology and get doctors and other providers on board. Each would have ongoing administrative and marketing expenses. Where are the cost savings?

Kent Conrad, the Democratic senator from North Dakota who put forth the idea of co-ops, has estimated that each would need at least 500,000 members to have clout in the market. But even a co-op of that size would be dwarfed by the larger insurance companies. WellPoint, the nation's largest insurer, covers more than 30 million Americans.

Cooperatives would be too small to bargain for cost savings with pharmaceutical companies, hospitals and physician groups. Only a government-provided health plan would have the capability to negotiate consumer-favorable prices and prompt private insurers to do the same.

It's always possible that Congress could draft legislation to make a system of co-ops workable. But doing so would require extensive restrictions on insurance firms to protect consumers and create an advantage for the cooperatives. Bipartisan enthusiasm for the idea may shrivel when it comes to working out the details.

The battle over health care reform has been long and nasty. The temptation to compromise is understandable. But Democrats, who control Congress and the White House, must not settle for a health plan that fails to grant access to all Americans and cap the runaway costs of medical care.

— The Kansas City Star

n n nIn the end, sensible end-of-life counseling proposals in health-care reform had to be dropped, because too few Americans bothered to understand what was being proposed.From a practical standpoint, consultations must be removed from the legislation to save more-pressing elements of reform. Willful distortions of optional end-of-life counseling spiraled out of control. This is not a proud moment in American politics.Financing beneficiaries' optional consultations about a range of end-of-life care is a good idea. Families need it. Patients benefit.But a well-orchestrated rumor campaign ensured this element of the plan could not survive. It became too much of a distraction.The idea that the government would stage death panels cutting care to critically ill patients is an absurdity, perpetuated by conservative publications and a woman, Betsey McCaughey, whose claim to fame is trashing Former President Clinton's health care reform.Sarah Palin joined the frenzy, proving how dangerous she would have been as vice president.Ironically, the idea for such consultations supposedly came from Georgia Sen. Johnny Isakson, a Republican. Doctors, patients and families will have to wait for a saner moment in the debate to include this important care.Sometimes, hysteria wins. What a shame for those who may not have access to information that would aid them in making excruciatingly painful decisions.