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Health care critics on both sides are off base

When legislation is as long and complex as the health care reform bill finally gaining Senate passage, critics from both the left and right can inevitably find some legitimate areas for criticism.

In essence, conservatives think the massive measure goes too far in terms of extending Washington's reach and costs too much. Liberals feel it doesn't go far enough in curbing insurance companies and contains too many compromises.

But many analysts from both sides agree that, as imperfect as some parts might be, the bill would achieve substantial good by guaranteeing every American's access to health care and eliminating some of the worst current problems, such as the lack of coverage for those with pre-existing conditions.

Unfortunately, thanks to the nature of modern political discourse and much of the media coverage, these facts rarely have attracted the main attention during the months of heated debate. Instead, discussion has focused on such lesser aspects as the conservative claim that the measure authorized "death panels," the liberal argument that everything depends on including a "public option" and the heated dispute over funding of abortions.

The debate often has been further clouded by hypocrisy, misrepresentation and an air of unreality about the problems inherent in enacting such legislation.

Here are some examples:

• Republicans argued that Senate Democrats are enacting the measure in late-night sessions while most Americans focus on Christmas. They neglect to mention they forced those sessions by concentrating on delaying tactics, rather than presenting amendments to improve the bill.

• Last Sunday, a top Senate Republican, Sen. John Kyl of Arizona, charged that covering an additional 30 million Americans still would leave 20 million uncovered. Of course, if Senate Republicans had their way, none of these would be covered.

• A recurrent GOP theme has been the cost, though Republicans six years ago enacted prescription drug coverage under Medicare without paying its substantial costs, relying on a surplus they simultaneously were squandering on tax cuts and a misbegotten war in Iraq.

When the bipartisan Congressional Budget Office reported this Senate health care bill would cut the projected deficits over the next two decades, Republicans cast themselves as defenders against projected cuts in Medicare without saying that a main target, the expensive Medicare Advantage program, is seen as a significant contributor to spiraling health costs.

• Liberals denounce the Senate measure for failing to include a government-run program to compete with big insurance companies, knowing the votes were not there to pass one in the Senate. Its inclusion would have doomed the entire measure.

• They also have accused President Barack Obama and the Democrats of accepting too many compromises in provisions aimed at the insurance companies or dealing with abortion, overlooking the fact that most of this was done to attract the needed 60 votes.

• Leading figures from both parties, including such Republicans as Iowa Sen. Charles Grassley and Maine Sen. Olympia Snowe and Democrats like former Vermont Gov. Howard Dean, have called for going back to the drawing boards. In fact, it took months to construct a bill capable of passing, and Congress would not spend a second full year on this subject.

With all this, it might be a minor miracle the bill has reached the stage that both sides already are focusing on the problems that will arise in combining House and Senate versions, now that the Senate passed its bill Thursday.

Senators like independent Joe Lieberman and Democrat Ben Nelson, who only backed the measure after gaining concessions, already warn that they won't support a bill that comes back from the Senate-House conference with significant changes.

In at least three areas, one chamber or the other will have to make a major compromise: the "public option" in the House bill but not the Senate version; the rival riders defining abortion coverage; and/or the means of financing expanded health and Medicaid coverage.

For those Democrats who hope to resolve these by Obama's State of the Union address next month, forget it. It's probably going to take longer. And that will give both sides more time for hyperbole and misrepresentation before this landmark measure finally reaches the White House.

Carl P. Leubsdorf is the former Washington bureau chief of the Dallas Morning News.

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