Listening to Republican rhetoric on healthcare reform legislation, one would think the Democratic leadership in Congress and President Obama were about to commit extreme violence upon the people of the United States. According to Republicans, “the American people” do not want healthcare reform as crafted by the bills that have already passed both houses of Congress. The Republican refrain is we ought to start over. In the weekly Republican address, Senator Tom Coburn of Oklahoma said Democrats intend to use a “procedural trick” to “ram through” healthcare reform legislation.

The rhetoric of ram and jam to achieve the goal of healthcare legislation mischaracterizes the status of the legislation and legislative alternatives for passing the bill. Further, to make sweeping statements about American public opinion obscures the fact that polls show that people support the particular elements of the bills and support for them goes up when they learn the details.

A poll taken by the Kaiser Family Foundation in mid-February found that 32% of the respondents wanted Congress to “pass legislation that has been approved.” Twenty per cent wanted Congress to pass provisions where there is broad agreement.” Thirty-five percent said that if a candidate for Congress opposed health care reform legislation it would make them “less likely” to vote for them (26% more likely; 36% not much difference.)

In a Newsweek poll, also taken in mid-February, when asked if they favored or opposed, “Creating a government-administered public health insurance option to compete with private plans”, 50% favored the public option; 42% opposed it; 8% unsure. Republicans are correct that people do not like the legislation that has already passed both houses. However, many American dislike it not because it is seen as some nefarious socialist “government take-over”, but rather because it does not include a public option. For these people the legislation does not go far enough. Despite the public’s reticence, Democrats plan to pass healthcare reform legislation and use the process of reconciliation in the Senate to make changes to the Senate bill that would please members of the House of Representatives.

It is important to remember that comprehensive healthcare reform bills have already passed both houses of Congress. Republicans would have us believe that Democrats intend to pass comprehensive healthcare through reconciliation. Reconciliation is a procedure in the Senate that allows for certain provisions that pertain to the federal budget to pass with a simple majority. Filibuster is not allowed so that it does not take 60 votes to stop debate on the issue. The Democrats can use this procedure to pass limited changes to the Senate bill that the House of Representatives want. One such fix is to drop the “Nebraska FMAP.” (FMAP is the Federal Medical Assistance Percentages that determine the amount of federal matching funds to go for state expenditures for certain social services and state medical and medical insurance expenditures.) I do not know whether or not a public option could pass through the reconciliation process. In sum, there is nothing”tricky” going on here.

Some observers see the divide between the Democrats and Republicans as representing a philosophical difference – small government and individualism vs. large government and communitarianism. This observation would make sense if this were the Republican argument. However, they denounce big-government within the context of blatant distortions of the facts. Coburn spoke of a half-trillion dollar tax increase; a half-trillion dollar cut in Medicare; “job killing” penalties on business; tax-payer funded abortions; and rationed care.

Taxes are necessary to pay for any new program, but the taxes are targeted. The cuts in Medicare will not diminish patient care; the penalties on business are only on those who could provide health insurance to their employees, but do not. President Obama’s proposal is “consistent with the Senate bill in that it does not impose a mandate on employers to offer or to provide health insurance, but does require them to help defray cost if taxpayers are footing the bill for their workers.”(from the President’s Proposal February 22, 2010) This, in my opinion, is fair. There will be no taxpayer funded abortions, and care will be no more rationed than it is now. As the system exists now, insurance companies ration care.

Coburn sets up several binary oppositions. Patient centered care vs. government centered; expanded options vs. expanded government; access vs. taxes; cost vs. quality. These binaries present false choices. Another way to think about government is to remember that the government is us. Government is the way we regulate behavior and define relationships within the nation through law. It is not the only kind of governance; we govern our behavior based on religious beliefs, morals and manners. However, the laws we pass reflect both national values and a nation character. Individuals comprise the government and the government is composed of each of us. And at some point in our lives, most of us will be patients. Because government plays a role in providing healthcare does not mean that medical care and medical decisions are not patient centered.

Moreover, when government is involved in providing healthcare, individuals have a say through their elected representatives what kind of basic health care they can expect. They have a say in regulating insurance companies and building a floor of coverage that is the least we expect insurance companies to cover. The current bills do much to address insurance company abuses such as denial of coverage for pre-existing conditions, caps on coverage, and recisions. Expanded options ought to and can also mean a government option.

Expanded government involvement is not necessarily evil incarnate. A government option can bring down costs and help to improve the quality of care. The good thing about the President’s Proposal and about the Senate bill is that they invest in community health centers. According to the President’s proposal, “About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care.” The “President’s Proposal invests $11 billion in these centers.” The President’s Proposal also provides for “comprehensive mental health services in community settings.” This will be a way to determine the effectiveness of wellness on bringing down health care costs.

Coburn complains of a lack of bi-partisanship. But it was the Republicans who rejected bi-partisanship. One Senator spoke of stopping healthcare reform and making it President Obama’s Waterloo. I have heard neither a retraction, an apology nor a repudiation of this remark by any Republican Congress member. Their united obstruction of healthcare legislation demonstrates a decision to defeat healthcare reform. Early on in the process there were bi-partisan efforts. The idea that voters will punish President Obama and the Democrats for pushing ahead with healthcare reform is, in my opinion, a serious miscalculation. It is a miscalculation for both Republicans and for conservative Democrats.

My guess is that most of the 30 million uninsured are voters. They no doubt have family and friends who are also voters. The millions of people with pre-existing conditions vote. People who face bankruptcy because of healthcare expenses vote. People who have been subject to insurance caps and recisions vote. Their family and friends vote. People who are working jobs they hate because they need the healthcare benefit for themselves or for their families vote. People whose insurance premiums are going up vote. Small business people who want to give health insurance coverage to their employees and can use the tax credit to do this vote. People who want to see healthcare reform pass so that this nation establishes the principle that health care is a human right that governments have a moral obligation to provide for its citizens vote. People who want the government of this nation to reflect the values of liberty and justice for all, including just distribution of health care vote. People who see health care as important to the general welfare of this nation and as an important step to taking us to a more perfect union vote.

Spiritual wisdom warns us about the pits we dig for someone else to fall into. We risk falling into these pits of our own making. Karma warns that we will receive what we give. Wisdom teaches us that we reap what we sow. Healthcare reform may well be a Waterloo, but only time can tell whose Waterloo it will be.