So it’s health care overhaul this year — or bust. If this is the bet, right now I’d put my money on bust.

President Obama’s urgency in trying to bring rationality to the broken health insurance system is understandable. Few Americans are blind to the necessity for quick action. But the trouble with the way health care 2.0 is starting to play out is that it is looking an awful lot like the original. Obama has determinedly avoided a commitment to anything resembling his own proposal. This is because the White House has concluded that Hillary Clinton’s 1994 health care revision effort failed because it was sent to Capitol Hill as diktat.

That’s a distortion, but it has become part of Washington political lore, and so the media and every succeeding administration, I suppose, must buy into it.

But substantively, the trouble the new health insurance reform effort confronts now is the elemental difficulty confronted then: There is easy agreement on what’s wrong with the current system but there is no consensus on how to fix it. Let alone on paying for whatever the “fix” is.

Not even Ted Kennedy, the Democrats’ elder statesman on health care, is moving boldly where he has gone before. He has outlined only the barest essentials for a health insurance bill — an outline that happens to include developing a public insurance option for those unable to purchase private insurance. A number of Senate Democrats — not to mention just about all Republicans — recoil at this idea, saying such a plan would compete “unfairly” with the private insurance industry. That is, a public plan would quite possibly be cheaper, more efficient to administer, and provide people with the sort of reliable and reasonably priced insurance that Medicare has long provided for the elderly. In other words, the public might find out that government-sponsored insurance works better than the corporate product.

Even among Democrats, so wide is the initial divide on this point that Kennedy and Sen. Max Baucus of Montana, who chairs the Senate Finance Committee and thus has a pivotal role to play in writing a health bill — and deciding on tax legislation to pay for it — were compelled to issue a joint statement on Saturday vowing to produce two health measures that are “similar and complementary.” We’ll find out what that means later.

Even if a public plan were created, we would then have a big legislative fight over what is included in the “basic” package of benefits to be offered. The most incendiary point would involve women’s reproductive health care — the mere mention of which sends anti-abortion activists into a frenzy. Many of them consider “reproductive health care” to be code words for abortion or routine birth control, which a vocal faction of the anti-abortion movement also opposes. This argument would necessarily take place as the earth settles over the grave of Dr. George Tiller, who was murdered at his church in Kansas on Sunday morning after decades of being targeted by anti-abortion extremists.

Even without an abortion imbroglio, wrangling over the makeup of the basic benefit would be a full-employment program for lobbyists. Should vision and dental care, which often are provided at a supplemental cost for those who now receive insurance through employers, be part of it? What about end-of-life care, the costliest medical service of all and one that many experts say needs to be curtailed if the United States is ever going to slow the rapid escalation in health costs?

And speaking of experts, they tend to disagree with average Americans (otherwise known as voters) on what’s wrong with the system. Kaiser Family Foundation President Drew Altman has analyzed this divergence in a spot-on account of polling data posted on the organization’s Web site. One example: Experts say that as much as 30 percent of current care given to patients is “unnecessary.” But 67 percent of the public says Americans don’t get the tests and treatments they need, and only 16 percent believes that they themselves have received unnecessary care.

And we haven’t even gotten to the conundrum of how to pay for whatever revisions are put in place — another full-employment program for lobbyists, with bonuses.

Congress has roughly five months of work time left during this calendar year.

Obama’s “fierce urgency of now” was a compelling campaign sound bite. But it competes, now, with the subtle yet audible sounds of stalemate.

Marie Cocco’s e-mail address is mariecocco(at)

© 2009, Washington Post Writers Group

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