Health care reform is being rolled toward the intensive care unit, and Dr. Obama knows it. Heroic lifesaving measures must be taken, and quickly.

Barely a day goes by without some new setback to the administration’s praiseworthy effort to put good care within the reach of the millions of people who, when it comes to their personal health, need to rely on the power of prayer rather than the application of medical science.

  • On Aug. 13 Chuck Grassley of Iowa, the top Republican on the Senate Finance Committee, reported that the panel would excise a controversial provision for end-of-life counseling. This came amid the “death panels” panic that the GOP orchestrated among uninformed Americans, who had been told the provision would amount to “pulling the plug on Grandma.”
  • On Aug. 15 Sen. Kent Conrad of North Dakota, a key Democrat on reform legislation, said flatly that the Senate votes needed for passage simply weren’t there.
  • During the same weekend in which Conrad made his comment, President Barack Obama and two of his top aides signaled that the White House would, if necessary, sacrifice the so-called public option element in an effort to get the overall reform through Congress. Afterward, the administration said, in effect, hey, that’s not what we meant, but many media observers refused to believe that Obama had not indeed indicated he was willing to trade away the public option in order to apply much-needed grease to the wheels of the reform package.
  • On Aug. 20 House Speaker Nancy Pelosi, D-Calif., declared, “There’s no way I can pass a bill in the House of Representatives without a public option.”
  • On Aug. 21 Maine Republican Olympia Snowe — like Conrad a member of the “Gang of Six” that is negotiating the reform legislation in the Senate Finance Committee — said the public option would not be in the legislation issued by the panel and that committee members “have not had the public option on the table.” (In the wake of this Snowe report a White House spokesman appearing on MSNBC put on a bipartisan smiley face and repeated that the president was interested in working with everyone concerned and that Obama considered the public option only one part of the reform package.)
  • On Aug. 21, with Congress in recess, the president left on vacation with his family. He deserves the rest, but it’s not good news that Obama will be at his leisure as congressional opponents hammer away at reform on their home turfs.

And so it goes.

Reform faces serious trouble on both the right and the left. Conservative members of Congress are unlikely, of course, to vote for any form of “socialized medicine,” and more and more House liberals are now saying they won’t support legislation that has been unacceptably weakened. One of many recent examples of possible liberal defection came on the Aug. 18 edition of MSNBC’s “Hardball” when Rep. Anthony Weiner argued to host Chris Matthews that if a health care co-op plan took the place of the public option there would not be adequate cost saving. “[A] co-op plan won’t do it,” the New York Democrat said. Would he vote for legislation having no strong prospect of good cost saving? “Probably not.” (To see a news article that gives specifics of the public option and co-op approaches, click here.)

At this point, Obama knows he can get acceptable legislation only if he overcomes the Republican propaganda drive — a drive based in large part on exaggeration and lies — and wins strong public support for solid reform. Congressional members who want to be re-elected — and that is almost all of them — listen to the folks back home, and the loudest noises of recent weeks have come from impassioned crowds howling against reform at town hall meetings. It is imperative that Americans on the other side make themselves heard in endorsing reform and speaking out against watering down the legislation by removing beneficial clauses such as the public option.

Put another way: If there’s no strong public support, there will be no effective reform of health care this year.

Obama’s series of town hall meetings has been part of his campaign to bring the public to his side on this issue. On Aug. 19 he took another step by addressing, via two conference calls, more than 100,000 members of the American clergy and laypersons, both Jewish and Christian, in the hope that they would help sell health care reform at their synagogues and churches. Undoubtedly there is a profound moral facet to providing medical care to people who cannot afford it under the present system. Lives can depend on the quality of medical treatment and whether care was administered early enough.

Reaching out to the religious community was a sound idea. Some will argue that to lobby the clergy drills a hole in the church/state barrier. Well, perhaps, but history offers ample examples of presidential administrations using moral suasion in the churches to further political agendas. Surely the saving of thousands of lives is a matter fit for discussion with religious leaders, who, sadly, in the past sometimes have been pressed to support morally dubious actions.The president must redouble his effort to use the bully pulpit to communicate to the public that U.S. health care reform — sought at least since the presidency of Harry Truman — is long overdue. In large part Obama’s success in convincing the public will depend on his effectiveness in beating down the untruths being pushed by the far right. If he cannot quickly make his case to more Americans, true, deep reform of health care may be off the table for years. And, on the political side, if he loses on this, his presidency runs the risk of being permanently crippled.

It’s time for Obama to pull out all the stops. The president must re-energize the extraordinary grass-roots coalition that helped put him in the White House. But progressives won’t rally behind Obama until they know what they’re fighting for. The president must promise to veto any bill without a strong public option. The risk is worth the reward: Pressure on Congress from progressive Americans and moderates is the key to achieving a new system of health insurance. Liberals, showing the same vigor they displayed in helping elect the president, must turn up the heat on Congress.

It’s a shame that Congress must be blackjacked by constituents into doing the right thing, but that seems to be the reality. The House and Senate votes needed for passage of a strong plan won’t be lined up unless federal legislators are flooded with calls, letters and e-mails from back home demanding that the U.S. join the enlightened nations that provide comprehensive health care for all their citizens. This will happen only if America’s progressives lead the charge, just as they did during the last presidential campaign. They must not let any disagreements with Obama’s foreign policy stand in the way of rallying to this monumental domestic cause.

Reform hangs on two pins: whether Obama is able to reach progressives and moderates, and whether progressives kick-start a dynamic and expansive rally within their ranks.

The years of national waiting for comprehensive health care need to end now, and that is unlikely to occur if liberal voters continue to be so silent and inactive. There has been no shortage of people screaming “I want my America back” and railing against bogus claims about health care reform. We have heard from gatherings populated with near-hysterics; now let’s hear the voices of compassion and reason.

T.L. Caswell was on the editing staff of the Los Angeles Times for many years and now edits for Truthdig.

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