They say speed kills, but nothing will kill America faster than foot-dragging on health reform. The country is traveling head-long toward fiscal and systemic oblivion under current conditions, yet our leaders are bogged by endless discussions about which countermeasures to endorse.

President Barack Obama, in a meeting in Cleveland on Thursday, drew laughter in noting that reforming health care has been talked about since the Truman administration. While this might be a great punchline, it’s nothing to joke about. What other policy takes a half-century to debate?

Talk about a filibuster.

Stalling for another day, week or month to consider revisions to the health care reforms now before Congress only brings America that much closer to an ugly end: more citizens lacking heath insurance, more bankruptcies due to medical expenses, more social safety nets disintegrating.

Time is immaterial. The metrics of importance are cost containment and universal coverage — in that precise order. State and federal initiatives for the latter have been easily enacted, like the much ballyhooed policies in Maine and Massachusetts, only to be eventually victimized by the former.

They’ve toppled under their cost. That’s the story of Maine’s Dirigo Health, which six years into its existence has fewer than 9,400 enrollees, a far cry from universal coverage. Its revenue never supported its operations, a fundamental flaw in an otherwise laudable, but far too grandiose, policy notion. 

Only this year, with a new tax on private health insurance claims promising $38 million in revenue, may Dirigo find the fiscal sustainability it’s never had. Or, if Congress acts, it could find itself moot. 

In Massachusetts, a trailblazing first-in-the-nation program of mandated health insurance coverage has been a rousing success. The state has a mere 2.6 percent rate of uninsured, best in the country. (Maine by comparison is about 10 percent.)

Yet the cost monster has arrived. According to USA Today, the price of this near-universal coverage to taxpayers has been an additional $600 to $700 million per year. Then, the recession’s double impact — lower tax revenue and the increased utilization of public insurance — has thrown the Bay State’s budget into turmoil.

So much so, in fact, that Massachusetts officials are attacking the oft-blamed villain of health care in response: reforming “fee-for-service” payments to medical providers, which would ostensibly remove any financial incentive to provide lavish, excessive or unnecessary tests or treatments.

This avenue is keenly eyed by Obama administration officials for savings, under dispute by some doctors who essentially say, gripe all you want about wasteful tests, but Americans are living longer, healthier and altogether better for their money. The system is expensive, yes, but it produces results.

Nobody should argue that. What Americans want out of health care isn’t a cheaper system, just one where costs aren’t blatantly crippling. That’s the real reform. Expanding insurance coverage — the second act of this play — is just that, an expansion, not a reform.

There are 47 million Americans now without health insurance that could be covered tomorrow, by instituting a hodge-podge of new subsidies and loosened eligibility requirements for Medicaid or Medicare.

Of course, this is where speed would kill, because costs would remain unaddressed. That cannot happen again. One thing states, acting as the policy laboratories for Washington, have proven is that true health care reform is not possible without bending the cost curve.

How do we do this? Unpopular ideas. Taxes on the rich, draconian efficiency committees and complex analyses of physician quality and outcomes, for example. Or, not so unpopular ones, like a public health insurance option that injects some competition and leverage into health care markets that could desperately use it.

We know what reform requires. The ideas are here. The will is here. The need is here.

The time is now.

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