Memo to Democrats on health-care reform: Just do it

If we're lucky, Thursday's summit meeting will turn out to have been the last act in the great health-reform debate, the prologue to passage of an imperfect but nonetheless history-making bill. If so, the debate will have ended as it began: with Democrats offering moderate plans that draw heavily on past Republican ideas, and Republicans responding with slander and misdirection.

Nobody really expected anything different. But what was nonetheless revealing about the meeting was the fact that Republicans — who had weeks to prepare for this particular event, and have been campaigning against reform for a year — didn't bother making a case that could withstand even minimal fact-checking.

It was obvious how things would go as soon as the first Republican speaker, Sen. Lamar Alexander, delivered his remarks. He was presumably chosen because he's folksy and likable and could make his party's position sound reasonable. But right off the bat he delivered a whopper, asserting that under the Democratic plan, "for millions of Americans, premiums will go up."

Wow. I guess you could say that he wasn't technically lying, since the Congressional Budget Office analysis of the Senate Democrats' plan does say that average payments for insurance would go up. But it also makes it clear that this would happen only because people would buy more and better coverage. The "price of a given amount of insurance coverage" would fall, not rise — and the actual cost to many Americans would fall sharply thanks to federal aid.

His fib on premiums was quickly followed by a fib on process. Democrats, having already passed a health bill with 60 votes in the Senate, now plan to use a simple majority vote to modify some of the numbers, a process known as reconciliation. Alexander declared that reconciliation has "never been used for something like this." Well, I don't know what "like this" means, but reconciliation has, in fact, been used for previous health reforms — and was used to push through both of the Bush tax cuts at a budget cost of $1.8 trillion, twice the bill for health reform.

What really struck me about the meeting, however, was the inability of Republicans to explain how they propose dealing with the issue that, rightly, is at the emotional center of much health-care debate: the plight of Americans who suffer from pre-existing medical conditions. In other advanced countries, everyone gets essential care whatever their medical history. But in America, a bout of cancer, an inherited genetic disorder, or even, in some states, having been a victim of domestic violence can make you uninsurable, and thus make adequate health care unaffordable.

One of the great virtues of the Democratic plan is that it would finally put an end to this unacceptable case of American exceptionalism. But what's the Republican answer? Alexander was strangely inarticulate on the matter, saying only that "House Republicans have some ideas about how my friend in Tullahoma can continue to afford insurance for his wife who has had breast cancer." He offered no clue about what those ideas might be.

In reality, House Republicans don't have anything to offer to Americans with troubled medical histories. On the contrary, their big idea — allowing unrestricted competition across state lines — would lead to a race to the bottom. The states with the weakest regulations — for example, those that allow insurance companies to deny coverage to victims of domestic violence — would set the standards for the nation as a whole. The result would be to afflict the afflicted, to make the lives of Americans with pre-existing conditions even harder.

Don't take my word for it. Look at the Congressional Budget Office analysis of the House GOP plan. That analysis is discreetly worded, with the budget office declaring somewhat obscurely that while the number of uninsured Americans wouldn't change much, "the pool of people without health insurance would end up being less healthy, on average, than under current law." But here's the translation: While some people would gain insurance, the people losing insurance would be those who need it most. Under the Republican plan, the American health care system would become even more brutal than it is now.

So what did we learn from the meeting? What I took away was the arrogance that the success of things like the death-panel smear has obviously engendered in Republican politicians. At this point they obviously believe that they can blandly make utterly misleading assertions, saying things that can be easily refuted, and pay no price. And they may well be right.

But Democrats can have the last laugh. All they have to do — and they have the power to do it — is finish the job, and enact health reform.

Paul Krugman is a regular columnist for The New York Times.