The turd in the jello bowl is the mandate that everyone buy health insurance.  Such a mandate would be fine if Congress also makes sure that folks can buy decent insurance at a decent price.  But this part of the reform equation costs money.  Most of the trillion dollars in the House bill goes to subsidies generous enough (barely) to make the individual mandate work.

So pseudo-centrists are calling on Obama to "scale back" reform.  Baucus asked his Gang of Six to consider a plan of $600 billion, which would cut off subsidies for a family of three at about $54,000 and permit insurance companies to sell high-deductible plans for $9,000 or more. A sprained ankle and a couple sore throats would leave that family of three paying 20% of its pre-tax income on health expenses. 

And voting Republican until Bristol Palin's second term.

The Washington Post's Stephen Pearlstein - who had some good columns on health reform lately - on Thursday urged Democrats to accept a compromise that embraces Baucus' approach to financing.  That approach leads inexorably to Baucus' skinflint approach to subsidies.

Jonathan Cohn of the New Republic analyzed this folly in a great post titled Dumb Policy, Dumber Politics.  Over at Daily Kos, the usually calm David Waldman righteously drew the implications:

I don't get how you can possibly hand me a health care bill with an individual mandate and no public option. If I'm uninsured or poorly insured, and the answer coming out of Congress is that I now have to buy crappy insurance from some private company that has no plan to actually help me pay for my health care without raking me over the coals, then I've gone into this fight an ardent supporter of strong reform, and come out a teabagger.

I share Waldman's conclusion:  "Fuck the hell out of that."  But we should understand that overcoming corporate-funded resistance to the public plan will only get us part way to a solution.  The problem runs deeper, involving the federal deficit and the Senate's almost reflexive resistance to any kind of tax increase. As much as we have to fight for the public option, we also have to demand a big bill and the big taxes on millionaires necessary to fund it.

Follow me here a bit into the policy weeds.  The bill approved by three committees in the House provides a barely adequate array of subsidies costing about $140 billion a year.  But House Democrats accepted a White House dictate - reportedly driven by Rahm Emanuel - to cap the cost of the bill at $1 trillion over 10 years.  That leaves about $40 billion per year too little to make coverage affordable to everyone, even with the public option.  So the House plan holds off on requiring insurance or paying subsidies until 2013. 

So even under the best proposal now on the table, Americans won't see the benefits of expanded coverage until after the next presidential election.  Worse, by opening negotiations with a barely acceptable bid, Rahm invited what we are seeing now:  a disastrously low-ball proposal touted as a sensible compromise.

Happily, the cost of the bill is the biggest thing working in favor of the public option.  You wouldn't know it from watching the news, but the public option saves $150 billion over ten years.  So, try as they might, establishment types like Pearlstein just can't fashion a sell-out strategy that makes any political sense.  To avoid completely screwing Joe Sixpack, you need either to give him a public option or to raise taxes on Joe Millionaire even more than the House Democrats propose to do.

Just because something makes no sense, of course, is no guarantee the likes of Reid, Baucus, and Conrad won't do it.  So let's add no "no cheapskate bill" to our shortlist of demands for health reform.