It's an either-or choice nine months of negotiation have made into incompatible extremes.
Advocates of controlling costs, like Joe Flowers at The Health Care Blog, say only a single-payer or public option system can work, by having government set product and service prices.
The government is currently the largest buyer of health care in the country, the third-largest in the world, but it lacks the power to set prices for hospital stays, medicines and tests. That's bought, under contract, the way we buy military hardware.
Giving government pricing power, and using that power, would move the choice on how much service people can expect into the political arena, where countries like Germany place it.
That's socialism, critics charge, so the Democratic alternative is a mandate, making everyone buy from the current market, an idea found in the Baucus plan. Subsidies would let more people participate.
The result of that, as former HHS Secretary Michael Leavitt correctly states in today's Wall Street Journal, is income redistribution. If the market sets the price of care, and government subsidizes the market, then every dollar given to someone for buying care has to come from someone else.
Socialism or income redistribution. Is that all the Democrats have? Meanwhile we pay twice what Germans pay to serve everyone, while 20% of us are stuck with charity or nothing.
Administration officials have been looking at eHealth to build Health Insurance Exchanges (HIE) that offer competition and, thus, have an incentive to lower costs.
But have you used eHealth? It can buy only what insurers offer, and what they offer in the individual market right now is crap, catastrophic policies with more loopholes than the IRS code.
So define what coverage is in plain English and then offer an HIE, say the Baucusites. Sounds good in theory, but in practice the bigger the buyer, the better the discount. Only government can get the lowest price, and then only if government demands it.
Which brings us back on the merry-go-found to what liberals want, a public option or single-payer system that puts government's thumb on the cost scale.
Conservatives are enjoying the show. It was conservatives like Charles Grassley and Mike Enzi who got Baucus to drop the public option. This lets other conservatives like Leavitt attack the mandate as "income redistribution."
All this has gotten Senate Democrats so dizzy that they are as likely to pass no reform as anything, leaving Republicans laughing all the way back to power.