'Blue Dog' Democrats need to act now on health care

HOUSE SPEAKER Nancy Pelosi, seeking to rally her caucus to approve health-care reform, reminded wavering members in an interview on ABC Sunday, "We're not here just to self-perpetuate our service in Congress. We're here to do the job for the American people." A noble sentiment, and one we wish all of Ms. Pelosi's colleagues shared. But coming from a congresswoman who generally racks up more than 80 percent of the vote in her California district, it might not be entirely persuasive to members whose "self-perpetuation" is in considerably greater doubt this year. Those are, to a large extent, the "Blue Dog" moderate Democrats and recently arrived members from districts that do not vote overwhelmingly Democratic. Many of them genuinely want the country to make progress on health care, but they are justly worried -- as are many of their constituents -- about enacting an expensive new entitlement at a time of rising federal debt.

Our advice: Don't just agonize, do something. If the Blue Dogs stuck together, they could insist that health-care reform be made more responsible than the version recently endorsed by President Obama. In particular, the tax on expensive employer-provided health-care plans, which senators weakened from its initial form and whose effective date Mr. Obama then chose to postpone, could be strengthened and made to bite as soon as the spending begins. This tax has twin virtues. It raises money and it "bends the curve" on costs -- more than any other single provision. In other words, it would begin to affect the growth in health-care costs for everyone.

While they're at it, moderate Democrats also could strengthen a Medicare commission designed to promote cost-effective medicine. The panel is designed to steer payments away from expensive therapies that don't work, but its reach in the Senate proposal is constricted in the first years of reform. Improving that, and the so-called Cadillac tax, would show that Congress is serious about controlling costs and not just spending more. And it would allow members to go home and say they stood up to both extremes in Washington and championed bipartisan, common-sense reforms. That might even be good for self-perpetuation.