It's better to take more time rather than rush through a Pandora's box of perverse incentives like the 1,900-page House bill (HR 3962). The quality of the reform is far more important than the date of enactment. At the same time, that doesn't mean it's OK to kick back and relax for another 15 to 20 years.

Open the House bill and out flies a menagerie of stinging things: Job-killing employer mandates, payroll taxes and surtaxes. Hazy market rules to be set and re-set by a powerful "Health Choices Commissioner." A public option menacing private markets and amplifying the financial disasters of Medicare and Medicaid. Onerous red-tape and reporting requirements for firms and individuals. Dozens of new government agencies. New incentives for lawsuits. And a staggering price tag, according to the nonpartisan Centers for Medicare and Medicaid Services (CMS) and the Lewin Group (which analyzed an earlier, but similar, version of the bill).

Reform that improves on the status quo must meet several conditions: Lower costs over the long haul. No damage to the quality of health care. No bureaucrats interfering with doctor-patient decisions about care. Easier shopping for health insurance. And above all, no threat to Americans' financial security.

HR 3962 fails on these counts and more. Far better to tear off a few more calendar pages than to rush through a destructive assault on one-sixth of the U.S. economy. No segment of society needs reform more than small business does. Millions of independent firms and their employees have struggled with suffocating costs and administrative burdens for nearly a generation. The status quo is unacceptable, but the House bill shows how to make things even worse.

So what's the ideal pace for the Congressional proceedings? The actual pace seems to alternate Waiting for Godot (talk, talk, talk) and Lucy and Ethel in the chocolate factory (1,900-page dump-and-vote). Something in the middle would be nice.

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(NOTE: At this writing, the new Senate bill isn't out yet.)

To paraphrase President Obama, "the U.S. Congress works better when they have deadlines." As practicing physicians, the National Medical Association is very concerned about the tens of thousands of Americans who lose their coverage every day. For their sakes we should be reviewing the final bill now, so that Obama can sign it this year. The deadline is necessary. We hope the Senate Majority Leader will find it feasible.

Health-care reform is not a fairytale, though it often seems to be an elusive dream. And that dream, in order to be realized, needs good politics as well as good policy. Looking back across the American landscape, great presidents, led by an enduring sense of urgency, dared to birth a nation, end slavery, champion citizen rights, broker a Square Deal, a New Deal and ultimately a Fair Deal. Change agents have fought tirelessly to advance the American domestic agenda, though universal health coverage has never been among the purse.

What about now? Time remains of the essence. Meaningful reform and not an artificial cutoff should be the priority. Too often in a rush to be efficient we become less effective. Neither must we deliberately delay or prolong a solution, yet we must build a foundation, upon which progress can begin.

Still is the 2009 deadline necessary? Yes, if none other than to serve as a wake-up call, and a due date, rather than an expiration or "best when used by" clause. Why? Because every day in the status quo is another day someone is denied access, loses coverage, avoids treatment or halves a pill because they cannot afford to be healthy. And truthfully, it is within our power to bring considerable change.

At the stroke of midnight on the close of the 2009 session, health-care reform will not magically turn into a pumpkin. Suffice to say, the answer lies partially in a timeline, but more so in steely resolve.

Like the fabled Cinderella, our one glass slipper may be that down-payment on a more perfect system. History has shown us that incremental victories can be potent in the run-up to seismic change. Though having a fairy godmother (instantaneously hatch 60 senators or better, turn a pumpkin into a bipartisan bill), would be less messy, the alternative to do it ourselves would be no lesser feat.

So, all magic aside--those superheroes we need are dressed not in capes or costumes, but wear everyday clothes, resemble the reflections we see in the mirror and bear names not too unfamiliar from our own. Oh, and last but not least, our moment is now. The baton is in our hand and the gun has fired. Most likely, it won't be a sprint, and hopefully neither a marathon. Too many wait.

Every year, the primary deadline Congress has is September 30th, the cut-off date for passing all federal spending bills. Do they meet it? No. The last time they stuck to it was 1994, in fact. Does it serve to spur progress and keep efforts moving? Absolutely.

Let's examine the alternative: no deadline. I can picture the current health-care debate creeping far into 2010, derailing on middling controversies and irrevocably mired in partisan dissent.

Clearly, deadlines are necessary. Congress needs them in order to sustain the momentum that keeps big reform efforts like this one from going off the tracks. And while the deadline set by President Obama may not be met, it is doubtful we would have made the amount of progress we have seen to date without it.

I know deadlines seem completely arbitrary, but the reality is that deadlines are often necessary to get work done. How many of us wait until April 15 to pay our taxes? Without a deadline, we would probably wait even longer.

The same is true for health-care reform. Like taxes, it is a painful process. There are potential winners and losers. Politicians are making many difficult decisions as part of reform, and people typically don't like change, especially if they don't think it will benefit them. The strategy is then to delay. Delay can often weaken reform, or when there are competing priorities, delay can shift focus elsewhere. A deadline forces all parties to come together to make a decision. It is true that too early a deadline can result in a bill that isn't ideal. But let's face it...no one bill is going to address all the problems with our health-care system. There are going to be many bills necessary over many years to continue to refine the changes. We need to start somewhere, and making people take action by an imposed deadline is an effective strategy to get work done! For those who say the deadline is not feasible, I say let's go ahead and see!

The 2009 deadline for health-care is more a race against the 2010 mid-term elections and the fear of losing more seats in Congress than it is about the right outcome.

There are still many issues that remain unresolved as it pertains to merging the two bills that are, essentially, oil and water. Will there may be a public plan? Will there be more taxes and, if so, for whom? These remain two of many critical laments that remain unresolved. The Senate is still awaiting yet more numbers from the Congressional Budget Office on what these options will really cost.

The goal of having the president sign a bill before the end of the year seems unrealistic with so many unanswered questions. President Obama has an opportunity to pass landmark legislation on health-care reform, but it is far more important to get it right then simply get it done.

My spirits tend to sag a little bit at this time of the year. I'm pretty sure it's a sunlight/Vitamin D deprivation sort of thing. But the health-care non-reform legislation coming down the pike has me dragging even more than normal compared to the typical Wisconsin November. We've read proposed legislation from the House of Representatives that expands access to care dramatically (with an expanded price tag to boot) while doing nothing to rein in wasteful spending nor drive towards health. In its present state it's just another deferred tax for our children and their children and their children's children to pay. So where's the health-care delivery transformation in the bills being bandied about in Congress? Where's the waste removal effort going to come from? Certainly not from government. And that's why my biggest beef is with the weak employer non-penalties for non-participation.

It's a very simple formula, folks. Public option + weak employer penalties = socialized medicine.

Why do I want to see employers retain responsibility for providing health-care? Because employers -- not government -- will drive accountability, innovation and value in ways that government simply will not.

Can Congress present something by year's end to President Obama? Is it feasible or even necessary? In its present form, I certainly think not. It seems that the House passed its legislation, packed as it is with bogies, knowing that in reconciling their bill with the Senate many of the more left-leaning pieces would be shot down when the moderates finally flex their muscles. At least I hope that will prove to be the case.

I can understand the political reasons why President Obama has set a 2009 deadline for passing health-care legislation. As Congressional sessions head into federal election years, the political difficulties of passing any major legislation increase significantly. It gets harder for proponents and opponents to focus on the merits of the legislation simply because everything they do gets looked at through the lens of election campaigning.

That being said, this is a complex piece of legislation with far-reaching implications with many details that can have big negative long-term consequences. It must be done right, and getting it right is more important than getting it done fast. Having worked on complex postal reform legislation that dragged past the 2006 elections into a one-week special session that passed at 2:45 am December 10, I found that, even if it would have been easier for the legislation to have passed in 2005, the final product was better for having been delayed almost a year.

The President has done a masterful job keeping this legislation on the front burner and pushing it forward even when it looked like it could have gone off the rails. He should give Congress a chance to work out the tough issues even if it takes beyond the end of the year.

No, it is not necessary to pass this confusing, verbose mess of legislation this year. The health-care reform issue has been convoluted to the extreme. We have politicians making decisions based on factors they don't even understand. Millions of us no longer trust their motives and know their representatives don't, quite frankly, know what they're doing.

When a matter of this importance becomes a power play, our elected officials are no longer listening to the people. Perhaps that is the reason for the rush to pass this ridiculous 2,000 page bill in the House and who-knows-what in the Senate. "Quickly now, let's do this to prove the politician is quicker than the eye of the average American."
Most of us recognize slight of hand when we see it. Yes, we need some changes and some solutions but those decisions should be made by those who have experience in the field of health care.

As to the question of feasibility? Of course, it's feasible if enough of our representatives compromise, as their arms are twisted by those with greater political aspirations. There would be a high price to pay if they pass this legislation without cleaning it up, simplifying it and getting to the heart of the real issues. This mess isn't about helping the citizens of this fine country. It is now a game of Monopoly to see who can win, own and achieve the most power. Some forms of treachery have been around forever. This is just another shell game with bigger shells and so much more at stake.

The magnitude of the changes in our current health-care system necessary to "get it right" warrants thorough, informed and thoughtful analysis and debate. The federal legislature is the worst place for that to happen. There are other priorities such as unemployment, the need for banking oversight and wars, to name just a few, that interfere with the "informed and thoughtful" part.

By rushing the delivery of a bill by the end of 2009, the Democrats and President Obama will be able to produce an accomplishment, and there will be several very good things in that bill. If a bill is delayed, it will continue to distract from the other very important priorities. The delay will be evidence of the lack of leadership by Sen. Harry Reid (D-Nev.) and the lack of support for Obama. The very significant problems with our current health-care system will continue.

I am in favor of the deadline simply because it focuses attention on delivering a very necessary change. Given the politics of the Senate, the deadline is probably not feasible.