President Obama's rationale for tackling health care reform while the nation's economic bus careened toward the ditch was that reform was essential to pulling the bus out of its skid.
Companies that provided insurance coverage for their workers were getting the python treatment from rising expenses. They were forcing those workers to absorb more and more of the costs of their own protection, or see the protection itself shrink. At many kitchen tables, "deductible" and "co-pay" became cuss-words.
The federal government faced health care expenses under Medicare and Medicaid that were climbing toward levels that would drown the taxpayers. The states shared in that misery.
People were tethered to their jobs, hindered from following a bright idea or a dream, because they couldn't afford to be without employer-provided group health coverage. Folks laid off amid the recession and losing coverage looked disaster in the eye.
These vexing problems are still very much with us, it's hard not to notice, even with Obama and his Democratic allies in Congress finally securing passage of their reform bill last spring.
The bill's full effects kick in on a drawn-out schedule over several years. It was the best the supporters could do, as Republicans fought the bill tooth and nail. Opponents figured if they could beat Obama in the big showdown, he might just dry up and blow away.
Democrats facing the voters on Tuesday find themselves on the defensive, with the economy still in the dumps despite a few encouraging signs and health care reform a promise whose benefits so far are spotty at best.
But not only was reform pressed as a matter of economic necessity - it also reflected Obama and the Democrats' understanding that in the United States of America, the difficulty many people faced in obtaining the health care they needed was morally beyond the pale.
Everyone has heard the horror stories: People denied insurance coverage because of some long-ago ailment, people forced into bankruptcy by medical bills, uninsured people dependent on crowded emergency rooms for the kind of care that keeps minor conditions from becoming major. (And the cost of that emergency room treatment shows up in other folks' insurance premiums.)
Pressing ahead with reform made economic sense and was the right course in terms of ensuring care for all Americans that the well-off can still afford to take for granted. Republicans yearn to see the Democrats, having won the battle, lose the war as they surrender their congressional majorities.
If that's the outcome this week, the victors along with the GOP will be the forces within the health care and insurance industries that have such huge stakes in the for-profit status quo.
What an unholy alliance this has been, demonizing reform that would serve the nation and millions of citizens while aiming to 1) help Republicans reclaim power and 2) protect incomes that often are exorbitant. And the opposition prevented the reform, as enacted, from including the kind of steps that would effectively address a desperately serious problem - health care costs that simply keep on rising.
It is the sheer size of the nation's health care bill that threatens to swamp us, collectively and individually. Yet the health reform law's thrust is not to control costs. It is to expand coverage.
In a country blessed with a splendid medical infrastructure, for people to go without care because they can't afford it is flatly scandalous. But better access to the health care system means that more services will be offered, procedures done, hospital beds filled, drugs prescribed.
Insurance companies, welcoming new customers required to sign up for coverage, will be free to keep on raising their premiums - premiums that are taxpayer-subsidized for the poor. The costly paperwork burden will grow even heavier. The nation's physical health might improve, but its economic health will continue to be afflicted with the obesity of unsustainable costs.
True health care reform would seek to transform the industry's business model. There would be a turning away from the traditional pattern of fee for service - which, naturally, creates an incentive to offer more services than are medically necessary even when conscientious providers try hard to avoid that. The emphasis would be on coordinated case management, as is now the standard at top-flight care centers such as the Mayo Clinic.
In this campaign season, Triangle residents have seen GOP congressional candidates Renee Ellmers (nurse and manager of her physician-husband's clinic) and physician-turned-businessman B.J. Lawson rip health care reform, even though many care-givers think reform was vitally important.
A majority in Congress supported reform in the face of all-out, expedient opposition from Republicans and their industry allies. Yes, that majority included the Triangle's House trio, Democrats Bob Etheridge, David Price and Brad Miller.
Don't blame them for the fact that the law they bravely backed doesn't do all it should do to cure our health care system. Give them credit for trying. And give them a chance to make it better.