Republicans know one big thing about health care reform: Helping to derail President Clinton's reform plan in 1994 did wonders for them politically.

Actually, they know another big thing as well: For the past year, they have resisted President Obama's health care reform plan, and once again things seem to be working out well for them politically. The evidence is the outcome of the statewide elections in Virginia, New Jersey, and Massachusetts. So what if Democrats call Republicans the "Party of No"? "No" seems to be what voters want to hear.

Democrats may be willing to forge ahead with or without Republican support.

Or do they? That's the question going into next week's White House health care summit. If the bipartisan gathering produces no deal, will Republicans come out looking like heroes or bums? Heroes, if they are viewed as having saved the country from a deficit-busting, tax-raising, Big Government nightmare. Bums, if they are perceived as having once again thrown sand into the gears of government. The last time that Republicans tried shutting down the federal government, in 1996, the move didn't work out well for them.

They face a similar danger now. In this month's CBS News/New York Times poll, 62 percent of Americans said they think that the president is trying to work with Republicans in Congress to get things done. Precisely the same percentage said they think that Republicans in Congress are not trying to work with the president.

What do the people want? Compromise. Seventy-two percent of respondents said that Obama should compromise to get things done; 74 percent said that congressional Republicans should do the same.

The president, at least, sounds ready to compromise. "My hope is that we can find enough overlap that we can say, 'This is the right way to move forward, even if I don't get every single thing that I want,' " he said after meeting with congressional leaders last week.

What's happening now is reminiscent of the arguing over the shape of the table before the 1969 Paris peace talks during the Vietnam War. Republican leaders insist on "starting from scratch," that is, ignoring the health care bills that the House and Senate have already passed. In a February 8 letter to the White House, the House's two top Republicans, Minority Leader John Boehner of Ohio and Minority Whip Eric Cantor of Virginia, wrote, "If the starting point for this meeting is the job-killing bills the American people have already soundly rejected, Republicans would rightly be reluctant to participate."

Democrats refuse to just throw the House and Senate bills out, pretending that the whole legislative process didn't happen. Remember, the Senate Finance Committee engaged in weeks of bipartisan negotiations, led by Chairman Max Baucus, D-Mont. But only one Republican senator supported the result in committee. And every Republican senator ended up filibustering the supposedly bipartisan bill.

Obama said, "I'm going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals": reforming insurance practices, reducing the deficit, and expanding insurance coverage. Republicans support the first two goals but want to take a slower, step-by-step approach to expanding coverage, which would help control costs and avoid the explosive issue of imposing mandates.

The two sides don't seem that far apart. Why not just compromise?

Here's the problem: Suppose you stop insurance companies from screening out people with pre-existing conditions. If you don't expand the number of people covered, the cost of insurance premiums -- and thus public outrage -- will skyrocket. That's a nightmare scenario for Democrats: Health care reform passes and makes things worse for the more than 80 percent of Americans who now have coverage.

Democrats, therefore, may be willing to forge ahead with comprehensive reform with or without Republican support. So they are where they were on January 18, before the special Senate election in Massachusetts. They can pass "the Democratic health care plan." It would always be vulnerable to partisan attack unlike major legislation that passed with bipartisan support, such as Social Security, Medicare, the civil-rights bills, the Reagan tax cuts, No Child Left Behind, and prescription drug insurance.

Democrats have already voted for the House and Senate bills. They can't back away now. What they can do is pass a plan that has a reasonable chance of working.

This article appeared in the Saturday, February 20, 2010 edition of National Journal.

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