These are the times that try our souls.

Right-wing vigilantes are disrupting town halls on health reform all over the country. Senator Jim DeMint, a Republican from South Carolina, openly calls for perpetuating health care's status quo -- 50 million uninsured (and rising) and cost trajectories we cannot sustain -- so that President Obama, leading a country at war and facing the worst economic crisis in 80 years, will be "crippled." A well-orchestrated and even better funded Big Lie campaign, scares our nation's seniors into vocally opposing reform efforts that will actually strengthen the Medicare program and help them get the care they need when they need it.  The Enemies of social progress are happy tonight.

Still, the Finance Committee continues to trudge on with goals of a bipartisan agreement. President Obama and leading Democrats remain faithful, for now, that we can win both Republican and Democrat support for the comprehensive health reform that our country so dearly needs. As a health economist who has spent more than 15 years in Washington, I understand why bipartisanship, in ways big and small, is better for health reform in the long run. I have devoted the last four years of my professional life to that goal.  I also understand how hard this aspiration is -- not least for the small group of Republicans who truly want to find common ground.   

But as we begin the August recess, we should get a few things straight.  The most important word of "comprehensive bipartisan health reform" is the first. Comprehensive.

• If we do not ensure that ALL Americans have affordable access to quality health insurance and health care, it is not comprehensive.
• If we do not realign incentives for providers and patients alike, so we can "bend the curve," and make sure that our health system efficiently delivers the right care the first time to all of us, it is not comprehensive.
• And if we do not establish a balanced, sustainable source of financing, drawing on new revenue and health system savings from modernization and more efficient care, it is not comprehensive.

So let there be no doubt. I want and believe in bipartisanship. But it is more important that reform be comprehensive than bipartisan.

The question before us today is this: is it still possible to accomplish comprehensive bipartisan reform? On the right, the bulk of the Republican Party has decided that total war to protect the status quo is preferable to good faith cooperation and compromise. On the left, a sizeable contingent of progressive Democrats are so focused on the "robustness" of the public plan that they seem to lose sight of many of the goals of comprehensive reform. 

To be clear, I support a public plan operating on a level playing field because it provides Americans who distrust private insurance another choice and establishes a benchmark competitor much needed in some markets that lack any true competition. However, I also believe that properly reformed markets, generous subsidies, and a credible threat of a public plan if premiums are unsatisfactory in the first year could make insurance markets work very well for all Americans.  This option is far superior than doing nothing.  The debate over a public health insurance plan should not stand in the way of reform. 

In addition, intense pressure from Republican leadership appears to have made the bipartisan negotiating process in the Finance Committee difficult to say the least, including reports that Republican leadership is threatening Senator Grassley's status on the Judiciary Committee over his stance on health care. At the same time, the unwillingness of the left to consider modifying the open-ended (and highly regressive) tax subsidy for high income workers with health benefits far more generous than members of Congress, has left the Committee strapped for cash.  According to recent press reports this means the Finance Committee bill could include less-generous subsidies and permit greater variation in premiums based on age than the other committee bills. Combine this with a co-op instead of a public plan and it is not surprising many Finance Democrats are getting anxious. 

Clearly we all need a week off, me included. But before we take a breather, there are a few things we should remember:

• The three Republicans still in the Finance talks (Chuck Grassley, Olympia Snowe and Mike Enzi) could have more support within their party than it may appear. A dozen Republicans and Democrats supportive of the Healthy Americans Act published an opinion piece early this week in the name of bipartisan reform. They were honest that their approach is not the only way to reach consensus, but they also reminded us that, "It's time to stop trying to figure out what pollsters say the country wants to hear from us and focus on what the country needs from us. The American people can't afford for Congress to fail again." Also this week, the third ranking Republican, Lamar Alexander, committed to withhold criticism of the Finance Committee process over recess, "We respect their work, and so I think we owe it to them to let them finish their work," he said.

Republicans negotiating in the Finance Committee know they are never going to win over the more extreme branch of their party -- both those who oppose comprehensive reform on ideological "free market/no taxes" grounds and those who just don't want to give Obama a victory. Finance Republican negotiators would be wise to focus on policies that could win over their allies, including reasonable medical malpractice reform and a commitment to slow the rate of health care cost growth.

• It is still possible to finance generous subsidies without traveling outside the health system for revenue. Capping the tax free benefit of employer-sponsored insurance for high-income Americans with policies far more generous than those enjoyed by members of Congress is a two-fer: it uses a highly regressive tax benefit for progressive goals and helps us address rising health care costs. This type of policy could also help workers share in the growth in the economy in the future by refocusing compensation packages on wages, rather than very generous health benefits that most workers may not want or need.
• The cost of inaction is too high to fail. Over the coming weeks, we would be well-served to take a step back and remind ourselves why we are in this fight in the firsts place. Thousands of Americans dying because they do not have access to the care that health insurance affords. Households crippled by health insurance premiums rising faster than wages. Businesses struggling to compete internationally because of the ever-rising cost of health care. Federal and state governments driven further and further into debt because of health care cost growth. Failure is simply not an option this time.

Bipartisan reform is still possible. But everyone has a role to play in the coming weeks. Democratic leaders, including the President, have to make it clear that Republicans who buck their leadership and the right wing to support real health reform will get a large share of the credit for this historic achievement. Let them share credit for helping millions of Americans get access to high quality affordable health care for themselves and their families, putting our economy on more stable footing, and reaching across the aisle and taking political risks and doing what is right. Liberal Democrats have to be willing to compromise on specific policies, but not overall goals, in exchange for a bipartisan social commitment to one of the party's most long-sought-after goals: making quality health care affordable for all Americans, from this day forward. Finally, and perhaps most critical, reasonable Republican lawmakers must be willing to put politics aside and stand up to their party in the name of our nation's best interest. Sounds like a bargain to contemplate inside the Finance Committee and outside this sweltering August, full of portent, and lingering, whispering hope.