Writing about health care policy is a really daunting challenge. To be really good at it, you have to really get down in the weeds. You have to understand a lot about the budget. You need to understand the insurance industry. You have to familiarize yourself with all the various programs that the government already offers and understand who is being served and excluded in those programs. It’s like a balloon. Everytime you squeeze in one place, people pop out in another. There are sociological factors to consider and psychological factors. What incentives will drive up the cost of care? What will make people discriminate against hiring poor people? Poor parents? I sympathize with anyone who tries to cover this debate at a high level. I don’t pretend to. Aside from some basics, I focus on the politics of health care. But, I gotta ask…is Carl Hulse making an honest mistake here?

In trying to reach critical mass for legislative success, advocates of health care overhaul face an extremely delicate balancing act. With the death of Senator Edward M. Kennedy of Massachusetts, Democrats control 59 seats, meaning they need at least one Republican to join them if they are to proceed without employing a procedural shortcut that could cause havoc in the Senate.

And Senate Democrats have substantial differences of their own. More liberal members like Senator John D. Rockefeller IV of West Virginia and Senator Bernard Sanders, independent of Vermont, have been strong advocates of a public insurance option; many of the more centrist Democrats have come down just as strongly against one. Centrists are interested in holding costs down; progressives want to bring more Americans under the insurance umbrella, a push that drives costs up.

Now, that is an excerpt from an article that is currently running on the New York Times’ home page. It’s a simple matter to go over and look at the Times’ sister paper, the Boston Globe, and learn that the Democrats may have 60 votes again as soon as the end of next week.

Legislative leaders on Beacon Hill believe they have narrow majorities in both chambers to give Governor Deval Patrick the power to appoint an interim US senator, in a sign that the controversial measure may pass. But the bill must still survive Republican attempts to delay or kill it through parliamentary maneuvers.

In a key development, House Speaker Robert A. DeLeo, who has been publicly noncommittal, made a decision to back the proposal and was privately calling members yesterday to make the case. House vote-counters said support among lawmakers numbers in the mid-80s – more than enough in the 160-member body.

Patrick has signaled privately that he’d like to sign the bill by Friday and make an appointment within days, possibly having an interim senator in place by next week.

Hulse’s whole premise is that the Democrats will need at least one Republican because they need 60 votes and only have 59 members in their caucus. But it looks quite likely that this will be a non-issue by the time the Senate will have to vote on the health care bill.

But that is actually a minor problem compared with the next part of the excerpt.

Centrists are interested in holding costs down; progressives want to bring more Americans under the insurance umbrella, a push that drives costs up.

That fits in with stereotypes about big spending liberals and budget hawk centrists, but it’s actually false in this case. Bringing more people under the insurance umbrella (primarily young healthy people in their 20’s) spreads the risk around and is one of prime means of driving down costs. Not only that, but progressives are pushing for a public option which will compete for the uninsured on a non-profit basis, creating a downward pressure on what the private insurance companies can charge on the open market. That also reduces the total amount the government will have to pay in subsidies to those who cannot afford insurance. Centrists may focus on reducing the overall expense of the budgeted bill, but their solution doesn’t do a good job of bending the curve of rising health care costs and it does very little to reduce the price of insurance for the customer.

In this case, the progressive position is the more budget-friendly position and the centrist position is just insurance corporation-friendly without any other advantages.

This really is a battle between the people and the powerful, and the progressives are defending the people. But they’re also playing the traditional role of the Blue Dogs, in that their plan is also the plan for budget hawks. The centrist position is incoherent and only understandable as a sell-out to corporate interests. I know this is hard sledding, but Carl Hulse needs to do better both on the political landscape and on the policy.